Older adult abuse in a service for sexual and domestic violence: Medico-legal implications from the experience of an Italian center.

Older adults are subject to vulnerability and abusive behaviors have serious negative health consequences. Since the phenomenon is underestimated, several challenges are faced to prevent, diagnose, and treat abuses on older adults. In this context, clinical forensic medicine practitioners can play a pivotal role. A retrospective monocentric analysis of all the files concerning victims of violence observed in the SVSeD Center in Milan over the age of 65 for a five-year period was performed. For each medical report, data regarding the variables of the victims, the type of violence, and the variables of the perpetrators were analysed. Older adult victims of abuses were 166. Abuses against women were more frequent than against men (less than 6 % of consultations). In one third of cases, subjects also suffered from disabling diseases and reported signs of physical violence. Perpetrators were male known individuals in almost 90 % of cases. Violence was perpetrated by a partner or a family member. The present study may help in identifying risk factors for domestic violence against older adults. Consequently, preventive policies should be designed to interrupt the vicious circle of violence. Older adult abuse deserves additional focus and better education for healthcare professionals and further research should be carried out to better understand the actual epidemiology of the phenomenon and to develop therapeutical and caring strategies.

Murder-suicides in Milan: case history from 1990 to 2018. Criminological and medico-legal considerations.

This study reviews autopsies performed by the Legal Medicine department of the University of Milan from 1990 to 2018. In particular, the characteristics of the perpetrator, the victim and the type of existing relationship, the means used, and the place and time of the crime. A retrospective analysis was conducted, extracting data from the Milan Institute of Legal Medicine database, selecting cases of murder-suicide from the archive between 1990 and 2018 (a total of 75 cases with 84 murder victims). Available data was processed statistically. Univariate and bivariate analysis techniques were mainly used. Significance tests (Chi-square) and correlation studies (Pearson's R) were also conducted, the results of which were then examined and discussed in light of legal, medical and criminological expertise.In almost all cases, suicide followed immediately after the murder, at home and in the context of an emotional relationship. The murderer and person committing suicide is almost always male and the victim female. A firearm was the most common weapon in cases of both murder and suicide.The results indicate that the issue of gender is relevant in murder-suicides as indicated by international and national literature on homicides. Furthermore, the use of firearms endorses the importance of limiting their availability through more restrictive laws.

Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations.

BACKGROUND: Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault. METHODS: It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor's Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1st 2011 to 31st December 31st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge's final judgment. RESULTS: Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim's deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction. CONCLUSIONS: Many factors seem able to influence the judge's judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim's statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed.

Lethal extracranial hemorrhage due to intracranial clivalchordoma: An autopsy case.

We present a case of a 48-year-old man's unexpected death affected by a relapsed clivalchordoma. After partial excision surgery of the neoplasm, he manifested 5 days later, in conditions of well-being, a sudden lethal extracranial hemorrhage from nose and mouth. The autopsy examination and the subsequent histological investigations did not allow us to clarify the exact origin of the bleeding. Based on the negativity of the accurate examinations performed, the extent of the bleeding, and the findings highlighted by the means of the nuclear magnetic resonance (NMR) carried out a few days before death, we have considered reasonable to localize the source of hemorrhage in the intrapetrous tract of the left internal carotid artery. Since this is a unique event, never previously documented, we believe that our report may be of interest to the scientific community.

Male victims of sexual abuse and domestic violence: A steadily increasing phenomenon.

Violence perpetrated on male victims is a phenomenon that is currently underestimated by both national and international scientific communities, since males are historically (and stereotypically) considered the perpetrators rather than the victims of violence. As a consequence, the available literature lacks data which would allow a better understanding of this issue and its presenting features. We undertook a retrospective analysis of 231 medical files of male victims of violence over a five-year-period (2014-2018) at the Soccorso Violenza Sessuale e Domestica Centre in Milan, Italy. The sample included 112 victims of sexual violence and 119 victims of domestic violence, most of whom were younger than 18 years of age. The main aim of this study was to describe the presentations of male victims of violence in order to understand the phenomenon better, increase awareness of the issue and enable improved health-care management. The need to pay more attention to this vulnerable part of the population is mandatory in health-care services, and it includes: the provision of management guidelines, training to attending physicians and a supportive service to male survivors. Understanding which risk factors are related to male abuse can help with the development of programmes that identify, prevent and minimise violence - this being especially useful for primary-care clinicians. This is the first Italian study to deal with domestic and sexual violence involving male victims.