[Forensic examination of sexually abused children]. / Den retslaegelige undersøgelse af mindreårige udsat for seksuelle overgreb.

INTRODUCTION: The Department of Forensic Medicine, Aarhus, performs examinations of children suspected to have been sexually abused when reported to and requested by the police. A preliminary study was taken to evaluate all cases in one year including the legal outcome. MATERIAL AND METHODS: The material included all cases in one year, all examined on request by the police. All written material including court decisions were reviewed. RESULTS: The material included 34 cases with three boys, median-age 11 years, and 31 girls, median age six years, at the time of examination. The sexual abuse events were fondling, vaginal (14), anal (7) and oral (5) intercourse as well as showing pornography. The medical examination was most often performed more than one week after the abuse. The examination revealed normal findings in 20 cases, non specific findings including erythema of the vestibulum in 13 cases and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of age and were family members or someone known to the child. Eight perpetrators were convicted in court, of whom three admitted having abused the child. DISCUSSION: The time interval between the sexual abuse and the time of examination is important to the ano-genital findings at the examination. A medical examination in cases of sexual child abuse seldom provides legal proof of sexual abuse. The most important evidence is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.

Medical examination of sexually abused children: medico-legal value.

UNLABELLED: The Department of Forensic Medicine (forensic pathology and clinical forensic medicine), Aarhus, Jutland, Denmark, performs examinations of children suspected to have been sexually abused when reported to and requested by the police in Jutland, Denmark. Jutland covers an area of 210,000 km2 with about 300,000 inhabitants in Aarhus. A colposcope initially equipped with an Olympus camera, but now with a video camera attached has been used since 1994. Since 1994 the department has performed more than 100 examinations of children suspected of having been sexually abused. A preliminary study was taken to evaluate all cases from 1995 including the legal outcome. RESULTS: The material included 34 cases with three boys, mean age 11 years, and 31 girls, mean age 8 years, at the time of the examination. The sexual abuse events were fondling including penetration of the vagina, vaginal (14), anal (7), and oral (5) intercourse as well as cunnilingus and nontouching abuses. The medical examination was most often performed more than a week after the abuse. The examination revealed normal findings in 23 cases, nonspecific findings including erytherma in 13 cases, and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of ane and were family members or someone known to the child. Nine perpetrators were convicted at court, of whom three admitted having abused the child. CONCLUSION: A medical examination in cases of sexual child abuse seldom provides a legal proof of sexual abuse. The most important is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.

[Domestic violence]. / Vold i familien.

The purpose of this study was to analyze the development in the incidence of violence against women committed by husband/spouse and violence against children committed by parents. This study is based on a prospective registration during a one year period (1993-94) of women and children who attended the casualty wards and/or the Department of Forensic Medicine because of exposure to violence. The results were compared with similar studies from 1981-82 and 1987-88. The incidence of domestic violence within the age group of 25-34 years (the major group) was in 1993-94 1.9 per 1000 per year, in 1981-82 1.7 and in 1987-88 2.9. Twelve percent of the women had been exposed to violence characterized as severe. Twenty (6.6%) women were registered more than once. Thirty-eight percent of Danish women and 25.8% of foreign women reported the incident to the police. The incidence of violence against children remained unchanged at 0.3 per 1000 per year during the three registration periods.

[Decline of violence in ]rhus. Violence registered in ]rhus hospital during a period of 12 years]. / Faldende vold i Arhus.

The aim of this study was to describe the changes in frequency and character of interpersonal violence in Aarhus during a twelve year period. A one year (1993-1994) prospective registration of all persons exposed to violence and attending the casualty wards or the Department of Forensic Medicine was performed. The results were compared with similar studies performed in 1981-1982 and 1987-1988. The incidence in the last one year period had decreased significantly to 5.5 cases/1000 inhabitants compared to 6.5 in 1981-1982 and 7.5 in 1987-1988. The decrease was most distinct among men between 15-24 years of age. Ninety percent of the lesions were minor and the severity did not differ from the former study. Among risk factors associated to severe violence were men between 25-49 years of age, foreigners, use of knives and domestic violence. Firearms were only involved in 0.8% of the cases. Significantly higher proportion of the victims reported the incidence to the police in 1993-1994 than previously.

Epidemiology of violence in a Danish municipality. Changes in the incidence during the 1980s.

A one-year prospective study of injuries caused by violence was performed at the two casualty wards and at the Institute of Forensic Medicine in Arhus, and the results were compared with those of a similar study done six years earlier. Whereas the population at risk increased by 4% to just over a quarter of a million, the number of cases increased by 14% to 1874 (p = 0.06) and the number of persons by 17% to 1726 (p = 0.01). The overall incidence increased for females from 3.0 to 3.7 per 1000 (maximum 7.4 per 1000 females 35-39 years old), and for males from 10.6 to 11.1 per 1000 (maximum 33.4 per 1000 males 15-19 years old). Statistically significant increase of age-specific incidence rates was only found among females 35-49 years old, where, however, also the largest frequency of repeated registrations was noted. As in the former investigation, almost three-fourths of male violence took place at bars and discotheques or on the street, usually associated with unknown person(s), whereas one-half of female violence occurred at home with the partner as the most frequent counterpart. Police recorded cases increased from 16 to 22% (p less than 0.05).

Epidemiology of violence in a Danish municipality. Changes in severity during the 1980s.

Between April 1987 and April 1988, all assault victims attending the two casualty wards and the Institute of Forensic Medicine in Arhus were registered, and an extensive questionnaire was completed by the casualty ward physician. These data were compared with the data from an analogous study undertaken six years earlier. A total of 1874 patients were victims of personal violence in 1987 compared to 1639 in 1981. The most common cause of injury was one or more blows from a fist and/or kicks (used in approximately 70% of all cases). The present study demonstrated an increasing use of firearms and assaults involving attempts to strangle the victim. Ninety-eight percent of the injuries were classified as no injury or AIS-grade 1-2 in both 1981 and 1987. The number of AIS-grade 2 injuries increased from 1981 to 1987 due to an increased number of facial injuries, but the number of homicides and AIS-grade 4-6 injuries decreased in the interval. Based on the present study, it is concluded that the severity of interpersonal violence did not increase in the Arhus area in the 1980s.

[Street violence in Arhus]. / Gadevold i Arhus.

As part of a one-year prospective investigation of all violent accidents in Arhus undertaken in the casualty departments and the Medicolegal Institute, the extent and severity of street violence were analysed and compared with violence in and near pubs. Street violence constituted 26% of all accidents due to violence and involved 1.3 persons per day. 75% were blameless and 68% of these were attacked outside the region where they lived. Violence in the street, in pubs and in the vicinity of pubs was concentrated in the centre of the city, in the evening and night hours, at weekends and involved young men. Street violence and violence in the vicinity of pubs differed from violence in pubs in that significantly more of the victims were blameless (approximately 75%), several persons were the perpetrators (approximately 40%) and blows and kicks were combined (approximately 15%). As assessed by the Abbreviated Injury Scale (AIS), the lesions sustained in street injury did not differ from those of violence in or near pubs: 86% were minor injuries, 11% moderate and none proved fatal. 75% of the victims could be treated completely in the casualty department or by the general practitioner or dentist. Street violence is concentrated to the middle of the city, at weekends and in the evening and night hours and is similar in many ways to violence in and near pubs. The authors consider that exposure to street violence is, to a great extent, connected with participation in night life of the city.

[Violence and women in Arhus. Changes in the 1980's]. / Vold og kvinder i Arhus. Aendring i 1980'erne.

As part of a one-year prospective investigation of accidents due to violence in Arhus carried out by the casualty departments and the Institute of Forensic Medicine in cooperation with the Arhus Police and the Crisis centre for female victims of violence, the fraction of violence which involved women was analysed. A total of 492 contacts were received from 424 women. The average age was 32 years. The home was the commonest site of violence with the husband as the commonest perpetrator of violence (192). In 98 cases the perpetrator was unknown. The majority had received blunt injuries (blows and/or kicks). The lesions frequently appeared to be limited from a therapeutic viewpoint. In 143 women, however, the lesions were potentially serious. Thirteen women were hospitalized and 60 were referred for treatment in other departments. Violence was commonest in the evening and night hours and there was a tendency to an increase towards the end of the week. The majority (279) stated that the episode was not their fault. The police were contacted in 25% of the cases. A total of 164 requests were made for access to the Crisis Centre by female victims of violence. Of these, 30 women had been seen by a doctor and 23 had previously been hospitalized. Compared with conditions five years previously, a considerable increase in the number of registered violent accidents to women was observed. On the other hand, no definite evidence was found that the nature of the violence to which they had been exposed had altered during the past five years.

Alcohol involvement in violence. A study from a Danish community.

All cases of assaults with violence (n = 1639) from a well defined area were registered for 1 year. A positive alcolmeter test (% greater than 0.2) was registered in 488 cases (29%). A further 216 patients (13%) were found under the influence of alcohol according to a simple clinical judgement. In nine of ten manslaughter and murder cases alcohol was involved. Young men, 19-29 years of age, comprised the majority of victims. Of the episodes of violence 66% took place during the weekend. In 250 cases the alcohol concentration surpassed 1.5%. Almost 50% of the violence episoded took place in or around restaurants. Blunt violence was concerned in 73% of the episodes. Gunshot was registered in five cases, stabbings in two cases.

Interpersonal violence: patterns in a Danish community.

We studied all cases of assault with violence (1,639) in a Danish population of 275,000 over a one-year period. Most victims were young men. The incidence rose during evenings, nights and weekends, and assaults were often seen in or around bars and restaurants. Women accounted for 64 per cent of all victims of assault in the home. Influence of alcohol was identified in 43 per cent of all cases. The fist was the most frequent agent of assault; use of firearms was a very rare act of violence but was associated with death in three out of five cases. There were 10 deaths in all.