Ear bleeding: A sign not to be underestimated in cases of strangulation.

Otorrhagia is commonly associated with cranial trauma and diving accidents. In some forensic manuals, bleeding in the ears is anecdotally associated with strangulation. We report 2 cases of criminal strangulation with hemotympanum and otorrhagia, emphasizing the importance of this sign with strangulation. We present the proposed pathophysiology of the injuries and the value of otoscopic evaluation to complete the external examination in forensic cases suspicious for strangulation.

[Improving suicide prevention]. / Pour une meilleure prévention du suicide.

Suicidal thoughts precede a suicide attempt. Knowing the people who are exposed to such thoughts enables prevention to be improved. The results of a study of the general population show that one in five French people claim to have already seriously considered committing suicide. This represents a particularly concerning public health issue.

[Social vulnerability is more frequent in victims of interpersonal violence: value of the EPICES score]. / La précarité est plus fréquente chez les victimes de violences volontaires : intérêt du score EPICES.

OBJECTIVES: To evaluate social vulnerability of victims of interpersonal violence having consulted a service of forensic medicine with an individual index of social vulnerability. POPULATION AND METHODS: The population of victims of interpersonal violence was composed of 275 subjects having consulted the service of forensic medicine of the CHU of Saint Etienne. The social data were collected by questionnaire. Social vulnerability was measured by an individual index (EPICES) calculated on the basis of 11 weighted questions related to material and social deprivation. This population was compared with a reference population; the reference population was people, aged more than 16, living in the Rhône-Alpes region and examined in 2005 in one of the Health examination Centres (HECs) of the French General Health Insurance System, that is 7553 men and 6002 women. The comparisons between the two populations were made after redressing the population of the HECs on various socio-demographic data of the Rhône-Alpes region. The relations between violence and the variables studied were measured by odds ratios adjusted on age and sex. RESULTS: The population of the victims of violence is younger than the reference population (p<0.001). It is characterized by a lower level of education (p<0.001, 15% in the higher education level vs 23%) and the categories Employees and Manual workers are more frequent (p<0.001). The situation with respect to employment is also different between the two populations, unemployment rate is higher (OR=2.25) and the retired are fewer (OR=0.41). Subjects in social vulnerability are more frequent in the victims (57% vs 36%). All these differences persist after adjustment on age and sex. The context in which the aggression took place (family, public area or at work) varies significantly according to social vulnerability. On the other hand, the majority of the other medico-legal characteristics are not different according to the level of social vulnerability. CONCLUSION: The population of the victims of interpersonal violence has a socio-economic profile different from the reference population. Social vulnerability is associated with interpersonal violence, in particular with violence in the public and family area.

Guidelines for doctors attending detainees in police custody: a consensus conference in France.

Medical practice in police custody needs to be harmonized. A consensus conference was held on 2-3 December 2004 in Paris, France. The health, integrity, and dignity of detainees must be safeguarded. The examination should take place in the police station so that the doctor can assess the conditions in which the detainee is being held. If the minimum conditions needed for a medical examination are not available, the doctor may refuse to express an opinion as to whether the detainee is fit to be held in custody or may ask for the detainee to be examined in a hospital. Doctors are subject to a duty of care and prevention. They should prescribe any ongoing treatment that needs to be continued, as well as any emergency treatment required. Custody officers may monitor the detainee and administer medication. However, their role should not be expected to exceed that required of the detainee's family under normal circumstances and must be specified in writing on the medical certificate. Doctor's opinion should be given in a national standard document. If the doctors consider that the custody conditions are disgraceful, they may refuse to express an opinion as to whether the detainee is fit for custody.