Social vulnerabilities and health conditions of arrestees in the Greater Paris area, France, in 2013: a multicentre cross-sectional study.

OBJECTIVE: The aim of this study was to describe the health and social conditions of arrestees, as compared to the general population. METHODS: We studied a sample of 600 adult arrestees in three locations in the Greater Paris area, prospectively included (February-May 2013). A descriptive analysis has been performed, then prevalence was estimated using an indirect standardisation according to age, based on data from a population-based, representative survey in the same area. RESULTS: Arrestees had a median age of 31 years; 92% were males. As compared to the general population, arrestees had a lower level of education (8.6 vs. 7.6%, p < 0.001), were more frequently unemployed (42.0 vs. 11.9%, p < 0.001) and in a difficult financial situation (43 vs. 11%, p < 0.001) and had less significant social support (48.1 vs. 87.9%, p < 0.001). They reported also more frequently a chronic health condition (54 vs. 36%, p < 0.001) and a limited health insurance coverage (36 vs. 15%, p < 0.001). CONCLUSION: Comparative analysis of male arrestees and males from the general population showed that the former had worse social and health conditions. These results argue for widespread medical interventions on all arrestees. Medical examination during detention could act as a gateway to health care and social support.

Evaluating the Functional Impairment of Assault Victims in a Judicial Context: A Multicentered Retrospective Study in Seven French Forensics Units.

Functional impairment is of major importance in the evaluation of assault victims. French law assesses the seriousness of the violence in terms of the functional impairment experienced by the victims, quantified by the duration of the victims' inability to fulfill their usual daily activities, measured in days of "total incapacity to work" (TIW). Significant variations in the duration of TIW have been reported depending on the examination centers or physician. To date, few studies, all monocentric, have focused on the determinants of this variability. We aimed to study the functional impairment of assault victims by searching for determinants of TIW. We conducted a retrospective multicenter study, including assault victims from seven forensic medicine units. The data were automatically extracted from the medical certificates drawn up and gathered within the ORFéAD database. Thirty-eight variables were studied, relating to the victim's characteristics, the circumstances of the examination and the assault, the physical and psychological symptoms, and the duration of TIW. A total of 5,663 victims were included, including 2,438 (43%) women. The median age was 32 years (min; max [10; 98]). The median duration of TIW was 2 days (min; max [0; 182]). Male gender, age, time to examination, examination center, traumatic injuries (ecchymosis, hematoma, wound, bone fracture), use of a weapon, and functional limitation were associated with the duration of TIW (p < .05). The associations formerly identified in a monocentric setting were confirmed and new determinants were identified. This study has allowed a better understanding of the factors influencing the evaluation of functional impairment and determination of the TIW of assault victims. This first study using ORféAD is intended to be supplemented by the participation of other forensic units, and the inclusion of other variables, such as violence type, victim categories, or the examining physician.

[Evaluating the functional impairment of assault survivors in a judicial context: frequency of aggravating factors according to the French Penal Code and evidence for heterogeneous medical practice]. / Examen médical des personnes victimes de violence : fréquence des facteurs aggravants au sens du Code pénal, hétérogénéité des pratiques.

OBJECTIVES: In cases of assault and battery, the French Penal Code considers some aggravating factors. No data are available on the frequency of aggravating factors. Our main objective was to determine this frequency. A secondary objective was to present the evaluation in several forensic medicine units of the duration of the victims' inability to fulfil their usual daily activities, in days of "Total incapacity to work" (TIW). METHODS: Data were collected from six forensic medicine units on 300 evaluations of assaults survivors: aggravating factors, characteristics of the victims and of the assaults, results of medical examination, and determinants of TIW. RESULTS: Aggravating factors were present in most cases (232 of 300, 77%). Median duration of TIW was 2 days (range: 0-60). Medical evaluation ended in the absence of TIW in 0 to 56% of cases in the 6 units (Chi(2), P<0.0001). Forensic physicians considered that they had not evaluated the victims' mental state in 63 of 300 cases (21%). This rate varied significantly from one unit to another (P<0.0001). Determinants of TIW were primarily traumatic injuries in 45% of cases and functional impairment in 55%. Such proportions varied from one unit to another (P=0.01). Mental state impairment was the main determinant of TIW in 0 to 23% of cases (P=0.009). DISCUSSION: The present study documented the high frequency of aggravating factors and the heterogeneity of forensic evaluation in cases of assault and battery. Identifying determinants of TIW in everyday practice can participate in the development of national guidelines.