The Present Legal Status Regarding the Utilization of Mechanical or Pharmacological Restraints in Psychiatric and Social-Health Settings.

No abstract present.

Forensic age estimation in Barcelona: analysis of expert reports issued between 2011 and 2018.

INTRODUCTION: In recent years, there has been a notable increase of migratory movements into Europe with the arrival of not (reliably) documented young individuals within EU-Member States. Accordingly, the need for forensic age assessments likewise increased in order to administratively differentiate along the legally relevant cut-off age of 18 completed years. The objective of our study was to analyse the expert reports of forensic age estimation issued in Barcelona between 2011 and 2018. METHOD: In all cases, data on the medical history, physical examination, radiology of the left hand and orthopantomography were collected. In cases without third molars and a complete ossification of the hand, a CT scan of the clavicles was also performed. RESULTS: A total of 2754 expert reports were evaluated; 96.7% were males, the majority were of North African origin, mainly from Morocco (63.6%), and 19.6% were sub-Saharan Africans; 65.4% had a level of bone maturation corresponding to the last three standards of Greulich and Pyle. Most cases had mineralization of the third molar corresponding to the F, G or H stages of Demirjian. In 85.9%, there was a correspondence between bone and dental age. A total of 28.8% of the subjects were evaluated as being aged over 18 years; 86.2% of North Africans were considered to be younger than 18, and 82% of sub-Saharan Africans were considered to be over 18 years old. CONCLUSIONS: In Barcelona, most of the subjects evaluated were male and North African, and 71.2% of the cases were considered to be minors.

Aspectos médico-legales de la pandemia por COVID-19 / Medico-legal issues of COVID-19 pandemic

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[A prospective study of drug-facilitated sexual assault in Barcelona]. / Estudio prospectivo de la sumisión química con finalidad sexual en Barcelona.

BACKGROUND AND OBJECTIVE: To determine the frequency and characteristics of suspected drug-facilitated sexual assault (DFSA) among the victims of sexual assault in Barcelona. MATERIAL AND METHODS: Prospective study of every adult consulting an emergency service because of alleged sexual assault and receiving forensic assessment in the city of Barcelona in 2011. RESULTS: A total of 35 of 114 cases (30.7%) met suspected DFSA criteria. Compared with the other victims, suspected DFSA cases were more likely to experience amnesia, to have been assaulted by night, after a social situation and by a recently acquainted man, to have used alcohol before the assault and to be foreigners. In this group ethanol was detected in blood or urine in 48.4% of analyzed cases; their mean back calculated blood alcohol concentration was 2.29g/l (SD 0.685). Also, at least one central nervous system drug other than ethanol was detected in 60,6%, mainly stimulant drugs of abuse. CONCLUSIONS: Suspected DFSA is frequent among victims of alleged sexual assault in Barcelona nowadays. The depressor substance most commonly encountered is alcohol, which contributes to victims' vulnerability.

[Forensic assessment of violence risk]. / Valoración forense del riesgo de violencia.

Over the last 20 years there have been steps forward in the field of scientific research on prediction and handling different violent behaviors. In this work we go over the classic concept of "criminal dangerousness" and the more current of "violence risk assessment". We analyze the evolution of such assessment from the practice of non-structured clinical expert opinion to current actuarial methods and structured clinical expert opinion. Next we approach the problem of assessing physical violence risk analyzing the HCR-20 (Assessing Risk for Violence) and we also review the classic and complex subject of the relation between mental disease and violence. One of the most problematic types of violence, difficult to assess and predict, is sexual violence. We study the different actuarial and sexual violence risk prediction instruments and in the end we advise an integral approach to the problem. We also go through partner violence risk assessment, describing the most frequently used scales, especially SARA (Spouse Assault Risk Assessment) and EPV-R. Finally we give practical advice on risk assessment, emphasizing the importance of having maximum information about the case, carrying out a clinical examination, psychopathologic exploration and the application of one of the described risk assessment scales. We'll have to express an opinion about the dangerousness/risk of future violence from the subject and some recommendations on the conduct to follow and the most advisable treatment.

Análisis descriptivo de la simulación de síntomas psicológicos en una muestra forense / Descriptive analysis of malingered psychological symptoms in a forensic sample

INTRODUCCIÓN: La simulación, definida como intento deliberado de mentir o engañar en relación con una enfermedad o discapacidad, exagerando la sintomatología, con el objetivo de obtener un beneficio personal, es un fenómeno complejo, poco estudiado en nuestro contexto profesional. El objetivo de este estudio fue analizar el modo en que se manifiesta dicho fenómeno en el ámbito forense. MATERIAL Y MÉTODOS: Se seleccionó una muestra incidental de 190 sujetos atendidos en la Unidad de Psicología (IMLCFC) durante 16 meses. Se les administró el Inventario estructurado de simulación de síntomas, a la vez que se valoraban ciertos indicadores clínicos de simulación y otros resultados psicométricos. Se realizó un análisis estadístico descriptivo de la muestra, así como de las correlaciones entre sospecha clínica y psicométrica, y entre sensibilidad del instrumento específico y de los instrumentos genéricos. RESULTADOS: El criterio clínico estructurado para detectar la simulación correlaciona moderadamente con el resultado obtenido en el Inventario estructurado de simulación de síntomas; la puntuación total en esta prueba presenta una correlación positiva, aunque atenuada, con los indicadores de exageración del principal test de psicopatología; la simulación es un estilo de respuesta altamente prevalente en sujetos de la jurisdicción social, con un patrón de respuestas significativamente incrementado respecto al observado en muestras penales. DISCUSIÓN: La valoración de la simulación de síntomas psicológicos en el contexto forense requiere de una estrategia multimétodo que incluya el juicio clínico estructurado, instrumentos específicos de detección y otras pruebas psicométricas complementarias, al efecto de generar validez convergente que contribuya a la detección de dicho fenómeno

INTRODUCTION: Malingering, defined as a deliberate attempt to lie or deceive in connection with an illness or disability, exaggerating the symptomatology, with the aim of obtaining a personal benefit, is a complex phenomenon, seldom studied in our professional context. The objective of this study was to analyse the way in which this phenomenon manifests itself in the forensic field. MATERIAL AND METHODS: An incidental sample of 190 subjects attended in the Psychology Unit (IMLCFC) over 16 months was selected. The Structured Inventory of Malingered Symptomatology (SIMS) was administered to them, while assessing certain clinical indicators of malingering and other psychometric results. A descriptive statistical analysis of the sample was performed, focusing on the correlations between clinical and psychometric suspicion, and on specific vs. generic test sensitivity. RESULTS: The structured clinical criterion to detect malingering correlates moderately with the result obtained in the SIMS; the total score in this test presents a positive, albeit attenuated, correlation with the exaggeration indicators from the main psychopathology test; malingering is a highly prevalent response style in subjects seeking work-related sickness compensation, with a pattern of significantly increased responses compared to that observed in criminal samples. DISCUSSION: The assessment of malingered psychological symptoms in the forensic context requires a multi-method strategy that includes structured clinical diagnosis, specific detection instruments, and other complementary psychometric tests, in order to generate convergent validity that contributes to the detection of this phenomenon

Evaluación de las periciales extrajudiciales en Cataluña (España) en 2016-2017 / Evaluation of extrajudicial expert advice in Catalonia (Spain) in 2016-2017

INTRODUCCIÓN: Desde la entrada en vigor de la Ley 35/2015, los Institutos de Medicina Legal y Ciencias Forenses realizan periciales extrajudiciales a petición de particulares para la resolución de las reclamaciones por accidentes de circulación. El objetivo es analizar los aspectos médico-legales más relevantes de estas periciales. MATERIAL Y MÉTODO: Se trata de un estudio descriptivo retrospectivo de las periciales extrajudiciales en las divisiones de Barcelona y l'Hospitalet y Tarragona del Instituto de Medicina Legal y Ciencias Forenses de Cataluña durante los años 2016-2017. Los datos se obtuvieron de los registros de periciales extrajudiciales de ambas divisiones. RESULTADOS: Se realizaron 547 informes médico-forenses. Los accidentes fueron mayoritariamente causados por colisión por alcance entre turismos en trayectos urbanos. Las lesiones fueron en su mayoría de carácter leve, siendo la afectación cervical la más frecuente. En un alto porcentaje, se resolvió con tratamiento conservador en una media de 69 días, asociándose la aparición de secuelas leves en casi la mitad de los casos. El perjuicio estético se informó en el 14%. No hubo diferencias entre ambas divisiones. CONCLUSIÓN: Las periciales extrajudiciales resultan una fuente de información valiosa para la valoración de los perjuicios causados a las víctimas de accidentes de circulación. Como en otros estudios, la mayoría de lesiones son de carácter leve y se asocian a colisiones entre turismos, causando secuelas en la mitad de los casos. Parece que la vía extrajudicial es eficaz en las reclamaciones por accidentes de circulación, pero son necesarios más estudios para obtener una visión más completa

INTRODUCTION: Since the application of Law 35/2015, the Legal and Forensic Medicine Institutes provide extrajudicial expert advice at the request of individuals for the resolution of traffic accident claims. The objective is to analyze the most relevant medical-legal aspects of this expert advice. MATERIAL AND METHOD: This is a retrospective descriptive study of the extrajudicial expert advice in the divisions of Barcelona and l'Hospitalet, and Tarragona of the Catalonian Legal and Forensic Medicine Institute from 2016-2017. The data was obtained from the extrajudicial expert records of both divisions. RESULTS: 547 medical-forensic reports were made. The accidents were mainly caused by a rear collision between cars on urban routes. The injuries were mostly minor, with cervical involvement being the most frequent. A high percentage were resolved with conservative treatment in an average of 69 days, there were mild sequelae in almost half of the cases. Aesthetic damage was reported in 14%. There were no differences between the two divisions. CONCLUSION: Extrajudicial expert advice is a valuable source of information for assessing the damage caused to traffic accident victims. As in other studies, most injuries are mild and are associated with collisions between cars, causing sequelae in half of the cases. It seems that the extrajudicial route is effective in helping resolve traffic accident claims, but more studies are needed to obtain a more complete vision

Denuncias por responsabilidad profesional médica en Barcelona (2004-2009). Análisis médico-forense / Medical professional liability claims in Barcelona (2004-2009). Medico-legal analysis

En los últimos años ha habido un incremento de reclamaciones contra médicos por presunta mala praxis. Nuestro objetivo ha sido analizar retrospectivamente las denuncias por responsabilidad médica en los juzgados de Barcelona durante los años 2004-2009, evaluadas en el Instituto de Medicina Legal y Ciencias Forenses de Cataluña. MATERIAL Y MÉTODO: Se realizó a partir de 3 bases de datos: la primera, las 283 periciales elaboradas por los médicos forenses durante estos años; la segunda, el programa informático judicial TEMIS-2; y la tercera, revisión de sentencias judiciales. RESULTADOS: En 257 casos (90,81%) la reclamación fue penal, 18 (6,36%) procedimientos contencioso-administrativos, 5 civiles (1,77%) y 3 de Fiscalía (1,06%). La edad media fue de 48,38 años (DE±19,39), en el 62,77% la perjudicada fue una mujer, siendo estas las que sufrieron más secuelas. En el 88,34% la reclamación era contra un médico, siendo la más habitual el mal resultado terapéutico (32,86%). Las especialidades más denunciadas fueron la traumatología, obstetricia y ginecología y cirugía general. Hubo más reclamaciones en la sanidad privada. En el 72,41% de los casos que llegaron a juicio la sentencia fue absolutoria y de los 8 que fueron condenados, solo en uno hubo prisión. La mediana del tiempo hasta la sentencia fue de 1.602 días. CONCLUSIONES: La vía penal es la más frecuente. Las mujeres reclaman más y sufren más secuelas. Las especialidades quirúrgicas son las más denunciadas. En el 27,59% de los casos que llegaron a juicio hubo sentencias condenatorias y solo en uno privación de libertad

In recent years there has been an increase in claims against doctors for alleged malpractice. Our objective was to retrospectively analyze complaints of medical liability in the courts of Barcelona between 2004-2009, evaluated at the Institute of Legal Medicine and Forensic Sciences of Catalonia. MATERIAL AND METHOD: We used 3 databases: the first, the 283 forensic reports prepared by forensic doctors during those years; the second, the judicial computer programme TEMIS-2; and the third, a review of judicial sentences. RESULTS: In 257 cases (90.81%) the claim was criminal, 18 (6.36%) contentious-administrative proceedings, 5 civil (1.77%) and 3 Prosecutor's Office claims (1.06%). The average age was 48.38 years (SD±19.39), in 62.77% the injured party was a woman, and they suffered more sequelae. In 88.34% the claim was against a doctor, a poor therapeutic outcome being the most common (32.86%). The most reported specialties were traumatology, obstetrics and gynaecology, and general surgery. There were more complaints in private healthcare. In 72.41% of the cases that came to trial the sentence was acquittal, and of the 8 convictions, only one was imprisoned. The median time to sentencing was 1,602 days. CONCLUSIONS: The criminal route is the most frequent. Women claim more and suffer more consequences. Surgical specialties are the most reported. In 27.59% of the cases that came to trial there were convictions, and only one resulted in deprivation of liberty

Violencia de pareja y enfermedad mental / Intimate partner violence and mental illness

La violencia de pareja es un grave problema de violación de los derechos humanos, de trascendencia mundial con repercusiones sociales, familiares, económicas y judiciales. Analizamos los estudios realizados con el objetivo de describir tipologías de maltratadores para valorar el riesgo de reincidencia y el tratamiento. La prevalencia de enfermedades mentales graves en general es baja. Presentan con mucha frecuencia déficits psicológicos, como pérdida de control sobre la ira, dificultades de expresión de las emociones y distorsiones cognitivas sobre la mujer y la relación de pareja. El abuso de alcohol, los trastornos de personalidad, los celos patológicos y la depresión son probablemente los trastornos psicopatológicos más frecuentes. El homicidio es la violencia más grave, pero infrecuente y difícil de predecir. Las ideas suicidas del agresor son un predictor del homicidio de pareja. Finalmente, se revisa la valoración del riesgo de violencia de pareja, para poder prevenir y gestionar el riesgo

Intimate partner violence is a serious violation of human rights of great global importance with social, family, economic and legal repercussions. We analysed the studies that describe abuser typologies that can help us assess the risk of recidivism and treatment. The prevalence of serious mental illnesses in general is low. Batterers often have psychological deficits such as loss of control over anger, difficulties in expressing emotions and cognitive distortions about women and their relationship. Alcohol abuse, personality disorders, pathological jealousy and depression are probably the most frequent psychopathological disorders. Homicide is the most serious act of violence, but it is infrequent and difficult to predict. Suicidal ideation must be considered as an important risk factor for intimate partner homicide. Finally, we review intimate partner violence risk assessment in order to prevent and manage the risk

Muerte súbita cardíaca en circunstancias especiales / Sudden cardiac death in special circumstances

La muerte súbita del deportista es un acontecimiento infrecuente, pero causa un impacto tremendo en la comunidad. Su incidencia es muy variable, siendo la cardiopatía coronaria la causa más frecuente en sujetos mayores de 35 años. En los jóvenes las más habituales son las miocardiopatías y la anomalía congénita de las arterias coronarias. En muchos casos se realiza la autopsia judicial. Se practicará el levantamiento de cadáver y una autopsia detallada, solicitando análisis toxicológicos e histopatológicos. Si la autopsia es negativa, se solicitarán análisis genéticos para descartar enfermedades que pueden causar arritmias cardíacas. Las muertes súbitas en custodia, incluyendo las que ocurren en el contexto de la reducción y contención, tienen un especial interés en medicina forense tanto por la pluralidad de causas intervinientes como por las circunstancias en que se producen, así como la repercusión mediática y médico-legal que suponen. Este artículo realiza una revisión desde un enfoque pragmático para el médico forense (AU)

Sports-related sudden death is an unusual event. It causes a great social impact. The incidence has been heterogeneous, and coronary artery disease is the most frequent cause in subjects over 35 years-old. Cardiomyopathies and congenital coronary artery anomalies are more usual in younger people. The performing of a medicolegal autopsy is necessary in most cases. A detailed death scene investigation has to be performed, along with a full autopsy with toxicological and histopathological investigation. If the autopsy is negative, genetic studies are requested to rule out disease that may cause cardiac arrhythmias. Sudden deaths in custody, including those occurring in a restraint and containment context, have a special interest in Forensic Medicine, for the multifactorial causes as for the circumstances in which they occurred, as well the social media and medicolegal repercussions. This article presents a review, using a practical approach, for the forensic physician (AU)

La consolidación de Revista Española de Medicina Legal (2008-2018) / Strengthening of Spanish Journal of Legal Medicine (2008-2018)

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El test del reloj en la evaluación forense / Clock drawing test in forensic assessment

Introducción: El test del reloj es una prueba de cribado neuropsicológico que se utiliza con frecuencia en la práctica clínica. Objetivo: Valorar la utilidad del test del reloj en el ámbito forense. Evaluar 3métodos de corrección, explorar la fiabilidad y validez, y valorar su utilidad en procesos judiciales de modificación de la capacidad de obrar. Material y métodos: Se analizaron 40 casos incursos en procedimientos judiciales. Se realizó una entrevista clínica estructurada, exploración neurológica y psicopatológica a través de la prueba CAMDEX-R. Se administró el Mini-Mental State Examination, la Global Deterioration Scale y el test del reloj a la orden corregido con los métodos de CAMCOG, Manos y Méndez. La muestra se dividió en 3grupos: degenerativo, psiquiátrico y sin trastorno. Resultados: El grupo degenerativo es el que obtuvo peores resultados en el test del reloj en los 3métodos de corrección. La fiabilidad y validez de la prueba resultaron adecuadas. Los pacientes incapacitados judicialmente presentaron peor rendimiento en el test del reloj. Conclusiones: Los 3métodos de corrección del test del reloj se muestran eficaces. Valorando el coste-beneficio, se recomienda el método más breve. Los pacientes con una sentencia de modificación de la capacidad civil presentan peores resultados en el test del reloj

Introduction: The clock drawing test is a neuropsychological screening test that is frequently used in clinical practice. Aim: To evaluate the usefulness of the clock drawing test in the forensic environment. To evaluate 3methods of correction, and to determine its reliability and validity, and assess its usefulness in judicial processes of modification of legal capacity of a person. Material and methods: A total of 40 cases were analysed in legal proceedings. A structured clinical interview, and a neurological and psychopathological examination were conducted using the CAMDEX-R test. The Mini-Mental State Examination, the Global Deterioration Scale, and the clock drawing test were administered to the order corrected using the CAMCOG, Manos and Méndez methods. The sample was divided into 3groups: degenerative, psychiatric, and without pathology. Results: The degenerative group obtained the worst results in the clock drawing test in the 3correction methods. The reliability and validity of the test were adequate. Patients judged not to be legally capable had a worse performance in the clock drawing test. Conclusions: The 3methods of correction of the clock drawing test are shown to be effective. Evaluating the cost-benefit of the short method is recommended. Patients with a modification of legal capacity ruling showed worse results in the clock drawing test

Aspectos periciales en el síndrome del latigazo cervical / Medicolegal issues in whiplash injury

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