Gynecological health and uptake of gynecological care after domestic or sexual violence: a qualitative study in an emergency shelter.

BACKGROUND: Domestic and sexual violence have been linked to adverse gynecological and obstetric outcomes. Survivors often find it difficult to verbalize such violence due to feelings of shame and guilt. Vulnerable or socially excluded women are frequently excluded from research, particularly qualitative studies on violence. This study aimed to characterize the perceived impact of domestic or sexual violence on the gynecological health and follow-up among women with complex social situations. METHODS: We analyzed the data following inductive thematic analysis methods. RESULTS: Between April 2022 and January 2023, we conducted 25 semi-structured interviews, lasting on average 90 min (range: 45-180), with women aged between 19 and 52, recruited in an emergency shelter in the Paris area. The women described physical and psychological violence mainly in the domestic sphere, their altered gynecological and mental health and their perception of gynecological care. The levels of uptake of gynecological care were related to the characteristics of the violence and their consequences. The description of gynecological examination was close to the description of coerced marital sexuality which was not considered to be sexual violence. Gynecological examination, likely to trigger embarrassment and discomfort, was always perceived to be necessary and justified, and consent was implied. CONCLUSION: This study can help question the appropriateness of professional practices related to the prevention of violence against women and gynecological examination practices. Any gynecological examination should be carried out within the framework of an equal relationship between caregiver and patient, for the general population and for women with a history of violence. It participates in preventing violence in the context of care, and more widely, in preventing violence against women.

Screening for domestic violence during pregnancy follow-up: evaluation of an intervention in an antenatal service.

To assess the impact of a brief training for obstetricians and midwives about screening for domestic violence during pregnancy follow-up and to identify barriers to a routine enquiry. A monocentric quasi-experimental study was performed in an obstetrics department in Paris, France. We asked patients during their pregnancy follow-up to complete a survey describing their demographic characteristics. They were also asked if a health professional had screened them for domestic violence during the current pregnancy. Exclusion criteria were refusal and inability to complete the survey alone. Health professionals attended a brief training about domestic violence. The intervention provided general information about domestic violence to alert health professionals (prevalence, risk factors, consequences on women's health, pregnancy, and children) and guidelines on screening and how to deal with women disclosing domestic violence. They also had to complete a survey about their knowledge and practice concerning domestic violence. Two months later, patients consulting for their pregnancy follow-up completed the same survey. Health professionals were not aware of the study's aim throughout its course. The primary outcome was the rate of patients screened for domestic violence during pregnancy follow-up. The secondary outcome was the identification of barriers to a routine enquiry. Four hundred ninety-five patients completed the first survey (control group): 21 patients (4.8%) had been screened for domestic violence. Twenty-one health professionals attended the intervention. Eight (38.1%) stated that they never screened for domestic violence, and 3 (14.3%) stated that they always did. Three hundred ninety-five patients completed the second survey (experimental group): 17 patients (4.3% vs 4.8%, p = 0.53) stated that they had been screened for domestic violence. The main barriers to screening mentioned by health professionals were the presence of the partner, the lack of awareness of the need to screen, uncomfortable feelings, and the difficulty to identify victims. There was no increased screening for domestic violence during pregnancy follow-up after a brief training of obstetricians and midwives. An early training during medical studies or more extensive training for professionals could be more efficient.

Adolescent arrestees detained in police cells: an observational study in the Paris, France, area.

OBJECTIVE: Custody conditions in police cells are often demeaning and considered inappropriate for human beings. The detention of young adolescents in police custody has received little attention. Our study aimed to describe the characteristics of adolescents under 18 detained in custody. METHODS: We studied all arrestees aged 13-17 examined in 1 year (January 01-December 31, 2014) in a suburban district near Paris. We evaluated the proportion of adolescents under 18 among all arrestees detained in custody and their medical history, addictive behaviors, perceived health status, and opinion on custody. RESULTS: Arrestees aged 13-17 accounted for 1859 individuals. They were predominantly males (94%) and accounted for 19% of all examinations in custody. Nearly half of the arrestees aged 13-15 (42%), and two thirds of those aged 16-17 (65%) had been previously detained in police cells. Somatic and psychiatric disorders were reported by 7% and 4%, respectively, of arrestees aged 13-17. Alcohol, tobacco, and cannabis consumption were reported by 5%, 24%, and 12%, respectively, of arrestees aged 13-15. These proportions were lower than the 16%, 50%, and 35%, respectively, reported by arrestees aged 16-17 (p < 0.0001). Assaults were reported by 18% of arrestees aged 13-17. They had a fair, bad, or very bad opinion on custody in 43% of cases. CONCLUSION: The detention of adolescents in police stations is commonly associated with assaults at the time of arrest. High proportions of adolescent arrestees smoke tobacco or cannabis. We suggest that the medical examination in custody could be an opportunity for adolescents to initiate access to health care.

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.

Children detained in French police cells.

AIM: Police custody is detention in response to a suspicion of crime. In France, until the age of 13, pre-trial detention and police custody are not allowed. We aimed to evaluate the practical implementation of police detention of children aged between 10 and 12 years and describe the medical characteristics and history, perceived health status and opinion on custody of the potentially affected children. METHODS: A descriptive study was conducted in a French reference regional department of forensic medicine at the time of medical examination in police cells among arrestees younger than 13 years old examined over a 5-year period (1 January 2011-31 December 2015). RESULTS: Children aged 10-12 years (n = 60; males, 48, 80%), accounting for 60 of 57 687 examined arrestees (0.1%), were examined over the study period. Six individuals (10%) were arrested twice or more times during the study period (for a total of 76 detentions analysed). The most common suspected crimes were theft or robbery (42/76, 55%) and physical assault (22/76, 29%). Arrestees had a favourable opinion of custody in 33 of 76 cases (43%). Children reported physical assault by the police in 6 of 76 cases (8%), and the physicians observed recent traumatic injuries in 7 of 76 cases (9%). Daily tobacco consumption was reported by 4 of 60 children (7%). No child was considered unfit for detention by the physician. CONCLUSIONS: Children aged 10-12 years suspected of serious crimes accounted for 0.1% of detained individuals in police cells. Although infrequent, such situations are a matter of concern.

Violence at work: forensic medical examination of police officers assaulted while on duty: comparisons with other groups of workers in two centres of the Paris area, 2010-2012.

PURPOSE: To test for differences in somatic, psychic and functioning outcomes associated with assaults across four groups of workers, of which three are structurally at high risk of occupational violence. To report and compare job characteristics, characteristics of the assault and medical findings in police officers and other workers at the time of a forensic examination performed shortly after they complained for being assaulted while working. METHODS: A two-centre prospective study recruiting adult survivors of workplace violence who lodged a complaint to the judicial authorities and were examined by forensic physicians in the Paris area, between 2010 and 2012 over a 27-month period, was conducted. Victims were administered a dedicated questionnaire and filled in the peritraumatic dissociative experiences questionnaire. Bivariate and multivariate analyses were performed on collected data to account for potential biases. RESULTS: Compared to employees of public transports services, private security guards and other workers, police officers were less likely to report psychic disturbances and peritraumatic dissociative experiences, despite adverse factors such as a worse external working climate or more frequent exposure to workplace assaults. No differences were observed in terms of somatic symptoms or functional impairment across groups. CONCLUSIONS: Although structurally more exposed to adverse factors than other workers, police officers appeared to be more protected from negative outcomes. The reasons for this resilience should be more precisely investigated.

Expectations and perceptions of care among victims of sexual assault who first seek care from emergency, primary care and gynaecological doctors.

BACKGROUND: The role of health professionals is pivotal in providing support to victims of sexual assault. Our aim was to identify patient expectations of doctors after a sexual assault and to assess how they rated the doctors' responses. METHODS: We conducted a prospective observational study (May 2010-December 2012) involving victims of sexual assault (age >10 years) in a Department of Forensic Medicine near Paris, France. The patients included were those who had first sought care from a doctor prior to arriving at the Department of Forensic Medicine. Victims were asked by questionnaire and interviewed by the forensic physician about medical consultations before arriving at the Department, their expectations about those consultations and their feelings about the quality of support provided. Each patient's feelings were rated on a five-point scale. RESULTS: Among 1112 victims reporting sexual assault, 232 previously had a consultation, and were included in the study. Patients expected trauma care in 44% of cases, and received it in 40% (p=0.42), psychological support in 31% of cases, and received it in 21% (p=0.02), gynaecological care in 28%, and received it in 31% (p=0.52) and forensic support in 21%, and received it in 54% (p<0.001). The patients more frequently considered the provided support to be crucial when they received both forensic support and trauma care, psychological support or gynaecological care than when they only received trauma care, psychological support or gynaecological care (25% vs 3%, p=0.001). CONCLUSIONS: Physicians who are the first medical provider to see a patient after a sexual assault often fail to meet patients' expectations, particularly with regard to psychological support. Care received was perceived as best when physicians provided both forensic support and trauma care, psychological support or gynaecological care.

Detangling complex relationships in forensic data: principles and use of causal networks and their application to clinical forensic science.

The search for complex, nonlinear relationships and causality in data is hindered by the availability of techniques in many domains, including forensic science. Linear multivariable techniques are useful but present some shortcomings. In the past decade, Bayesian approaches have been introduced in forensic science. To date, authors have mainly focused on providing an alternative to classical techniques for quantifying effects and dealing with uncertainty. Causal networks, including Bayesian networks, can help detangle complex relationships in data. A Bayesian network estimates the joint probability distribution of data and graphically displays dependencies between variables and the circulation of information between these variables. In this study, we illustrate the interest in utilizing Bayesian networks for dealing with complex data through an application in clinical forensic science. Evaluating the functional impairment of assault survivors is a complex task for which few determinants are known. As routinely estimated in France, the duration of this impairment can be quantified by days of 'Total Incapacity to Work' ('Incapacité totale de travail,' ITT). In this study, we used a Bayesian network approach to identify the injury type, victim category and time to evaluation as the main determinants of the 'Total Incapacity to Work' (TIW). We computed the conditional probabilities associated with the TIW node and its parents. We compared this approach with a multivariable analysis, and the results of both techniques were converging. Thus, Bayesian networks should be considered a reliable means to detangle complex relationships in data.

The health of older arrestees in police cells.

BACKGROUND: detention in the harsh conditions of police cells can be a traumatic experience, even for young healthy individuals. It is thus legitimate to question the detention of elderly people. OBJECTIVE: we aimed to determine the proportion of detainees over age 60, their medical characteristics and history. METHODS: we studied all arrestees over age 60 examined in 1 year (1st January-31 December 2012) by physicians from our Department of Forensic Medicine in the Paris, France area. Our analysis included the arrestees' perceived health status and their opinion on custody. RESULTS: individuals over 60 accounted for 211 of 13,317 detainees (2%) and were predominantly males (177 of 211, 84%). The most frequent suspected crimes included physical assaults (135 of 345, 40%) and drunk driving (50 of 345, 14%). A total of 111 of 211 individuals (53%) reported somatic disorders. A history of psychiatric disorders was reported by 23 of 181 individuals (13%). Arrestees considered their overall health as good in 60% of cases (111 of 184). They had a good opinion on custody in 45% of cases (120 of 270). A proportion of 40% (84 of 211) were examined several times during custody and 10% were declared unfit for custody (34 of 347). CONCLUSIONS: elderly detainees commonly have chronic health disorders; only a minority of them are unconditionally fit for detention. The continuation of detention, which affects 90% of arrestees, should imply that detention conditions are adjusted so that the specific needs of elderly individuals are taken into account.

Detainees in police custody in the Paris, France area: medical data and high-risk situations (a prospective study over 1 year).

BACKGROUND AND OBJECTIVE: The annual number of detainees held in police custody in France is approximately 700,000. Medical data regarding arrestees are scarce across countries. We present the medical characteristics of detainees kept in police custody, including addictive behaviours and high-risk medical situations. METHODS: We conducted a prospective study over 1 year in a suburban area near Paris. RESULTS: A total of 19,098 medical examinations were performed on 13,317 individuals. The examinations mainly concerned male subjects (18,116 of 19,098, 95 %). Median age was 24 years (range 13-83). Medical examination was requested by the detainee in 6,638 of 16,801 cases (40 %). Assaults were reported in 4,052 of 17,312 cases (23 %) and occurred at the time of arrest in most cases (2,243, 13 %). A total of 2,394 of 13,317 detainees (18 %) had at least one chronic somatic disorder including asthma (603, 5 %), diabetes (263, 2 %) and arterial hypertension (205, 2 %). A history of psychiatric disorder was reported by 6 % of individuals (674 of 11,787). Regular alcohol drinking was reported by 58 % of detainees. Illicit drug use mainly involved cannabis (4,021 cases, 30 %). In 14,661 of 19,098 cases (77 %), detainees were considered to be unconditionally fit for detention in custody, and 274 detainees (1 %) were declared unfit to be detained. CONCLUSION: The present study showed a high frequency of alcohol or substance use and reported assaults or traumatic lesions in arrestees. Attending physicians should pay particular attention to addictive behaviours and traumatic injuries in arrestees, both for immediate care and for prevention.

Functional Impairment in Individuals Exposed to Violence Based on Electronical Forensic Medical Record Mining and Their Profile Identification: Controlled Observational Study.

BACKGROUND: Little is known about the functional consequences of violence when directly assessed as a primary outcome, and even less about how consistently these consequences are evaluated in a judicial context. The World Health Organization (WHO) highlighted the importance of a functional approach to health in 2001 with the release of the International Classification of Functioning, Disability, and Health (ICF). In most European countries, forensic physicians assess individuals exposed to violence to evaluate the outcomes of violence, providing certified medical evidence for magistrates' sentencing decisions. This evaluation involves a mix of objective, subjective, and contextual elements, such as reported symptoms of fear, pain, and details of the assault. Quantifying these subjective elements with scales could enhance their interpretation and application in a judicial context. OBJECTIVE: This study aims to (1) characterize and (2) assess 6 scales measuring subjective elements of functional impairment among individuals exposed to violence. METHODS: We conducted a retrospective study that included individuals exposed to violence examined in a French department of forensic medicine over 12 months. A typology of violence encountered in medical settings was built based on the mining of electronic health records and the use of pattern recognition algorithms. The optimal number of violence types was determined using a robust and stable clustering approach, involving sample resampling and a multimetric scheme. Patients were then paired according to their homogeneous profiles, and the intra- and interrater reproducibility of the scales was evaluated. RESULTS: All pain, fear, and life threat scales were significantly associated with higher functional impairment, suggesting that these measures contribute to the overall assessment of functional impairment. The intra- and interrater reproducibility of scales among similar situations of violence was measured, ranging from mild to good, with coefficients of concordance between 0.46-0.66 and 0.43-0.66, respectively. Individuals reporting intimate partner violence showed higher scores in both fear and perception of a life threat during the assault and medical interview, while individuals reporting battery by multiple unknown assailants presented higher scores only in perception of a life threat during the assault. We identified 5 remarkably stable profiles of situations of violence, consistent with clinical practice. CONCLUSIONS: Pain, fear, and life threat scales were related to functional impairment according to expert knowledge and demonstrated fair reproducibility under real-life conditions for similar situations of violence. Subjective elements related to functional impairment in individuals exposed to violence can be quantified using Likert scales during medical interviews.

Experience of Pelvic Examination and Uptake of Gynecological Care Following Domestic or Sexual Violence: a Systematic Review.

Pelvic examination, a routine practice for gynecological care, can cause anxiety and be considered traumatic. This study aimed to define the association between domestic or sexual violence and the experience of pelvic examination, as well as the uptake of gynecological care following domestic or sexual violence. Pubmed, Cochrane Library, ScienceDirect, and Google Scholar were searched, up to April 30, 2023. Cohort, cross-sectional, case-control studies and controlled trials assessing perception of pelvic examination or the use of gynecological care for women with a history of violence were selected and analyzed. Each study underwent a descriptive analysis and was assessed for bias using the Newcastle-Ottawa scale and the RoB2 tool. Twenty-three articles met the inclusion criteria. Eleven studies, including 7,329 women, investigated the experience of pelvic examination following lifetime or childhood sexual violence. Most reported an association between violence and adverse experiences of pelvic examination, such as discomfort, anxiety, distress, and pain perceptions. Ten studies, including 9,248 women, investigated the uptake of gynecological care following domestic or sexual violence and reported mixed results, such as a decreased or an increased uptake, particularly for acute symptoms. Two studies, including 1,304 women, examined both outcomes. The present study highlights the association between violence and adverse experiences of pelvic examination, as well as mixed results on the uptake of gynecological care. It argues for the necessity to screen for violence in consultations, particularly when considering a pelvic examination, to guarantee the utility of pelvic examinations, and to consider the traumatic impact of sexual violence in care.

Low uptake of gynecological consultation following domestic or sexual violence: A case-control study during pregnancy follow-up.

OBJECTIVE: The aim of this study was to examine the association between exposure to domestic and sexual violence and low uptake of gynecological consultation. STUDY DESIGN: Between October 2021 and October 2022, a case-control studywas conducted in mother andchild centers and sexual health centers in the Paris, France area. The case group included pregnant women who did not have a scheduled gynecological consultation in the past two years. The control group included pregnant women who had a scheduled gynecological consultation in the past two years. Pregnant women were interviewed using a standardized questionnaire about a history of domestic and sexual violence, the date of their last gynecological consultation and the gynecological health. RESULTS: A total of 405 pregnant women were included in the case group (n = 129) or in the control group (n = 276). After adjustment for age, couple, social security, supplementary health insurance, dyspareunia, abnormal vaginal discharge, dysmenorrhea, regular pelvic pain, mastodynia, vulvodynia and history of difficult delivery, a history of intimate partner violence was associated with the absence of a gynecological consultation in the past two years (OR 2.13; CI95% 1.21-3.73, p = 0.008). A history of sexual violence, regardless of age, was associated with the absence a gynecological consultation in the past two years (OR 1.92; CI95% 1.05-3.49, p = 0.03). The absence of a gynecological consultation was associated with dyspareunia and domestic or sexual violence (p < 0.0001 and p < 0.0001, respectively). CONCLUSIONS: This study highlighted the association between domestic and sexual violence and the absence of gynecological consultations in the past two years. It underlines the importance of screening for domestic and sexual violence during gynecological consultations and its impacts on mental health, in particular psychotraumatic symptoms, and on gynecological health, in particular dyspareunia.

[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. / Examen pelvien en gynécologie et obstétrique : recommandations pour la pratique clinique.

OBJECTIVE: To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS: A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS: The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS: The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.

[National organization of forensic medicine in France]. / Organisation nationale de la médecine légale en France.

Forensic medicine has long been characterized, in France, by diverse medical practices, which affected its recognition and development. A change was needed, Harmonization procedure includes the development of professional guidelines and allows forensic medicine to look at itself. However, the implementation of the recommendations is still far from complete. A national reform came into effect on 15 January 2011 and has defined a national reform of forensic medicine which includes funding by global budgets instead of fee-for-service. This reform allows easier organization and identification of forensic medicine units. One year later, tangible results are mixed. Forensic medicine is now more clearly identified but properly defined funding criteria are still lacking.

[Doctor's attendance in police custody]. / Intervention du médecin en garde à vue.

Medical examination is a right for every person detained in police custody in France. Examination of detainees usually takes place in the police station so that the doctor can assess the conditions in which the detainee is being held. In some cases, such as type I diabetes care, detainees need to be examined and treated in a hospital. Doctors are subject to a duty of care and prevention. Description of recent traumatic injuries is part of the doctor's mission. They should prescribe any ongoing treatment which needs to be continued, as well as any emergency treatment required. Custody officers may monitor the detainee and administer medication. Doctor's opinion should be given in a national standard document. If the doctor considers that the custody conditions are disgraceful, they may refuse to express an opinion as to whether the detainee is fit for custody.

Intimate partner violence against ever-partnered women in Europe: Prevalence and associated factors-Results from the violence against women EU-wide survey.

Study questions: To describe the prevalence of physical, sexual, and psychological intimate partner violence (IPV) against women in the European Union (EU) and to search for their determinants among demographic, socioeconomic, health-related factors, and partner characteristics. Methods: Observational study. Data from the violence against women survey, the first study conducted in the EU, which simultaneously measured all dimensions of IPV and many characteristics. The EU Agency for Fundamental Rights randomly conducted face-to-face interviews among the 28 countries with 42,002 women aged 18-74 who resided in the survey country and spoke the language. IPV is defined by a positive answer to at least one question about physical, sexual, or psychological violence perpetrated by a current or ex-partner. Findings: Among the 40,357 women having already been in a relationship, 51.7% (51.2-52.2) reported having been victims of violence in their lifetime. The prevalence of physical, sexual, and psychological IPV was, respectively, 20.0% (19.6-20.4), 8.4% (8.2-8.7), and 48.5% (48.1-49.0). Women, who were younger, employed, had highly qualified work, had at least one immigrant parent, lived in an urban setting, were unmarried, separated, divorced, widowed, childless, cohabited with a partner, and others over the age of 18, had worse self-perceived health, or a history of violence before the age of 15 were more likely to report IPV. It was the same when their partners had a lower level of education, no work, were home staying, earned less than they did, were involved in 10 years of relationship, were frequently drunk, or were violent otherwise. Major implication: The lifetime prevalence of reported IPV among women in Europe is high and likely underestimated. The results emphasize the importance of a comprehensive definition of IPV and partners' characteristics. They highlight socioeconomic differences and poorer health status for victims of IPV.

Skeletal age determination in adolescents involved in judicial procedures: from evidence-based principles to medical practice.

BACKGROUND: The ideal basis of age estimation is considered to be a combination of clinical, skeletal and dental examinations. It is not easy to determine how forensic physicians take account of evidence-based data obtained from medical journals in their medical decision-making. The question of what is an ethically acceptable probability that adolescents are incorrectly considered to be over 18 has not been answered. METHODS: In a retrospective study over 1 year (2007), 498 files (for 141 female subjects and 357 male subjects) regarding age assessment requested by the public prosecutor's office for purposes of criminal or asylum proceedings were reviewed. Chronological age was estimated from a combination of physical examination, radiographic examination of the left hand and determination of dental status. RESULTS: Estimates of chronological age in 498 subjects claiming to be 9-14 years old were incompatible with the alleged age in 356 (71%) when made by the forensic physician but in only 17 (3%) when based on data from published studies on age estimation in adolescents. CONCLUSIONS: The present study suggests that in most cases the forensic physician ignores the adolescent's word. Medical mission and ethics imply a need to listen to the claims of persons in custody, whatever the risk of false claims. This situation should prompt forensic physicians to keep up with published data on estimating the age of adolescents.