Not discussed: Inequalities in narrative text data for suicide deaths in the National Violent Death Reporting System.

BACKGROUND: The rate of suicide in the US has increased substantially in the past two decades, and new insights are needed to support prevention efforts. The National Violent Death Reporting System (NVDRS), the nation's most comprehensive registry of suicide mortality, has qualitative text narratives that describe salient circumstances of these deaths. These texts have great potential for providing novel insights about suicide risk but may be subject to information bias. OBJECTIVE: To examine the relationship between decedent characteristics and the presence and length of NVDRS text narratives (separately for coroner/medical examiner (C/ME) and law enforcement (LE) reports) among 233,108 suicide and undetermined deaths from 2003-2017. METHODS: Generalized estimating equations (GEE) logistic and quasi-Poisson modeling was used to examine variation in the narratives (proportion of missing texts and character length of the non-missing texts, respectively) as a function of decedent age, sex, race/ethnicity, education, marital status, military history, and homeless status. Models adjusted for site, year, location of death, and autopsy status. RESULTS: The frequency of missing narratives was higher for LE vs. C/ME texts (19.8% vs. 5.2%). Decedent characteristics were not consistently associated with missing text across the two types of narratives (i.e., Black decedents were more likely to be missing the LE narrative but less likely to be missing the C/ME narrative relative to non-Hispanic whites). Conditional on having a narrative, C/ME were significantly longer than LE (822.44 vs. 780.68 characters). Decedents who were older, male, had less education and some racial/ethnic minority groups had shorter narratives (both C/ME and LE) than younger, female, more educated, and non-Hispanic white decedents. CONCLUSION: Decedent characteristics are significantly related to the presence and length of narrative texts for suicide and undetermined deaths in the NVDRS. Findings can inform future research using these data to identify novel determinants of suicide mortality.

Istanbul Protocol implementation in Central Asia: Bending the arc of the moral universe.

In countries emerging from authoritarian rule, a major challenge is ending often widespread and systematic torture and ill-treatment practices. Between 2011 and 2019, Physicians for Human Rights (PHR), in collaboration with the Open Society Foundation (OSF), the Open Society Justice Initiative (OSJI) and regional and local partners, worked to establish effective torture investigation and documentation practices in the Central Asian countries of Kyrgyzstan, Tajikistan, and Kazakhstan. Our approach consisted of activities in three sequential phases - (1) assessment, (2) capacity building, and (3) policy reform. In this paper, we briefly describe activities during each phase and identify key lessons learned from these experiences and resulting policy and program reforms as a model for future efforts in other settings.

Discussion on Standardization of Forensic Assessment of Olfactory Dysfunction.

ABSTRACT: With the development of society, the improvement of living standards and the advancement of research methods, olfactory function has been paid more and more attention. Therefore, higher requirements for the forensic identification of olfactory function have also been put forward. Standardization construction of forensic medical examination and identification of olfactory dysfunction is urgently needed. Based on a comprehensive review of olfactory function and forensic assessment of olfactory dysfunction, this paper elaborates on problems related to the principles and timing of forensic assessment of olfactory dysfunction, the requirements of identification of traumatic olfactory dysfunction, the subjective and objective methods of examination of olfactory function. Strict control of the above issues is an important mean of standardization of forensic assessment of olfactory dysfunction.

[The current problems of injury assessment dealt with in the publications in the journal "Sudebnomeditsinskaya ekspertiza (Forensic medical expertise)" for the period from 2000 till 2014].

The objective of the present study was the analysis of the scientometric characteristics of the publication activity of the authors participating in the journal "Sudebno-meditsinskaya ekspertiza (Forensic medical expertise)" for the long period from 2000 till 2014 with special reference to the assessment of the coverage of the most topical problems, such as diagnostics of various injuries and their variability, expert evaluation of the conditions and mechanisms of their infliction for the purpose of characteristic of the properties of traumatic objects (weapons). The study allowed to identify the leading domestic and foreign periodicals most frequently cited by the authors of "Sudebno-meditsinskaya expertiza". The most active authors of the journal represent the research groups of the departments and laboratories of the forensic medical expertise agencies based at Moscow, Sankt-Peterburg, Novosibirsk, Barnaul, Kazan, Perm, Rostov-on-Don, Ryazan, Tver, and Khabarovsk. It is concluded that the continuation of the analysis and assessment of the scientific activity of the specialists in the this field of forensic medical expertise is an indispensable condition for the further development and improvement of forensic medical expertise in the Russian Federation.

[Unnatural deaths must be investigated better--risk of crimes being missed. Examination of the police and the health care system management of deaths in three counties]. / Onaturliga dödsfall måste utredas bättre - risk att brott missas - Granskning av polisens och sjukvårdens dödsfallshandläggning i tre län.

In 2008 only 55 % of all deaths not deemed to be natural in Sweden underwent a medicolegal autopsy. In the present study we describe and compare the characteristics of unnatural deaths in three counties through review of death certificates for unnatural deaths and, when applicable, corresponding police reports. The majority of unnatural deaths that were not reported to the police were among elderly decedents, with the deaths most often resulting from a fall-related fracture or head injury. One subgroup among these deaths that were not recognized as reportable by the involved physician, estimated by extrapolation to a total of approximately 300 annually, nationwide, was considered to be at elevated risk for a criminal death (homicide). The causes of death in this group were due to, for example, high energy or sharp force trauma, gunshot injury, asphyxia, and drug and/or alcohol intoxication. We conclude that additional training in the handling of unnatural deaths is indicated for Swedish physicians.

Detainees in police custody: results of a health needs assessment in Northumbria, England.

PURPOSE: The purpose of this paper is to assess the health needs of detainees in police custody in Northumbria, England, and to identify any gaps in, or possible improvements to, the current model of healthcare provision. DESIGN/METHODOLOGY/APPROACH: The current model of service provision was investigated using a combination of existing literature, and interviews with key members of staff. In addition, researchers examined the custody records of a stratified random sample of 1,917 records from 2010 and 2011. Data were collected from the risk assessments completed by Custody Sergeants, and any associated records of medical assessments by Forensic Medical Examiners (FME). FINDINGS: Detainees experience a wide range of health problems. Delivery of healthcare in custody could be improved through increasing the skill-mix in this setting, computerising FME records and improving communication between agencies. Research limitations/implications - The police did not always record the reason why a forensic medical examiner was called out, thus this aspect of data collection was limited. ORIGINALITY/VALUE: This health needs assessment will help to determine the way in which resources for health care in custody, currently held by the police, are reallocated once the funding transfers to the NHS in the near future.

[On the interaction between State Forensic Medical Centers of the Russian Ministry of Defense and territorial organs of the Russian Federal Service on Surveillance for Consumer Rights (Roszdravnadzor): topical problems and possibilities for their solution].

The present paper is focused on the consideration of topical problems pertaining to the interaction between state forensic medical centers of the Russian Ministry of Defense (SFMF MD RF) and territorial organs of the Russian Federal Service on Surveillance for Consumer Rights (Roszdravnadzor) in the framework of unscheduled inspections of the organization and conduction of forensic medical expertise. Such inspections not infrequently give rise to conflicts between the administration of SFMF ND RF and commissions of territorial organs of Roszdravnadzor. The principal source of such conflicts is the representatives of Roszdavnadzor frequently fail to observe the requirements envisaged by the normative legal acts of the Russian Federation regulating activities of this state agency and the laws of the Russian Federation governing action management in the field of forensic medical expertise. The main causes behind the conflicts and their consequences are discussed, recommendations are proposed to resolve them.

[The comparative assessment of the practical value of the currently employed methods for the recognition and species specificity of the blood].

The objective of the present study was to evaluate sensitivity and specificity of the HemDirect method on test-plates (Seratec) for detecting human hemoglobin (HHb). These characteristics were compared with those of other widely used methods designed for the detection of blood traces, viz. thin layer chromatography, hemotest, spectrofluorimetry, and identification of blood species specificity (by countercurrent immunoelectrophoresis in agar and on the acetate-cellulose film). It was shown that the HemDirect test is highly specific and far more sensitive than other techniques used for the same purpose in the practical work. It can be recommended as the method of choice for the detection of blood microtraces.

[On the state of the budgetary funding of government forensic medical expert institutions in the Russian Federation].

The data on the budgetary funding of state-owned forensic medical bureaus in the Russian Federation for the period from 2005 to 2008 were collected and analysed. The results of the overall estimation and parameters characterizing the level of funding of these expert facilities are presented. Selected state forensic medical bureaus have been ranked based on the level of their financial support.

Legal changes towards justice for sexual assault victims.

The crime of rape is a major problem in India, evident from the reports in the press as well as official statistics. The accused has often gone free, because the victim did not file a complaint, or because of poor evidence gathering and well as lacunae in the law. This paper presents an overview of the laws applicable to sexual assault cases and amendments in these laws, specifically in terms of the roles and responsibilities of healthcare providers to bridge the gap in providing medical evidence to the courts.

[Approaches to optimization of the work of forensic medical specialists (as exemplified by the experience gained in the Republic of Tatarstan)].

Analysis of day-to-day activity of the forensic medical service and results of a questionnaire study involving forensic medical examiners, health care providers, and law enforcement officers carried out in the Republic of Tatarstan were used to develop recommendations for the improvement of the efficiency of work of these employee groups. It is concluded that its optimization will require further enhancement of material, technical, and methodological support of this service, its better organization, financial incentive for the personnel, and mobilization of social factors.

Legal controls of the medical profession.

PURPOSE OF REVIEW: The authors, after a brief historical review of the theme, review the articles published in the last year. The purpose is to verify how the field has moved on during this period, as a constant increase of legal and social controls on the medical profession is perceived. RECENT FINDINGS: Surprisingly, very few articles treating directly the theme reviewed were found. The better part of the articles examined legal aspects of the medical profession in a nonsystematic way. Among the ones selected those that dealt with internal controls (produced by the professional categories such as the Clinical Practice Guidelines) and those that dealt with external controls (produced by other social groups) could be identified. SUMMARY: The authors conclude that the existence of limits and internal and external controls is fundamental for a professional medical practice of quality. However, the excess of controls, which causes a defensive attitude, may negatively interfere in the quality of the care offered to patients.

Forensic neuropsychological evaluations in an academic medical center.

Within the expanding field of clinical neuropsychology, the subspecialty of forensic neuropsychology has developed. Currently, there is considerable diversity within the discipline as to how practitioners approach test selection, reports, and number of hours billed. How individuals handle these issues is subject to debate, but what is clear is that there are no specific guidelines as to how to conduct these evaluations. The current study provides an introduction to the issues faced by clinical neuropsychologists completing forensic evaluations. In addition, the authors present how the relevant issues are addressed in one neuropsychology service housed within a university-affiliated academic medical center.

[Possibilities of medical opinionating in cases associated with "exposure to direct danger of death or serious health damage"]. / Mozliwosci opiniowania lekarskiego w sprawach o "narazenie na bezposrednie niebezpieczenstwo utraty zycia lub ciezkiego uszczerbku na zdrowiu".

In the opinion of some forensic medicine experts, assessment of potential consequences in keeping with Article 160 of the Polish Penal code, which refers to the crime of "exposure to direct danger of death or severe health damage", lies within the competence of medicolegal specialists. This view is accepted by courts and prosecution offices. However, the knowledge of physicians in the field of predicting consequences which did not occur is only somewhat better than that of lawyers. In simple cases, e.g. in trauma involving a sensitive area of the body, passing an opinion confirming a serious danger is not associated with any major problems. Similarly, no problems arise when passing an opinion on the lack of such a danger e.g. in the case of traumawithout any injuries. In complex cases, however, which include the majority of medical error cases, passing an opinion on exposure to direct danger of death or severe health damage may be not feasible.

Legal medicine and the medical establishment.

Formal medical discipline-based regulation and professional support for legal medicine practitioners have been a long time coming. While informal associations and societies of like-minded doctors and dentists have existed for some time, they have not had the sort of "establishment credibility" that is required to influence policy-makers and drive formal processes for professional training and regulation in this area. The recent creation of formal medical College status for medico-legal specialists within the medical establishment is described and the advantages discussed. The creation of formal career pathways, organised training structures and policy advisory systems in legal medicine for government has the potential to support recruitment to this difficult and challenging area of medical practice. This can only be of benefit to the legal profession who rely on these medical practitioners in so many areas. The standards setting, recertification, revalidation and accreditation activities of a formal Royal Medical College are likely to have significant influence on the work of health and legal policy regulators at a time of considerable change.