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  • 51.
    Freeman, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    The role of forensic epidemiology in evidence-based forensic medical practice2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives This thesis is based on 4 papers that were all written with the same intent, which was to describe and demonstrate how epidemiologic concepts and data can serve as a basis for improved validity of probabilistic conclusions in forensic medicine (FM). Conclusions based on probability are common in FM, and the validity of probabilistic conclusions is dependant on their foundation, which is often no more than personal experience. Forensic epidemiology (FE) describes the use and application of epidemiologic methods and data to questions encountered in the practice of FM, as a means of providing an evidence-based foundation, and thus increased validity, for certain types of opinions. The 4 papers comprising this thesis describe 4 unique applications of FE that have the common goal of assessing probabilities associated with evidence gathered during the course of the investigation of traumatic injury and death.

     

    Materials and Methods Paper I used a case study of a fatal traffic crash in which the seat position of the surviving occupant was uncertain as an example for describing a probabilistic approach to the investigation of occupant position in a fatal crash. The methods involved the matching of the occupants’ injuries to the vehicular and crash evidence in order to assess the probability that the surviving occupant was either the driver or passenger of the vehicle at the time of the crash.

    In the second and third papers, epidemiologic data pertaining to traffic crash-related injuries from the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) was used to assess the utility and strength of evidence, such as vehicle deformation and occupant injury of a particular severity and pattern, as a means of assessing the probability of an uncertain issue of interest. The issue of interest in Paper II was the seat position of the occupant at the time of a rollover crash (similar to Paper I), and the association that was investigated was the relationship between the degree of downward roof deformation and likelihood of a serious head and neck injury in the occupant. The analysis was directed at the circumstance in which a vehicle has sustained roof deformation on one side but not the other, and only one of the occupants has sustained a serious head or neck injury. In Paper III the issue of interest was whether an occupant was using a seat belt prior to being ejected from a passenger vehicle, when there was evidence that the seat belt could have unlatched during a crash, and thus it was uncertain whether the occupant was restrained and then ejected after the seat belt unlatched, or unrestrained. Of particular interest was the relative frequency of injury to the upper extremity closest to the side window (the outboard upper extremity [OUE]), as several prior authors have postulated that during ejection when the seat belt has become unlatched the retracting seat belt would invariably cinch around the OUE and cause serious injury.

    In Paper IV the focus of the analysis was the predictability of the distribution of skull and cervical spine fractures associated with fatal falls as a function of the fall circumstances. Swedish autopsy data were used as the source material for this study.

    Results In Paper I the indifferent pre-crash probability that the survivor was the driver (0.5) was modified by the evidence to arrive at a post-test odds of 19 to 1 that he was driving.

    In Paper II NASS-CDS data for 960 (unweighted) occupants of rollover crashes were included in the analysis. The association between downward roof deformation and head and neck injury severity (as represented by a composite numerical value [HNISS] ranging from 1 to 75) was as follows: for each unit increase of the HNISS there were increased odds of 4% that the occupant was exposed to >8 cm of roof crush versus <8 cm; 6% for >15 cm compared to <8 cm, and 11% for >30 cm of roof crush compared to <8 cm.

    In Paper III NASS-CDS data for 232,931 (weighted) ejected occupants were included in the analysis, with 497 coded as seat belt failures, and 232,434 coded as unbelted. Of the 7 injury types included in the analysis, only OUE and serious head injury were found to have a significant adjusted association with seat belt failure, (OR=3.87, [95% CI 1.2, 13.0] and 3.1, [95% CI 1.0, 9.7], respectively). The results were used to construct a table of post-test probabilities that combined the derived sensitivity and (1 - specificity) rates with a range of pre-crash seat belt use rates so that the results could be used in an investigation of a suspected case of belt latch failure.

    In Paper IV, the circumstances of 1,008 fatal falls were grouped in 3 categories of increasing fall height; falls occurring at ground level, falls from a height of <3 meters or down stairs, and falls from ≥3 meters. Logistic regression modeling revealed significantly increased odds of skull base and lower cervical fracture in the middle (<3 m) and upper (≥3 m) fall height groups, relative to ground level falls, as follows: (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]). Additionally, C0-C1 dislocations were strongly related to fall height, with an OR of 8.3 for the injury in a ≥3 m fall versus ground level.

    Conclusions In this thesis 4 applications of FE methodology were described. In all of the applications epidemiologic data resulting from prior FM investigations were analyzed in order to draw probabilistic conclusions that could be reliably applied to the circumstances of a specific investigation. It is hoped that this thesis will serve to demonstrate the utility of FE in enhancing evidence-based practice in FM.

     

  • 52.
    Freeman, Michael D.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Everson, Todd M.
    Kohles, Sean S.
    Forensic epidemiologic and biomechanical analysis of a pelvic cavity blowour injury associated with ejection from a personal watercraft (Jet-Ski)2013In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 58, no 1, p. 237-244Article in journal (Refereed)
    Abstract [en]

    Jet-propelled personal watercraft (PWC) or jet-skis have become increasingly popular. The means of propulsion of PWC, which is a jet of water forced out of small nozzle at the rear of the craft, combined with a high risk of falling off of the seat and into close proximity with the water jet stream, raise the potential for a unique type of injury mechanism. The most serious injuries associated with PWC falls are those that occur when the perineum passes in close proximity to the jet nozzle and the high-pressure water stream enters the vaginal or rectal orifice. We describe the forensic investigation into a case of an anovaginal "blowout" injury in a passenger who was ejected from the rear seat position of a PWC and subsequently suffered life-threatening injuries to the pelvic organs. The investigation included a biomechanical analysis of the injury mechanism, a summary of prior published reports of internal pelvic injuries resulting from PWC falls as well as other water sports and activities, and a comparison of the severity of the injuries resulting from differing mechanisms using the New Injury Severity Score (NISS). The mean (±standard deviation [SD]) NISS values for reported PWC injuries [not including the NISS of 38 in this case study] were 11.2 (±9.5), while the mean value for reported water-skiing falls was half that of the PWC group at 5.6 (±5.2). It was concluded that the analyzed injuries were unique to a PWC ejection versus other previously described non-PWC-associated water sport injuries. It is recommended that PWC manufacturers help consumers understand the potential risks to passengers with highly visible warnings and reduce injury risk with revised seat design, and/or passenger seat "deadman" switches.

  • 53.
    Freeman, Michael
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Dobbertin, K
    Kohles, SS
    Uhrenholt, L
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Serious head and neck injury as a predictor of occupant position in fatal rollover crashes2012In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 222, no 1-3, p. 228-233Article in journal (Refereed)
    Abstract [en]

    Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the National Automotive Sampling System-Crashworthiness Data System for the years 1997 through 2007 in which we examined the relationship between a serious head and neck injury in an occupant and a specified degree of roof deformation at theoccupant's seating position. We found 960 occupants who qualified for the analysis, with 142 deaths among the subjects. Using a ranked compositehead and neck injury score (the HNISS) we found a strong relationship between HNISS and the degree of roof crush. As a result of the analysis, we arrived at a predictive model, in which each additional unit increase in HNISS equated to an increased odds of roof crush as follows: for ≥8cm of roof crush compared with <8cm by 4%, for ≥15cm of roof crush compared to <8cm by 6% and for ≥30cm of roof crush compared to <8cm by 11%. We describe two hypothetical scenarios in which the model could be applied to the real world investigation of occupant position in a rollover crash-related fatality.

  • 54.
    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.

  • 55.
    Freeman, Michael
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR; Department of Forensic Medicine, Aarhus University, Aarhus, Denmark.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Leith, Wendy
    Injury pattern as an indication of seat belt failure in ejected vehicle occupants2014In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 59, no 5, p. 1271-1274Article in journal (Refereed)
    Abstract [en]

    Prior authors have suggested that when occupant ejection occurs in association with a seat belt failure, entanglement of the outboard upper extremity (OUE) with the retracting shoulder belt will invariably occur, leaving injury pattern evidence of belt use. In the present investigation, the authors assessed this theory using data accessed from the NASS-CDS for ejected front seat occupants of passenger vehicles. Logistic regression models were used to assess the associations between seat belt failure status and injuries. Injury types associated with seat belt failure were significant OUE and head injuries (OR=3.87, [95% CI 1.2, 13.0] and 3.1, [95% CI 1.0, 9.7], respectively). The two injury types were found to be a predictor of seat belt use and subsequent failure only if combined with a high (0.8) precrash probability of belt use. The injury pattern associated with a seat belt failure-related ejection has limited use in the forensic investigation of crash-related ejections.

  • 56.
    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.

  • 57. Gudmannsson, Petur
    et al.
    Berge, Johan
    Druid, Henrik
    Ericsson, Göran
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    A Unique Fatal Moose Attack Mimicking Homicide2018In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 63, no 2, p. 622-625Article in journal (Refereed)
    Abstract [en]

    Fatalities caused by animal attacks are rare, but have the potential to mimic homicide. We present a case in which a moose attacked and killed a woman who was walking her dog in a forest. Autopsy showed widespread blunt trauma with a large laceration on one leg in which blades of grass were embedded. Flail chest was the cause of death. The case was initially conceived as homicide by means of a riding lawn mower. A review of the case by moose experts and analyses of biological trace material that proved to originate from moose, established the true source of injury. The dog probably provoked a moose, which, in response, stomped and gored the victim to death. The injuries resembled those previously reported from attacks by cattle and water buffalo. Fatal moose attacks constitute an extremely rare threat in boreal areas, but can be considered in traumatic deaths of unknown cause.

  • 58.
    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.
    Fatal brown bear attacks2015In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 21, p. 80-80Article in journal (Other academic)
  • 59.
    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.
    Fatal Eurasian brown bear attacks: two Swedish fatalities in modern times2015In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 60, no 6, p. 1658-1661Article in journal (Refereed)
    Abstract [en]

    Fatal bear attacks on humans are uncommon with only one reported case in Sweden since 1902. The bear population is, however, growing and the frequency of confrontations is likely to increase. Case I-A 40-year-old hunter and his dog were found dead near a bear's den. Autopsy showed that a large portion of the face, facial skeleton, and anterior portion of the brain was missing. Autopsy of the bear showed two nonfatal gunshot wounds. Case II-A 61-year-old man and his dog were found dead outside a hunting lodge. Autopsy revealed numerous wounds, including partial evisceration of the intestines. The victim's blood ethanol concentration was 0.27%. These cases confirm the presence of risk factors identified by the Scandinavian Brown Bear Research Project, that is, provocation by a dog, encountering an injured bear, and appearing close to its den. An additional possible factor in case II was ethanol intoxication.

  • 60.
    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.
    Intervention related deaths2015In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 21, no 1, p. 81-81Article in journal (Other academic)
  • 61.
    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.
    Off-road vehicle fatalities: a comparison of all-terrain vehicle and snowmobile accidents in Sweden2013In: International Association of Traffic and Safety Sciences (IATSS) Research, ISSN 0386-1112, Vol. 37, p. 12-15Article in journal (Refereed)
    Abstract [en]

    This study investigates accident fatalities involving two types of off-road vehicles: snowmobiles and all-terrain vehicles (ATVs). All snowmobile fatalities in Sweden from the 2006/2007 season through the 2011/2012 season, and all ATV fatalities from 2007 through 2012, were retrospectively examined. A total of 107 fatalities—57 snowmobile-related and 50 ATV-related—were found. Most deaths occurred on weekends (71% of the snowmobile-related and 72% of the ATV-related). A majority of the fatalities were males (91% and 94%), with the largest share in the age group 40–49 years (19% and 24%). The most common causes of death were blunt trauma (56% and 66%), drowning (30% vs 6%), and traumatic asphyxia (9% vs 14%). Among victims who were tested (95% vs 92%), a very high share was found to be inebriated (59% vs 61%), and mean blood alcohol concentration was also high (1.9 vs 1.7 g/l). Forty-seven percent of snowmobile-related fatalities and 48% of ATV-related fatalities had a blood alcohol concentration above 1.0 g/l. This means that there was a very strong association between off-road vehicle fatalities and drunken riding; steps to prevent riding while intoxicated seem to be the most important preventive measure. Automatic measures such as alcolocks are probably the most effective. The obvious at-risk group to target is middle-aged men with high alcohol consumption.

  • 62.
    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.

  • 63.
    Hagardson, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Rättsentomologi: Insekter som bevismaterial2009Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Det grekiska ordet entomon betyder - något som är inskuret eller uppdelat. Latinets insectum har samma innebörd. Benämningarna syftar på djur, som har en uppdelad kropp, hos insekterna bestående av huvud, mellankropp och bakkropp. Entomologi betyder alltså - Läran om insekterna [1].

    Kunskaper om insekter och deras livscykel kan vara behjälpliga i många sammanhang, så även inom rättsmedicinen. Rättsentomologi eller forensisk entomologi utnyttjar just denna kunskap. Rättsentomologi är alltså läran om insekter tillämpad på olika rättsfall.

    I Sverige är detta ett relativt nytt område men i Canada och USA är det i många stater ett accepterat och etablerat område. Framför allt används insektsdata som ett komplement till den mer klassiska rättsmedicinen för att fastställa hur länge en människa varit död, så kallad dödstidsbestämning eller fastställande av Post-mortem interval (PMI).

     

    Rättsentomologi baseras på att insekter koloniserar en död kropp efter en viss bestämd tidtabell. De olika arterna föredrar olika nedbrytningsstadier, och anländer därför till kroppen vid olika tidpunkter samt att det tar en bestämd tid för en viss insektsart att utvecklas från ägg till vuxen [35]. Man kan med hjälp av denna kunskap beräkna den ungefärliga tiden som har förflutit sedan den döda kroppen koloniserades. Ofta antar man att dödsfallet inträffade i samband med att kroppen blev tillgänglig för insekter men undantag finns.

    Det är framför allt utredningar rörande dödsfall som är 72 timmar eller äldre som är av intresse. Efter 3 dagar är oftast insekter den bästa och ibland enda metoden för att uppskatta dödstidpunkten.   

     

    Den insekt som har studerats mest är spyflugan. Calliphora är ett släkte inom familjen Calliphoridae, som är det som kallas spyflugor. Det finns ungefär 50 arter i Sverige. Dessa koloniserar kroppen snabbt efter döden och är bland de vanligaste insekterna som kan påträffas på en död kropp.

    I Sverige angrips döda kroppar av framför allt flugor under det varma halvåret.

    Det första tecknet på flugangrepp är små, gula till blekt gulröda korn framför allt i ögonvrår samt i mun - och näsöppning. Är klimatet varmt kan sådana ses redan några timmar efter döden. De är flugägg som redan efter några dagar utvecklas till små vitgula larver, som i dagligt tal lite felaktigt kallas ”likmaskar”. Fluglarverna är mycket rörliga och borrar sig djupt in i kroppens mjukvävnad och livnär sig på denna. Efter några veckor förpuppas de och efter förpuppningsstadiet uppträder en ny generation av flugor. I gynnsamma miljöer kan de på bara några veckor helt ödelägga en kropp.

  • 64.
    Hamnström, Georg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Investigation of factors that may indicate suicidal intent among cases of undetermined manner of death2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    : Ett flertal studier har visat att dödsfall som är klassade som oklara omfattar en viss proportion suicid, samt att det är vanligt i suicidforskning att inkludera dessa oklara dödsfall.  Syfte: Identifiera faktorer som indikerar på suicid i gruppen oklara dödsfall för att kunna estimera proportionen suicid i den här gruppen. Material och metoder: Detta är en register fall-kontrollstudie av dödsfall som klassificerats som självmord (n=100), naturliga (n=50), olycksfall (n=70) samt dödsfall klassificerade som oklara (n=150) i Sverige mellan år 2008-2012. Studien jämförde dödsfall, som klassificerats som självmord, naturliga och olycksfall, med dödsfall som klassificerats som oklara med avseende på bakgrundsvariablerna kön, ålder, civilstånd, tidigare självförvållade skador, alkohol- och drogmissbruk, psykiatrisk slutenvård, våldsam död, självmordskommunikation, somatisk sjukdom, problem i viktiga relationer, höga nivåer av ångest och användning av psykofarmaka. Resultaten analyserades sedan med en multivariatanalys med logistisk regression för att estimera proportionen suicid i den oklara dödsfallsgruppen. Resultat: Utifrån förekomsten av dessa riskfaktorer kan man uppskatta andelen sannolika suicid i den oklara dödsfallsgruppen till 10-22% (CI 95%, p<.001). Emellertid har inte upplägget av studien tillåtit någon utvärdering av andelen sannolika olycksfall. Slutsats: I genomsnitt finns troligen 55-75 suicid bland de oklara dödsfallen per år, men majoriteten av de oklara dödsfallen kvarstår som oklara med avseende på dödsklass även när analys av kända och potentiella riskfaktorer för suicid analyseras. Detta talar för att studier av riskfaktorer för suicid, liksom analyser av trender i suicidstatistik, bör fokusera på säkra suicid och inte inkludera dödsfall med oklart dödssätt.

  • 65.
    Holmgren, Jimmy
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Försvunnen=död?: En undersöning av gällande rätt vid dödförklaring av försvunna människor2013Student paper other, 5 credits / 7,5 HE creditsStudent thesis
  • 66.
    Håkansson, Camilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Barnmisshandel: Liten och misshandlad2009Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    År 2003 anmäldes 1 196 fall av misshandelsbrott mot barn i åldern 0-6 år.[1] Våldsbrott mot barn är annorlunda än våldsbrott mot vuxna – i nästan 90 % av fallen är förövaren bekant med barnet, och de flesta brotten är familjerelaterade.[2] Denna uppsats handlar om våld mot de allra minsta, mest försvarslösa individerna i vårt samhälle – det handlar om vårdnadshavares våld mot sina barn.

     

    Syftet med denna uppsats är att se vad barnmisshandel är, dess orsaker och konsekvenser, vilka straff som utdöms och hur det kan förebyggas.

     

    Jag har undersökt lagar, förarbeten, rättsfall och doktrin. Statistiken är främst hämtad från BRÅ. Jag har, förutom juridisk doktrin, även använt mig av litteratur för psykologer, lärare och socionomer.

     

    Jag kommer i detta arbete att skriva om ”barn”, med vilket jag avser personer som ännu inte har fyllt 15 år. Kriminalstatistiken skiljer mellan yngre barn (0-6 år) och äldre barn (7-14 år), och jag kommer främst att inrikta mig på yngre barn, då dessa är särskilt utsatta. Jag kommer uteslutande att ta upp fall då barn blivit misshandlade av en eller flera föräldrar eller vårdnadshavare. Uppsatsen kommer inte att beröra sexuella övergrepp – det är ett område som överlappar med barnmisshandel, men det skulle göra denna uppsats alltför lång. Av samma anledning kommer uppsatsen inte att täcka den andel barn som bevittnat våld, men inte själva blivit utsatta. Vad gäller definitionen för misshandel kommer jag främst att fokusera på misshandel, enligt definitionen i brottsbalkens 3 kap.

    [1] BRÅ 2004:3, Brottsutvecklingen i Sverige 2001-2003, s 69-70.

    [2] BRÅ 2008:23, Brottsutvecklingen i Sverige fram till år 2007, s 92.

  • 67.
    Höglund, Liz
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Shaken baby syndrome. Samspelet mellan det medicinska och rättsliga2016Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Barnaga blev förbjudet 1979 vilket stadgas genom 6:1 FB (Föräldrabalken). Stadgandet leder till att slag mot barn eller annan form av fysiskt våld mot barn faller in under brott i enlighet med BrB (Brottsbalken) [1], t.ex. 3:5, 3:6 eller 3:8.

     

    ”Kombinationen av subdurala blödningar, hjärnskador och ögonbottenblödningar talar mycket starkt för att barnet har misshandlats. Den medicinska diagnosen misshandel är bekräftad. I praktiken finns inga andra alternativ än att barnet misshandlats genom att det skakats om trafikolycka eller fall från hög höjd kan uteslutas.”[2]

     

    I Sverige antas ca 30 barn utsattas för skakvåld varje år, då inte alla fall kommer till känna finns det mörkertal.[3] Ur ett juridiskt perspektiv faller denna typ av våld in under brottet misshandel, men för att döma en person behövs bevisning. Bevisning kan dock läggas fram på olika sätt, bl.a. genom sakkunnigutlåtanden. Hur viktigt blir då läkarens utlåtanden vid en rättegång?

     

    Shaken baby syndrome (SBS), skakvåld, är en diagnos inom medicinsk litteratur och den påvisas genom avsaknaden av yttre skador samt triaden i form av subduralblödningar, retinala blödningar och hjärnödem.[4] Dock är denna diagnos dagens sanning och har idag fått utstå mycket kritik och diagnosen ses därför över. Hur berörs det rättsliga av denna kritik?

     

    Är SBS att ses som en säker diagnos vilken påvisar misshandel och hur fungerar samspelet i rätten mellan det medicinska och det rättsliga?

  • 68.
    Iserell, Vladmimir
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Sexuella brott mot barn: Rättsintyg och rättsundersökning som beviskrav och bevisvärdering i mål om sexualbrott2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Barn och ungdomar hör till en av de särskilt sårbara grupper när det gäller sexualbrott. Sexuella övergrepp mot barn är djuptintegritetskränkande brott som kan ge långtgående fysiska och psykiska men. Ångest, depression, inlärningsproblem, missbruk, kriminalitet, självskade- och självmordsbeteende samt relationssvårigheter och sexuella problem är bara några av utsatthetens negativa konsekvenser[1].

     

    Samhället ser väldigt allvarligt på sexuella övergrepp mot barn. Och med anledning av detta är utvärderingen av övergreppets beskaffenhet och säkerställandet av biologiskt material väldigt viktiga både ur rättsmedicinskt- och rättssäkerhets perspektiv. Rättsintyg som utfärdas efter genomförd kroppsbesiktning är ett viktigt bevis i mål om sexualbrott som kan leda till fällande dom. Samtidigt kritiserades det svenska rättsväsendet för stor försiktighet och restriktivitet som präglar arbete på sexuallbrottsområdet[2]. Kritiken mot rättsväsendet beror bl.a. på tolkning av fysiska fynd gjorda vid kroppsbesiktning. B. S. Astrup, P. Ravn, J. Lauritsen, och J.L. Thomsen, påpekar att förekomsten av fysiska tecken på trauma (inklusive genitala skador) upptäckta hos påstådda våldtäktsoffer är fråga för diskussion i många länder[3]. I Amnesty International rapport ”Case closed, Rape and human rights in the Nordic countries” påpekas bl.a. att ärenden avslutas ”även om det finns objektiva medicinska bevis” d.v.s. offren har fysiska spår av våldet. Men vad kan anses som ”objektiva medicinska bevis”? Tolkning av fynd gjorda vid kroppsbesiktning är inte enkelt och hänsyn till aktuella forskningar måste tagas vid bedömning av upptäckta skador.

     

    I framställningen nedan skall vi betrakta frågan om rättsintyg och rättsundersökning som beviskrav och bevisvärdering i mål om sexualbrott mot barn.

  • 69.
    Jansson, Emelie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Rättsentomologi2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    En av de första och kanske mest intressanta frågorna när en människa påträffas död är när hände det? Hur länge har personen varit död? Inte minst om man misstänker brott. Det är även en av de svåraste frågorna att besvara. Påträffas en avliden kropp relativt tidigt kan man med hjälp av kroppstemperaturen och till exempel likstelhetens utbredning göra en uppskattning om hur länge en person varit död. Om det däremot har gått några dagar, månader eller kanske till och med år behöver man andra metoder för att eventuellt kunna fastslå en dödstidpunkt. Det är där insekter som livnär sig av döda kroppar kommer in i bilden. Genom deras utvecklings- och livscykler kan man beräkna och uppskatta hur länge de har koloniserat en viss kropp och således dra slutsatser om hur länge personen i fråga minst måste ha varit död.

  • 70.
    Jansson, Emmilie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Barnmisshandel i historien och i medicinen2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Barnmmisshandel är inte ett nytt fenomen i samhället, utan något som existerat i evig tid. Förbättringar har skett i form av bl a lagstiftning för att skydda barn från att fara illa. Det medicinska arbetet har fått större roll i utredningen av dessa fall, då bl a sjukvården enligt lag är skyldig att anmäla till socialtjänsten då man misstänker att ett barn far illa. Sjukvårdspersonal kan idag även diagnostisera misshandel på ett bättre sätt än förr. Längre tillbaka i tiden trodde man sig ha sjukdomsförklaringar till varför en skada har uppstått, och ännu längre tillbaka hade religionen inverkan på synen på barnmisshandel. Det finns dock en del av barnmisshandel som aldrig kommer till varken sjukvårdens eller socialnämndens kännedom. 

  • 71. Jinhede, A.
    et al.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Sturup, J
    Crime scene investigations in child homicides: A population based study 1998-20122014Conference paper (Other academic)
    Abstract [en]

    Introduction: There has been a decrease in the number of child homicides in Sweden and internationally (Sturup & Granath, in press). Even so, the death of a child is one of the most tragic events and due to the vulnerability of children, these events are of special interest for the criminal justice system. If conjunction with the autopsy findings, a carefully examined crime scene is necessary for the reconstruction of the event (Randall, 2014). This study was set up to examine the crime scene reports in child homicides.

    Method and material: Data from an ongoing population based studies on child homicides 1990-2012 has been collected but since all police files in solved cases before 1998 were discarded, only cases from 1998 through 2012 were examined in this sub-study of crime scene investigations.

    Procedure: All crime scene reports were extracted from the police files and autopsy reports from the National Board of Forensic Medicine were collected (n=73). A crime scene investigator (AJ) collected data according to a systematic protocol.

    Results: The study is ongoing and detailed results will be presented at the conference. Preliminary analyses reveal that 23% of the children were killed by sharp force violence, 21% by asphyxiation, 12% by gunshot wound, 8% by blunt trauma, 7% by drowning, and 19% by other methods (arson, poisoning, vehicle, etc).

  • 72.
    Johansson, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bladh, Magnus
    Umeå University, Faculty of Medicine, Department of Odontology.
    Sjöström, Mats
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    The use of intraoral radiographs for identification of edentulous patients rehabilitated with implants2016In: Journal of Forensic Odonto-Stomatology, ISSN 0258-414X, E-ISSN 2219-6749, Vol. 34, no 1, p. 1-9Article in journal (Refereed)
    Abstract [en]

    The aims of this study were; i) to determine the accuracy by which two intra-oral radiographic examinations performed on patients with edentulous mandibles treated with dental implants can be matched. ii) to determine whether prosthodontic supra-construction is important for matching. iii) to investigate whether there is a difference between oral and maxilla-facial radiologists (OMR) and dental practitioners, not specialized in oral and maxillofacial radiology (NOMR), regarding their ability to match. The specific features of the radiographs used by the operators to acquire a match were also investigated. Intra-oral radiographic examinations from 59 patients were utilized. Radiographic examinations from 47 patients carried out at placement of the supra-construction and at subsequent follow-up examinations were used as "ante-mortem" and "post-mortem" records respectively. Examinations from 12 patients were added to the "post-mortem" records without "ante-mortem" records being available. The study was divided into two parts. In Part One all "ante"- and "post-mortem" records had the supra-construction masked and in Part Two it was visible. Seven dentists (4 OMR, 3 NOMR) were instructed to specify on what basis each matching was made on the confidence of a three-graded scale OMR had 93.2 % and 98.5 % accuracy in Parts One and Two respectively. NOMR had 63.8 % and 87.9 %. Bone anatomy was the most commonly used feature by OMR to obtain a match. For NOMR it was the appearance of the fixtures. OMR reported higher confidence in their ability to match the examinations. This study indicates that OMR could be a valuable resource in cases of identification where dental implants are a feature of the post-mortem dental records.

  • 73.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Teenager fatalities: epidemiology and implications for prevention2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A significant number of teenagers are killed each year by unintentional or intentional injuries. A teenager is in a vulnerable phase of her/his life, going from being a child to adult. This transition often includes testing the limits of their capabilities, which can include, e.g., high speed driving, testing alcohol and other drugs, including drinking and driving. The development from child to adult includes different psychological stress factors, such as, e.g., school problems, broken love affairs and bullying. The demands – perceived or real – also increases over time and vulnerable individuals can turn to self-harm and in the most extreme case suicide.

    The aim of this thesis was to investigate teenager fatalities in the northern half of Sweden and to suggest preventive measures.

    A survey of teenager fatalities during a twenty-year period revealed that the incidence of unintentional (n=248) deaths decreased, while intentional (n=102) deaths were unaffected over time. Most unintentional deaths were transportation related (n=204) while most of the intentional deaths were suicides (n=88). Twenty-eight percent of the decedents were test-positive for alcohol at autopsy.

    In a series of three studies, teenager suicides were investigated in depth, firstly through an interview study with the investigating police officer in charge of the investigation of a teenager suicide. Most of the suicides occurred in rural and depopulated areas despite the fact that most teenagers live in the larger cities along the coastline. A majority of the suicides appeared to be planned. Females, contrary to males, often had a psychiatric history. One of the conclusions was that police officers provide essential information concerning the circumstances around a teenager suicide.

    Parents who had lost a child through suicide, and in some cases siblings, were interviewed 15-25 months after the suicide. It was striking how the life of the surviving family members were still affected by the devastating trauma of the suicide; most parents testified that they were still struggling with the question “why?” and that they were thinking of their lost child every day. Post suicide support was often badly timed and insufficient, especially for the younger siblings. The family doctor has an important role as a co-ordinator of a long-term individually formulated support scheme for the bereaved.

    Evidence of suicide contagion and suicide cluster formation, i.e., one teenager suicide led to another suicide, was found in these studies, and two suicide clusters were identified, with links between the victims in each cluster. Both clusters occurred within a geographical and timely proximity. Everyone involved in the well-being of the young should be aware of the risk of contagion and suicide cluster formation.

    The fifth study concerned 12,812 teenagers who visited the Emergency Room at Umeå University Hospital due to an injury during 1993 through 2006. Sixty-one of these were found dead through 2007, 49 by unnatural (of which 38 were included) and 12 by natural causes. The standard mortality rate for unnatural death was calculated to 1.44 (1.02-1.98), confirming an increased risk of premature death. In many of these deaths, alcohol and drugs may have contributed. By increasing the awareness among health professionals that injury can predict a premature death - primarily among those who develop substance abuse - some premature deaths may be prevented by early intervention.

    This thesis confirms that most teenagers die from unnatural causes, mostly in transportation-related events and by suicide. By studying these deaths, preventive measures that could save lives have been suggested.

  • 74.
    Johansson, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Lindqvist, Per
    Division of Forensic Psychiatry, Dept. of Clinical Neuroscience, Karolinska Institute, Stockholm university, Sweden.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Teenage suicide cluster formation and contagion: implications for primary care2006In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, no 7, p. 32-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We have previously studied unintentional as well as intentional injury deaths among teenagers living in the four northernmost counties, forming approximately 55% of Sweden with 908,000 inhabitants in 1991. During this work, we found what we suspected to be a suicide cluster among teenagers and we also suspected contagion since there were links between these cases. In this present study, we investigate the occurrence of suicide clustering among teenagers, analyze cluster definitions, and suggest preventive measures. METHODS: A retrospective study of teenager suicides autopsied at the Department of Forensic Medicine in Umea, Sweden, during 1981 through 2000. Police reports, autopsy protocols, and medical records were studied in all cases, and the police officers that conducted the investigation at the scene were interviewed in all cluster cases. Parents of the suicide victims of the first cluster were also interviewed. Two aggregations of teenager suicides were detected and evaluated as possible suicide clusters using the US Centers for Disease Control definition of a suicide cluster. RESULTS: Two clusters including six teenagers were confirmed, and contagion was established within each cluster. CONCLUSION: The general practitioner is identified as a key person in the aftermath of a teenage suicide since the general practitioner often meet the family, friends of the deceased, and other acquaintances early in the process after a suicide. This makes the general practitioner suitable to initiate contacts with others involved in the well-being of the young, in order to prevent suicide cluster formation and para-suicidal activities.

  • 75.
    Johansson, Mattias
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Rutiner vid omhändertagande av avliden person, lokalt och regionalt: En kritisk granskning av olikheter i rutiner och riktlinjer inom Västra Götalandsregionens olika akutmottagningar och ambulanssjukvård2011Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    När en människa avlider mister inte bara en närstående sin anhörig utan det uppstår också en massa frågor. Hur skall jag göra nu? Vem tar hand om vad? I dessa fall ställs det ganska stora krav på vårdpersonal som skall visa vägen och svara på dessa frågor. När en människa har somnat in i sitt hem under lugna förhållanden är det många gånger så att hemsjukvården eller hemtjänsten är först på plats och i sin tur larmar en ambulans. I och med att ambulansen kommer till platsen startar en process med en hel del telefonsamtal till olika instanser. Eftersom personen avlidit i hemmet kommer detta att falla under primärvårdens ansvar och skötas efter oftast lokala rutiner. Många av dessa rutiner finns inte klart och tydligt dokumenterade lokalt utan alla ”vet” att det är så man gör.

     

    För att all sjukvårdspersonal som någon gång hamnar i denna situation ska kunna uppträda professionellt, bör man ha något stöd att luta sig mot. Det vill säga ett styrdokument som bör vara ganska detaljerat och kvalitativt utarbetat för att man skall kunna skapa en tryggare situation för en eventuell anhörig så att denna kan påbörja sin sorgeprocess.

    Samhällets intryck av sjukvården i Västra Götalandsregionen är att den, i mångt och mycket, sjunkit i sitt förtroende hos medborgarna bland annat på grund av långa väntetider innan man får vård på akutmottagningen eller bara för att få träffa en läkare (Västra Götalandsregionens årsrapport 2010, Vårdbarometern, befolkningens syn på vården 2002-2010). När någon avlider, antingen om det är hemma eller på sjukhuset, är det viktigt för den vårdpersonal som blir engagerad att bistå anhöriga som medmänniska, att den berörda personalen har både erfarenhet, empati och rutiner eller riktlinjer som stöd då det kommer att vara en mycket speciell situation.

     

    Det finns därför anledning att se över dessa styrdokument inom akutsjukvården, både ambulanssjukvårdens och akutmottagningarnas, för att skapa en regional riktlinje eftersom det hela styrs av samma ledning och man jobbar mot samma medborgare oavsett var i storlänet man befinner sig.

     

    Juridiskt finns det mycket att se över i dessa dokument. Många rutiner, riktlinjer och PM är skrivna i god tro utan att ha en juridisk förankring. När man tittar på flera utav de lagar som på ett eller annat sätt styr arbetet vid omhändertagande av en avliden, blir det ganska klart att gällande lagar och författningar inte följs när lokala rutiner skrivs. Är det av okunskap eller för att underlätta organisationens dagliga arbete?

    När är en människa död? I lag om kriterier om bestämmande av människas död (1987:269) finns grunden för när en människa skall räknas som död och hur man ska gå till väga för att fastställa detta. ”När hjärnans samtliga funktioner totalt och oåterkalleligt har fallit bort” räknas en människa som död. En undersökning av hjärnan och när man med säkerhet kan säga att ett cirkulations- och andningsstillestånd varat så länge skall dödens inträde fastställas.

    För sjukvårdens arbete är Hälso- och sjukvårdslagen (1982:763) en starkt styrande lag. Lagen innehåller grundläggande mål, krav och ansvarsfrågan för både kommuners och landstings hälso- och sjukvård. I 1 § finner vi den inledande bestämmelsen där det framgår vad som avses med hälso- och sjukvård vilket också innefattar att ta hand om avlidna. När omhändertagandet av en avliden sedan startar finns det fler lagar och förordningar att följa. Socialstyrelsens föreskrifter och allmänna råd om vissa åtgärder inom hälso- och sjukvården vid dödsfall (SOSFS 1996:29) ger en tydlig bild att ytterst är det landstingen och kommunerna som ansvarar för att en verksamhet är organiserad så att hälso- och sjukvårdens uppgift utförs smidigt. Det åligger landstingena och kommunerna i samarbete lokalt att skapa en tydlig arbets- och ansvarsfördelning samt att till samtliga berörda informera om dessa. Information till personal angående omhändertagande av avliden, möjligheten till någon person att rådfråga vid ett dödsfall utanför sjukhus, konstaterande av ett dödsfall, polisanmälan, undersökning av kroppen och utfärdandet av ett dödsbevis är i lagen tydligt beskrivet men ger också utrymme för att kunna skapa lokala föreskrifter och då helst i samarbete med andra berörda instanser som exempel Polisen eller Rättsmedicinalverkets rättmedicinska avdelningar. Vid identifieringen av en avliden tydliggörs hur personal skall gå till väga vid känd eller okänd identitet, hur kroppen ska id märkas samt när polisen skall kopplas in. Polisen i sin tur styrs av FAP 414-1 (RPSFS 2000:14) vid dödsfall. Polisens ansvar klargörs bland annat för underrättelse till skattemyndigheten efter utfärdat dödsbevis, beslut av undersökningsform av den avlidne, omhändertagande av värdesaker samt identifiering av en avliden. I denna lag hänvisas också tydligt till de andra lagar och förordningar som kan tänkas gälla i olika fall med avlidna och vilka yrkeskategorier eller myndigheter som kan beröras.

    Hälso- och sjukvårdslagen hänvisar till begravningslagen (1990:1144) om det finns skäl till en polisanmälan på grund av omständigheter och förhållande till dödsfallet där det också tydliggörs om vem, när och vart ett dödsbevis samt intyg om dödsorsak skall sändas. Begravningsförordningen (1990:1147) kompletterar begravningslagen när det gäller dödsbevis och intyg om dödsorsak samt att den belyser vilka myndigheter som i samråd kan meddela ytterligare föreskrifter. För att få rätt obduktionssätt, rättsmedicinsk undersökning eller klinisk obduktion, fastställs detta i obduktionslagen (1995:832) där det även klargörs vad de olika sätten innehåller samt vad målet med dessa är. Samtliga av dessa lagar och föreskrifter är tydliga i sitt innehåll och ger inte stora möjligheter till tolkningar ändå finns det stora utsvävningar i det innehåll som presenteras och analyseras.

     

  • 76. Jonsson, Anna Kristina
    et al.
    Söderberg, Carl
    Espnes, Ketil Arne
    Ahlner, Johan
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Reis, Margareta
    Druid, Henrik
    Sedative and hypnotic drugs-fatal and non-fatal reference blood concentrations2014In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 236, p. 138-145Article in journal (Refereed)
    Abstract [en]

    In postmortem investigations of fatal intoxications it is often challenging to determine which drug/s caused the death. To improve the interpretation of postmortem blood concentrations of sedative and hypnotic drugs and/or clonazepam, all medico-legal autopsies in Sweden - where these drugs had been detected in femoral vein blood during 1992-2006 - were identified in the databases of the National Board of Forensic Medicine. For each drug, concentrations in postmortem control cases - where the cause of death was not intoxication and where incapacitation by drugs could be excluded - were compiled as well as the levels found in living subjects; drugged driving cases and therapeutic drug monitoring cases. Subsequently, fatal intoxications were assessed with regards to the primary substances contributing to death, and blood levels were compiled for single and multiple drug intoxications. The postmortem femoral blood levels are reported for 16 sedative and hypnotic drugs, based on findings in 3560 autopsy cases. The cases were classified as single substance intoxications (N = 498), multiple substance intoxications (N = 1555) and postmortem controls (N = 1507). Each autopsy case could be represented more than once in the group of multiple intoxications and among the postmortem controls if more than one of the included substances were detected. The concentration ranges for all groups are provided. Overlap in concentrations between fatal intoxications and reference groups was seen for most substances. However, the concentrations found in single and multiple intoxications were significantly higher than concentrations found in postmortem controls for all substances except alprazolam and triazolam. Concentrations observed among drugged drivers were similar to the concentrations observed among the therapeutic drug monitoring cases. Flunitrazepam was the substance with the highest number of single intoxications, when related to sales. In summary, this study provides reference drug concentrations primarily to be used for improving interpretation of postmortem drug levels in obscure cases, but which also may assist in drug safety work and in pharmacovigilance efforts.

    (C) 2014 Elsevier Ireland Ltd. All rights reserved.

  • 77.
    Junuzovic, Mensura
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Firearm deaths in Sweden: epidemiology with emphasis on accidental deaths and prevention2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Prevention of firearm deaths and injuries is an important public health issue that may save human lives. The aim of this thesis was to investigate the epidemiology and attributes of accidental firearm fatalities in Sweden, and to provide a basis for further preventive measures. Data were obtained from the database of the National Board of Forensic Medicine, the National Patient Register, the Prescribed Drug Register, the Firearm Register, and from questionnaire responses.

    All 48 accidental firearm fatalities that involved hunting in 1983-2008 were investigated (Paper I). The victims’ mean age was 50 years, 96% were males. During moose hunting, most victims were mistaken for game (41%), whereas during small game hunting, fatalities were mostly related to falls (31%) and improper weapon handling (15%). Hunters’ habits and attitudes towards preventive measures and their experience of firearm incidents were investigated through a questionnaire, which was sent to 1,000 hunters (Paper II). The response rate was approximately 50%. The mean age of the respondents was 54 years and females accounted for 5%. One quarter of the respondents stated that they had witnessed a firearm incident caused by another hunter, of which more than half suggested that improper handling of the weapon and inappropriate hunting strategies were the main causes of these events.

    All 43 accidental non-hunting firearm deaths in Sweden 1983-2012 were investigated (Paper III). In 56% of cases, the fatality was caused by another person. Victims were mostly young males (mean age 25 years). The main cause of the incidents was human error. The majority of cases (63%) involved legal firearm. Most victims killed by illegal firearm (85%) were under the influence of alcohol and/or drugs at the time of death. Both the risk of being killed as a result of hunting (Paper I) and non-hunting accidental firearm injury (Paper III) decreased after the introduction of the mandatory hunter’s exam in 1985 (p < 0.001).

    Firearm deaths in Sweden including 52 accidental fatalities and 3 cases with undetermined manner of death in 1987-2013, as well as 213 suicides and 23 solved homicides in 2012-2013, were studied (Paper IV). The number of firearm suicides was positively correlated to the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in firearm homicides. The majority of the shooters in accidental deaths and suicides had no registered visits to inpatient care or specialized outpatient care. Less than half (42%) of all suicide victims had had a health care contact due to mental health problems. Physician’s mandatory reporting to the police of patients deemed unsuitable for possessing a firearm license did not include any of the suicide victims and the shooters in accidental deaths.

    This thesis confirmed that accidental firearm deaths are rare, and indicates that the firearm law changes in 1985 contributed to a decline of such fatalities. Human error was the main “cause” of the fatalities and future prevention measures should target improper weapon handling. Physician’s mandatory reporting to the police was suboptimal and barely contributed to the decline of accidental firearm deaths. If streamlined it may, however, represent an important prevention strategy in firearm suicides, claiming most lives among firearm deaths. A significant fraction of non-hunting fatalities, firearm suicides and homicides was associated with illegal firearm use, a fact calling for prevention issues targeting such firearm use.

  • 78.
    Junuzovic, Mensura
    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 firearm deaths during hunting2012In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 18, p. 97-97Article in journal (Refereed)
  • 79.
    Junuzovic, Mensura
    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.
    Unintentional firearm hunting deaths in Sweden2012In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 216, no 1-3, p. 12-18Article in journal (Refereed)
    Abstract [en]

    This study examined all unintentional firearm fatalities while hunting that occurred in Sweden between 1983 through 2008. The circumstances as well as the impact of the hunter's exam on fatality frequency were analysed. During these 26 years, there were 48 such fatalities, representing 53% of all (n = 90) unintentional firearm deaths during the same period. The average annual number of fatalities decreased over the last few decades. Very restrictive firearm legislation in Sweden combined with the introduction of a mandatory hunter's exam since 1985 accounted, at least partly, for this finding. Moose hunting accounted for 46% of the fatalities and small game hunting for the remaining cases. The mean age of the victims was 50 years and 96% of them were males; all shooters were males. During moose hunting, most of the victims were mistaken for game, whereas in small game hunting most of the fatalities were related to falls and improper handling of the weapon. Human error was thus the main cause of these fatalities.

  • 80.
    Junuzovic, Mensura
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
    Rietz, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Jakobsson, Ulf
    Lunds universitet.
    Midlöv, Patrik
    Lunds universitet.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Firearm deaths in Sweden2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 2, p. 351-358Article in journal (Refereed)
    Abstract [en]

    Background: Sweden’s firearm legislation obligates physicians to report patients that are deemed unsuitable to possess a firearm. This study aimed to explore the involvement of firearm use in firearm fatalities and to evaluate physician reporting concerning cases of firearm deaths.

    Methods: Fatal firearm suicides and homicides in Sweden were studied for the years 2012–2013, accidental deaths and undetermined manner of deaths for the period 1987–2013. Police reports and autopsy protocols were collected from the National Board of Forensic Medicine, healthcare data in 1 year before the fatality from the National Board of Health, and information about physician reports and firearm licences from the Swedish Police.

    Results: A total of 291 firearm deaths (213 suicides, 52 accidental deaths, 23 solved homicides and 3 cases with undetermined manner of death) were identified. Firearm suicides were positively correlated with the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in homicides. No suicide victim or shooter in an accidental death was previously reported by a physician to the police according to the firearm law. The majority of the shooters in accidental deaths and suicides had no registered health care visits. Less than half (42%) of all suicide victims had a previous health care contact due to mental health problems. Conclusions: Not one single suicide victim nor any shooter in accidental deaths in the present study had been reported according to the firearm law, bringing the evidence of a suboptimal framework.

  • 81.
    Junuzovic, Mensura
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University.
    Sjöberg, Ameli
    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.
    Unintentional non-hunting firearm deaths in Sweden, 1983-20122016In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 61, no 4, p. 966-971Article in journal (Refereed)
    Abstract [en]

    We examined the association between unintentional nonhunting firearm deaths and changes in firearm legislation in Sweden. There were 43 fatalities during the study time frame 1983-2012, representing 46% of all unintentional firearm deaths during the same period. The victims were predominantly young males (mean age 25 years). Slightly more than half of the deaths were caused by another person and were inflicted at close range. The main cause of the incidents was human error. The majority of the involved firearms were legal; however, most victims killed with illegal firearms were under the influence of alcohol and/or drugs at the time. The death rate decreased significantly following the introduction of the hunter's examination in 1985. Education and training associated with the hunter's examination was at least partially responsible for the decline in fatalities after 1985. Future prevention should target the availability of illegal firearms.

  • 82.
    Järvholm, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mannelqvist, RuthUmeå University, Faculty of Social Sciences, Department of Law.Olofsson, ChristerKallinge Vårdcentral, Karlskrona.Torén, KjellGöteborgs universitet.
    Försäkringsmedicin2013Collection (editor) (Other academic)
    Abstract [sv]

    Boken beskriver centrala försäkringsmedicinska begrepp ur ett både principiellt och kritiskt perspektiv samt ger en överblick över gällande regelverk. I boken framgår hur personförsäkringar utvecklats med tonvikt på svenska förhållanden men här finns även en jämförelse med andra närliggande länder. Försäkringsmedicinens medicinska och juridiska bedömningar belyses liksom dess kopplingar till juridiken och särskilt till skadeståndsrätten. Försäkringarnas innehåll och hur enskilda ärenden handläggs har förändrats varför flera områden, särskilt inom socialförsäkringen, är föremål för diskussion. Boken innehåller en kritisk analys av vissa sådana aspekter, bl.a. olika etiska perspektiv. Regelverken förändras i snabb takt och aktuella regler hämtas i dag framför allt via webben. Boken innehåller de viktigaste reglerna, framför allt inom socialförsäkringen, på en övergripande nivå.

    Syftet är att ge läsaren en fördjupad förståelse för de medicinska och juridiska principer som är centrala inom försäkringsmedicinen. Den innehåller också en övergripande beskrivning av gällande regelverk i Sverige och vissa andra länder.

    Boken vänder sig till personer som behöver en fördjupad förståelse för försäkringsmedicinska frågor, t.ex. läkare och annan sjukvårdspersonal, jurister och handläggare av personförsäkringar.

  • 83. Jönsson, Anna
    et al.
    Brundin, Lars
    Ahlner, Johan
    Hedenmalm, Karin
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Forensic Medicine.
    Antipsychotics associated with pulmonary emboli in a Swedish medico-legal autopsy series2007In: The International Association of Forensic Toxicologists and International Council on Alcohol, Drugs and Traffic Safety: 8th Ignition Interlock Symposium, 2007, p. 135-Conference paper (Other academic)
  • 84.
    Kronstrand, Robert
    et al.
    National Board of Forensic Medicine.
    Roman, Markus
    National Board of Forensic Medicine.
    Thelander, Gunilla
    National Board of Forensic Medicine.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Unintentional fatal intoxications with mitragynine and O-Desmethyltramadol from the herbal blend krypton2011In: Journal of Analytical Toxicology, ISSN 0146-4760, E-ISSN 1945-2403, Vol. 35, no 4, p. 242-247Article in journal (Refereed)
    Abstract [en]

    The leaves of Kratom, a medicinal plant in Southeast Asia, have been used as an herbal drug for a long time. At least one of the alkaloids present in Kratom, mitraynine, is a mu-receptor agonist. Both Kratom and an additional preparation called Krypton are available via the internet. It seems to consist of powdered Kratom leaves with another mu-receptor agonist, O-desmethyltramadol added. O-desmethyltramadol is an acitve metabolite of tramadol, a commonly prescribed analgesic. We present nine cases of intoxication, occurring in a period of less than one year, where both mitragynine and O-desmethyltramadol were detected in the postmortem blood samples. neither tramadol nor N-desmethyltramadol was present in these samples, which implies that the ingested drug was O-desmethyltramadol. The blood concentrations of mitragynine, determined by ultra-performance liquid chromatography-tandem mass spectrometry, ranged from 0.02 to 0.18 μg/g, and O-desmethyltramadol concentrations, determined by gas chromatogtraphy with nitrogen-specific detection, ranged from 0.4 to 4.3 μg/g. We believe that the addition of the potent mu-receptor agonist O-desmethyltramadol to powdered leaves from Kratom contributed to the unintentional death of the nine cases presented and conclude that intake of Krypton is not as harmless as it often is described on internet websites.  

  • 85.
    Kågström, Kristoffer
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Att straffa den galne2013Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    I augusti 2012 föll domen mot Anders Behring Breivik och domstolen ansåg att han varit psykisk frisk och tillräknelig. Frågan om Breiviks tillräknelighet var däremot inte lättbedömd och åklagaren ansåg att han varit psykiskt sjuk och otillräknelig vid gärningstillfället. De två rättspsykiatriska utlåtanden? som gjordes över hans psykiska tillstånd hade olika utfall; det första visade att han varit sjuk, det andra att han varit frisk. Utöver huruvida psykisk störning förelåg eller inte ger situationen upphov till andra mer principiella frågor. En av dessa är en klassisk straffrättslig frågeställning, nämligen om en person som genomfört en gärning under en psykisk störning ska anses ansvarig för sina brottsliga gärningar. Norge tillhör i det hänseendet en väletablerad straffrättslig tradition där den som genomfört en brottslig handling under en allvarlig psykisk sjukdom inte kan anses ansvarig och är rättsligt att se som oskyldig till brottet, fast än personen faktiskt genomfört en brottslig handling. Istället ges vård ges genom tvångsvårdslagstiftning. I Sverige har vi dock sedan 1960-talet valt en annan väg. Här har lagstiftaren ansett att även psykiskt störda lagöverträdare i tillräcklig utsträckning kan vara medvetna om sina handlingar och därmed hållas ansvariga. Påföljden blir dock i normalfallet rättspsykiatrisk vård.

  • 86.
    Liedbeck, Emilia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Kvinnlig könsstympning2010Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Kvinnlig könsstympning är en tretusenårig tradition utan religiös förankring.[1] En tradition med ett starkt fäste runt om i världen där tusentals föräldrar låter sina döttrar genomlida den smärtsamma process som kvinnlig könsstympning innebär. Hur kan man acceptera att ett barn eller en ung kvinna kan få sina mänskliga fri- och rättigheter åsidosatta? Vem är det egentligen som bär ansvaret, är det föräldrarna eller är det rentav staten som har ett ansvar?

     

    Kvinnlig könsstympning utförs på alltifrån nyfödda barn till flickor i tonåren. Majoriteten av ingreppen utförs inte på ett sjukhus med kliniskt rena instrument där tillgången till bedövning och professionell hjälp är sällsynt. Majoriteten av ingreppen utförs med rakblad, oren kniv eller en glasskärva, där flickorna ibland får dricka en dryck för att smärtan ska reduceras. Vissa flickor försätts i trance eller förs ner i ett vattendrag för att smärtan ska reduceras.[2]

    [1]    http://www.unicef.se/om-unicef/fakta-om-unicef-och-barns-rattigheter/kvinnlig-konsstympning

    [2]    Socialstyrelsen, Kvinnlig könsstympning, 2005, s. 14.

  • 87.
    Lindblom, Sophia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Helgedomen: Knutbyfallet ur ett rättspsykiatriskt perspektiv; en studie i dogmatism och personlighet2010Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Den här studien ämnar att utifrån det uppmärksammade händelserna i Knutby 2004, undersöka personlighet och relationen till dogmatism för grupperna kriminella och kristna med en pentekostal inriktning, vilket innebär en bibeltrogen och karismatisk orientering med en stark tro på en andlig sfärs påverkan på människan och tillvaron (Pingst.se, 2010). Begreppet dogmatism definieras här enligt Rokeach (1954) vilket innebär ett slutet kognitivt system som centrerats kring övertygelser om grundteser som inte ifrågasätts. Dogmatism innebär en auktoritärianism och ett ointegrerat tänkande och benägenhet att omtolka information så att det stämmer med de egna centrala föreställningarna. Vidare definieras begreppet personlighet här enligt Big Five teorin som är en indelning av människans universella personlighetsdrag i de fem dimensionerna; öppenhet (O), samvetsgrannhet (C), utåtriktning (E), vänlighet (A), samt känslomässig instabilitet (N) (Costa & McCrae, 1987). Det aktuella forskningsläget indikerar att det ointegrerade tänkandet är kopplat till individuella skillnader i kognitiv förmåga och informations bearbetning (Brown, 2006; Davies, 1998; Stanovich & West, 1997). Likaså har need for closure, vilket innebär ett behov av definitiv kunskap inom något område och undvikande av tvetydighet, visats påverka bearbetningen av information och skapa ett mer dogmatiskt tänkande (Webster & Kruglanski, 1994). Vidare har höga värden i N- och låga värden i O dimensionen relateras till dogmatism och auktoritärianism (Dy-Liacco et al., 2009; Francis, 1998). Enligt Dy-Liacco et al. (2009) antas också öppenhetsdimensionen (O) ha samband med dysfunktioner i individens gränser mot yttervärlden.  Forskning har även visat en positiv osystematisk relation mellan dogmatism och religion, som antas ha samband med need for closure (Saroglou, 2002a) och gruppen religiösa har generellt visat låga värden av känslomässig instabilitet (N) (Saroglou, 2002b). Likväl har forskning också visat att kristna med en pentekostal inriktning tenderar att i tre gånger så stor utsträckning som andra kristna drabbas av depressioner, vilket kan relateras till känslomässig instabilitet (N) (Paunonen & Ashton, 2001; Trice & Bjorck, 2006). Dogmatism har vidare relaterats till medlemskap i religiösa grupper som sätter sin tillit till auktoriteter (Vacchiano et al.,1969). Francis (2001) hävdar dock att variationen av dogmatism mellan församlingar med samma inriktning är större än mellan kyrkor med olika inriktningar. Till de auktoritära rörelserna hör grupperingar med hierarkisk organisation, stark tro på en andligs sfärs påverkansförmåga och en fundamentalistisk bibelsyn (SOU, 1998:113). Ledaren ses här som profetisk. Förebud eller bekräftelse läses in i den omgivande miljön och gruppen är bärare av ett starkt meningssystem som också ger tillhörighet och skapar engagemang. Vissa intensiva upplevelser sägs komma från en andlig sfär och som ett gudomligt ingrepp. Dessa upplevelser skapar känslan av att vara med om något utomvärldsligt och att leva i en reell andlig verklighet. Tänkandet om att det onda är personifierat av djävulen och ständigt är aktivt är djupt integrerat i tankevärlden hos dessa medlemmar. Om man inte kan ifrågasätta ledaren och är emotionellt eller socialt inlåst i gruppen leder det till att ens övertygelser blir starkare. I psykologiska termer kallas detta mystisk manipulation. Vidare har undersökningar påvisat att kriminella tankemönster rymmer dogmatiskt hållna ologiska övertygelser (Mandracchia, 2009; Morgan et al., 2010) och att gruppen kriminella visar höga värden av känslomässig instabilitet (N) (Ellison, 2006). Studien frågeställningar och hypoteser blir således: Finns det någon skillnad i dogmatism mellan gruppen aktivt utövande kristna, gruppen aktivt kriminella och personer som varken är aktivt utövande kristna eller aktivt kriminella? Om det finns en skillnad kan den relateras till någon av dimensionerna enligt Big Five teorin? Gruppen kriminella antas visa högre värden av dogmatism än övriga grupper, och dogmatism antas relatera till känslomässig instabilitet (N). Studiens mål (aims) är att belysa några av de mekanismer som kan ligga bakom gärningarna med speciellt fokus på uppkomsten av dogmatiskt hållna religiöst färgade övertygelser.

  • 88.
    Lindqvist, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Teenage suicides in northern Sweden: an interview study of investigating police officers2000In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 6, no 2, p. 115-119Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To disclose recurrent, dynamic, and static factors in teenage suicide involving the suicidee, his/her family, and the community; and to investigate the feasibility of using police as informants for suicide studies.

    SUBJECTS: All deaths categorised as suicide 1993 through 1995 among teenagers in Northern Sweden (n=15).

    METHOD: Semiqualitative interviews with police officers, and, when applicable, general practitioners. Police reports, necropsy protocols, medical records, and conscription data were also analysed.

    RESULTS: Most suicides occurred in rural and depopulated areas. In contrast to males, females often had a history of overt psychiatric problems with suicide attempts. At least two thirds of the suicides were planned.

    CONCLUSION: Cultural and sociopolitical aspects are important in teenage suicide as well as gender differences. Police officers can provide essential information. Identifying teenagers at risk remains difficult, however, due to low baseline rates.

  • 89.
    Lindqvist, Per
    et al.
    Division of Forensic Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Karlsson, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    In the aftermath of teenage suicide: a qualitative study of the psychosocial consequences for the surviving family members2008In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 8, no 1, p. 26-Article in journal (Refereed)
    Abstract [en]

    Background Studies of family reactions following teenage suicide are hampered by the psychological difficulties of approaching families and recruiting an unbiased sample of study subjects. By using a small but consecutive series of cases, we examined the qualitative aspects of loosing a teenage family member due to suicide. Such an understanding is important for future organisation of proper programs that provide professional support in the grief process.

    Methods From a large project on teenage unnatural death in northern Sweden 1981-2000 (n=88), 13 cases from 1995 through 1998 were retrospectively identified and consecutively analysed. Ten families agreed to participate. The open interviews took place 15 to 25 months after the suicide. The information gathered was manually analysed according to a grounded theory model, resulting in allocation of data into one of three domains: post-suicidal reactions, impact on daily living, and families´need for support.

    Results. Teenager suicide is a devastating trauma for the surviving family and the lacko of sustainable explanations for the suicide is a predominant issue in the grief process. The prolonged social and psychological isolation of the families in grief should be challenged. At the time of the interview, the families were still struggling with explaining why the suicide occurred, especially since most suicides had occurred without overt premonitory signs. The bereaved family members were still profoundly affected by the loss, but all had returned to an ostensibly normal life. Post-suicide support was often badly timed and insufficient, especially for younger siblings.

    Conclusions Family doctors can organise a long-term, individually formulated support scheme for the bereaved, including laymen who can play a most significant role in the grief process. There is also a need for better understanding of the families who have lost a teenager whom committed suicide and for the development and testing of treatment schemes for the bereaved family.

  • 90.
    Lundberg, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Rätt säkert rättssäkert?: Polisens handläggning av onaturliga dödsfall2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Dödsfall delas enligt svensk rätt upp i två fraktioner: onaturliga kontra naturliga dödsfall. Till naturliga dödsfall räknas dödsfall till följd av enbart sjukdom. Onaturliga dödsfall omfattar allt annat, delvis dödsfall till följd av 'yttre påverkan'. Mer specificerat kan det här vara frågan om olycksfall, homicid (uppsåtligt dödande) eller självmord.[1]

                          En läkare ska alltid konstatera och fastställa dödsfallet oavsett om det rör sig om ett naturligt eller onaturligt dödsfall.[2] Under vissa omständigheter ska läkaren även polisanmäla dödsfallet. Detta ska ske då det kan finnas skäl för en rättsmedicinsk undersökning.[3] En rättsmedicinsk undersökning kan aktualiseras för att upptäcka, utesluta eller utreda dödsfall till följd av våldsbrott.[4]

                          Efter de har mottagit anmälan tar polismyndigheten över handläggningen kring dödsfallsutredningen. Detta ingår allmänt i polisens uppgift i syfte att utreda och beivra brott.[5]                      I detta mandat ingår att avgöra om en rättsmedicinsk undersökning ska genomföras och i vilken form den i så fall ska utföras.[6] Grundprincipen är att varje dödsfall som anmäls till polisen bör utredas med en rättsmedicinsk undersökning men polismyndigheten har av olika skäl möjlighet att inte besluta om en sådan undersökning. Statistiken visar även att i närmare hälften av alla anmälda dödsfall genomförs ingen rättsmedicinsk undersökning.[7]

    Detta har visat sig problematiskt då en inte obetydlig del av brottsrelaterade dödsfall upptäcks först i och med en rättsmedicinsk undersökning. Det föreligger således en överhängande risk att våldsrelaterade brott aldrig upptäcks eller utreds.[8]

                          Polisens tillämpning av reglerna medför annorlunda uttryckt att rättssäkerheten riskeras. I beslutsfattandet om en rättsmedicinsk undersökning ska genomföras får polisen beakta både kriminaltekniskt samt medicinskt material. Det blir härmed viktigt att större vikt

  • 91.
    Lundgren, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    DNA analys som bevismedel i rättegång2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Evolutionen av DNA som ett verktyg för att fria eller fälla en misstänkt har varit betydelsefull. DNA är det kemiska ämne som är bärare av den genetiska informationen genomet som återfinns i världens alla organismer, däribland människan. DNA kan utvinnas ur förhållandevis små biologiska spår av saliv, blod, sädesvätska osv. 2006 trädde en lag i kraft som innebar en utökad användning av DNA-tekniken. Ändringar genomfördes i 28 kapitlet RB samt i polisdatalagen och det här banade väg för möjligheter till såväl DNA-provtagning som registrering av DNA-profiler. Detta ger i sin tur polisen förbättrade möjligheter till att hantera samt reglera mängdbrottsligheten. Tidigare kunde mängdbrott som exempelvis tillgreppsbrott, misshandel, narkotikabrott och vapenbrott av normalgraden inte föranleda en registrering.

  • 92.
    Lundström, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Rätten att besluta om obduktion2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    När en människa dött är det för många ett avslut. Detta kan sägas gälla främst de gånger en gammal människa dött av ålder eller att denne burit på en känd sjukdom, vari döden varit ofrånkomlig. Att dö gammal i sängen är, skulle jag vilja påstå, det mest humana sättet att dö på och troligtvis även det sätt de flesta vill dö på. I alla fall torde de flesta haft den bilden när de föreställt sig sin egen död. Men verkligheten är sällan samma bild som den vi föreställt oss och många gånger börjar ett nytt när ett kapitel avslutats. Så kan det till exempel vara när en människa dött och orsaken därtill inte är känd. Det finns olika typer av undersökning av en avliden person, och i detta arbete redogör jag för klinisk obduktion och rättsmedicinsk obduktion. Eftersom detta är stora ingrepp där inte bara den som undersöks, utan även närstående kan drabbas på olika sätt, kan man fråga sig om vem som får ta initiativ till ett sådant ingrepp. Har de närstående till en avliden någon rätt att begära obduktion för att få reda på dödsorsaken? Har de överhuvudtaget något att säga till om?

  • 93. Lynoe, Niels
    et al.
    Elinder, Göran
    Hallberg, Boubou
    Rosén, Måns
    Sundgren, Pia
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    A misunderstanding. Response to Dr Bilo et al2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1046-1046Article in journal (Other academic)
  • 94. Lynoe, Niels
    et al.
    Elinder, Göran
    Hallberg, Boubou
    Rosén, Måns
    Sundgren, Pia
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Authors' overarching reply to all the responses received to the systematic literature review on shaken baby syndrome2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1031-1031Article in journal (Other academic)
  • 95. Lynoe, Niels
    et al.
    Elinder, Göran
    Hallberg, Boubou
    Rosén, Måns
    Sundgren, Pia
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Conflicts of interest issues. Response to Lucas et al.2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1036-1036Article in journal (Other academic)
  • 96. Lynoe, Niels
    et al.
    Elinder, Göran
    Hallberg, Boubou
    Rosén, Måns
    Sundgren, Pia
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Insufficient evidence for 'shaken baby syndrome' - a systematic review2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1021-1027Article, review/survey (Refereed)
    Abstract [en]

    Shaken baby syndrome has typically been associated with findings of subdural haematoma, retinal haemorrhages and encephalopathy, which are referred to as the triad. During the last decade, however, the certainty with which the triad can indicate that an infant has been violently shaken has been increasingly questioned. The aim of this study was to determine the diagnostic accuracy of the triad in detecting that an infant had been shaken. The literature search was performed using PubMed, Embase and the Cochrane Library up to October 15, 2015. Relevant publications were assessed for the risk of bias using the QUADAS tool and were classified as having a low, moderate or high risk of bias according to predefined criteria. The reference standards were confessions or witnessed cases of shaking or accidents. The search generated 3773 abstracts, 1064 were assessed as possibly relevant and read as full texts, and 30 studies were ultimately included. Of these, 28 were assessed as having a high risk of bias, which was associated with methodological shortcomings as well as circular reasoning when classifying shaken baby cases and controls. The two studies with a moderate risk of bias used confessions and convictions when classifying shaken baby cases, but their different designs made a metaanalysis impossible. None of the studies had a low risk of bias. Conclusion: The systematic review indicates that there is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence). It was also demonstrated that there is limited scientific evidence that the triad and therefore its components can be associated with traumatic shaking (low-quality evidence).

  • 97. Lynoe, Niels
    et al.
    Elinder, Göran
    Hallberg, Boubou
    Rosén, Måns
    Sundgren, Pia
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    The scientific evidence regarding retinal haemorrhages. Response to Hellgren et al. and Levin2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1041-1042Article in journal (Other academic)
  • 98. Lynoe, Niels
    et al.
    Elinder, Göran
    Hallberg, Boubou
    Rosén, Måns
    Sundgren, Pia
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    The shaken baby syndrome report was not the result of a conspiracy. Response to Dr. Narang et al2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1050-1051Article in journal (Other academic)
  • 99. Lynoe, Niels
    et al.
    Elinder, Göran
    Hallberg, Boubou
    Rosén, Måns
    Sundgren, Pia
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    What are acceptable conclusions?: Response to Dr. Ludvigsson2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1032-1032Article in journal (Other academic)
  • 100. Lynoe, Niels
    et al.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    May the fear of being falsely accused of having shaken a baby increase parents' demands for scheduled Caesareans?2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1052-1052Article in journal (Refereed)
1234 51 - 100 of 169
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