Medicolegal analysis of physical violence toward physicians in Egypt.

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

Seeking Justice: How VAWA Reduced the Stronghold Over American Indian and Alaska Native Women.

The Violence Against Women Act (VAWA), originally passed in 1994, was successfully reauthorized in 2000, 2005, and 2013. Over time, VAWA altered the environment for many victims who had previously suffered in silence. This article focuses on how VAWA impacted American Indian (AI) and Alaska Native (AN) victims of dating and domestic violence. AI and AN women experience these crimes at a rate higher than the national average, yet they are often denied justice due to the interplay of federal and state laws and tribal sovereignty. VAWA affirmed tribes' sovereign authority to exercise criminal jurisdiction over non-Indians who commit crimes against AI and AN victims on tribal lands. This article also discusses future steps to enhance justice reforms.

Sharing reports about domestic violence and abuse with general practitioners: a qualitative interview study.

BACKGROUND: Domestic violence and abuse (DVA) is common and damaging to health. UK national guidance advocates a multi-agency response to DVA, and domestic homicide reviews consistently recommend improved information-sharing between agencies. Identification of patients experiencing DVA in general practice may come from external information shared with the practice, such as police incident reports and multi-agency risk assessment conference (MARAC) reports. The aim of this study was to explore the views of general practitioners (GPs) and the police about sharing reports about DVA with GPs. METHODS: Qualitative semi-structured interviews were conducted with GPs, police staff and a partnership manager. Participants were located across England and Wales. Thematic analysis was undertaken. RESULTS: Interviews were conducted with 23 GPs, six police staff and one former partnership manager. Experiences of information-sharing with GPs about DVA varied. Participants described the relevance and value of external reports to GPs to help address the health consequences of DVA and safeguard patients. They balanced competing priorities when managing this information in the electronic medical record, namely visibility to GPs versus the risk of unintended disclosure to patients. GPs also spoke of the judgements they made about exploring DVA with patients based on external reports, which varied between abusive and non-abusive adults and children. Some felt constrained by short general practice consultations. Some police and GPs reflected on a loss of control when information about DVA was shared between agencies, and the risk of unintended consequences. Both police and GPs highlighted the importance of clear information and a shared understanding about responsibility for action. CONCLUSION: GPs regarded external reports about DVA as relevant to their role, but safely recording this information in the electronic medical record and using it to support patients required complex judgements. Both GPs and police staff emphasised the importance of clarity of information and responsibility for action when information was shared between agencies about patients affected by DVA.

Mandatory reporting of child physical abuse and dental neglect by Australian dentists.

Child protection measures are organized into three major themes: laws; service programs; and status of outcomes of these interventions. Contextually, mandatory reporting of child abuse and neglect is governed by a complex system of State legislation across Australia. The purpose of this review was to investigate the evidence base for the legislative obligations of Australian dentists as mandatory reporters; the functionality of dental practice in the determination of orofacial signs of abuse and neglect; and, relevant knowledge and practice demonstrated by the Australian dental work force. Our research question explores the role of Australian dentists in intervention of child physical abuse and dental neglect. Information was sourced from literature and web-based reviews. Peer reviewed articles included reviews and empirical studies. Official websites/databases were accessed for relevant legislation. The study found that child protection laws lack an evidence base for including/excluding dentists as reporters. Child abuse and neglect is associated with strong orofacial signs, thus imparting a key advantage to utilizing dentists as potential notifiers. An action response to child abuse is not seen in the Australian dental service. This review identifies gaps in the dental literature concerning mandatory reporting, calls for optimization of the related evidence base, and uniform Australian child abuse reporting requirements.

Cibervíctimas con discapacidad: cuestiones victimológicas y retos forenses / Cibervictims with disabilities: Victimological issues and forensic challenges

No disponible

Protocolo de actuación médico forense para el reconocimiento del maltrato al anciano / Protocol for elder abuse medical forensic examinations

No disponible

Better Together? A Review of Evidence for Multi-Disciplinary Teams Responding to Physical and Sexual Child Abuse.

Multi-Disciplinary teams (MDTs) have often been presented as the key to dealing with a number of intractable problems associated with responding to allegations of physical and sexual child abuse. While these approaches have proliferated internationally, researchers have complained of the lack of a specific evidence base identifying the processes and structures supporting multi-disciplinary work and how these contribute to high-level outcomes. This systematic search of the literature aims to synthesize the existing state of knowledge on the effectiveness of MDTs. This review found that overall there is reasonable evidence to support the idea that MDTs are effective in improving criminal justice and mental health responses compared to standard agency practices. The next step toward developing a viable evidence base to inform these types of approaches seems to be to more clearly identify the mechanisms associated with effective MDTs in order to better inform how they are planned and implemented.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases.

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney's office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser's substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies.

Patterns of Oral-Maxillofacial Trauma and Determinant Factors among Brazilian Victims of Physical Aggression: A 4-Year Study.

PURPOSE: To determine the prevalence of oral-maxillofacial trauma among Brazilian victims of physical aggression and identify its associated factors from a medico-legal and forensic perspective. MATERIALS AND METHODS: A cross-sectional study was carried out involving the analysis of complete medico-legal and social reports of 3668 victims of physical aggression treated at a centre of legal medicine and forensic dentistry over the course of four years. The dependent variable was the occurrence of oral-maxillofacial trauma. The independent variables were sociodemographic status and characteristics of physical aggression. Statistical analyses included the chi-squared test (p < 0.05) as well as univariate and multivariate logistic regression analyses. RESULTS: Oral-maxillofacial trauma occurred in 1655 cases (45.1%). Individuals who lived in suburban areas (OR = 1.32; 95%CI = 1.11-1.58) and those who were victims of community violence (OR = 1.20; 95%CI = 1.03-1.40) perpetrated by someone known to them (OR = 1.24; 95%CI = 1.03-1.40) using physical force (OR = 2.31; 95%CI = 1.96-2.72) on weekends (OR = 1.19; 95%CI = 1.04-1.37) and during nighttime hours (OR = 1.23; 95%CI = 1.08-1.41) were more likely to exhibit oral-maxillofacial trauma. CONCLUSION: The prevalence of oral-maxillofacial trauma was high and the associated factors were area of residence, type of violence, type of offender, mechanism of violence, day, and period of occurrence.

"I know it because it happened to me!" Confrontations of children within forensic investigations.

Confrontations and cross-examination are considered to be a vital stage in forensic investigations; however, laboratory and field studies have systematically shown their adverse effects on children`s testimonies. The current field study aimed to assess the strategies utilized, and the frequency with which they are used, in confrontations within forensic investigations involving children following suspected abuse, and to assess their effects on the children's testimonies. The forensic investigations were conducted using the National Institute of Child Health and Human Development (NICHD) Protocol. The transcripts of 224 children aged 4-14, who were referred for forensic investigation following suspected physical or sexual abuse, were analyzed. All the cases included external evidence suggesting a high probability of abuse. The results indicated that confrontations of children were utilized in more than 60% of the forensic interviews, regardless of the child`s age. The vast majority of the interviewers' confrontation strategies involved references to the alleged suspects, with the number of confrontations ranging from 1 to 18 per interview. An examination of the children`s responses to the confrontations revealed that most of the children insisted on their initial reported testimonies; however, some of the children displayed confusion or fear, and one child recanted the allegation. The discussion addresses how confrontations and cross-examination, as a necessary stage of forensic investigation, can affect children`s testimonies, and the implications of these effects for the forensic context.

High-risk behaviours for the fœtus in pregnant women: The medicolegal and judicial aspects.

Pregnancy is a period of psychological change which may lead to difficulties of adaptation and psychological suffering and give rise to high-risk behaviours for the fœtus in pregnant women. These risk behaviours, which are defined by certain authors as a form of "maltreatment" of the fœtus, usually spring from the psychological distress of the pregnant woman but are not recognised as a specific medical disorder. We illustrate the difficulties encountered in the identification of, and the specific intervention in, these situations through the clinical case of a pregnant drugs-dependent patient subjected to several stress factors who, in addition to consuming substances, developed high-risk behaviours for herself and her pregnancy: self-endangerment under the influence of substances, falls or refusals of treatment. In our first part, we discuss the medicolegal possibilities afforded by French law to protect the fœtus in the event of the future mother's high-risk behaviours. In our second part, we discuss the successive evolutions of the legal status of the fœtus and pregnancy, and their consequences for medical practice and the clinical situations concerned. The lack of an answer concerning the designation of these behaviours, as either medical, legal or social acts, will prompt perinatal practitioners to a certain medicolegal prudence.

A randomized controlled trial of an intervention program to Brazilian mothers who use corporal punishment.

This study evaluated a positive parenting program to Brazilian mothers who used corporal punishment with their children. The intervention was conducted in four agencies serving vulnerable children, and at a home replica laboratory at the University. Mothers who admitted using corporal punishment were randomly assigned between experimental (n=20) and control group (n=20). The program consisted of 12 individual sessions using one unit from Projeto Parceria (Partnership Project), with specific guidelines and materials on positive parenting, followed by observational sessions of mother-child interaction with live coaching and a video feedback session in the lab. The study used an equivalent group experimental design with pre/post-test and follow-up, in randomized controlled trials. Measures involved: Initial Interview; Strengths and Difficulties Questionnaire (SDQ) - parent and child versions; Beck Depression Inventory (BDI); observational sessions with a protocol; and a Program Evaluation by participants. Analysis of mixed models for repeated measures revealed significant positive effects on the BDI and SDQ total scores, as well as less Conduct problems and Hyperactivity in SDQ measures from the experimental group mothers, comparing pre with post-test. Observational data also indicated significant improvement in positive interaction from the experimental group mothers at post-test, in comparison with controls. No significant results were found, however, in children's observational measures. Limitations of the study involved using a restricted sample, among others. Implications for future research are suggested.

The influence of sex on mock jurors' verdicts across type of child abuse cases.

This study examined the influence of victim sex, mock juror sex, and type of child abuse (physical, sexual, emotional, and neglect) on mock jurors' assessments of eyewitness and defendant integrity, continuous guilt ratings, dichotomous verdicts, and sentencing recommendations. Participants read one of eight versions of a trial transcript and then answered a self-report questionnaire. Female mock jurors were significantly more likely to find the defendant guilty overall. Moreover, female mock jurors recommended significantly longer sentences for defendants in sexual abuse cases; whereas, male mock jurors recommended significantly longer sentences for defendants in sexual and physical abuse cases. Male mock jurors perceived the defendant more favorably than female mock jurors; whereas, female mock jurors perceived the alleged victim more favorable than male mock jurors. These results suggest that juror sex may be an influential factor in child abuse cases overall.

Change over time in parents' beliefs about and reported use of corporal punishment in eight countries with and without legal bans.

Stopping violence against children is prioritized in goal 16 of the Sustainable Development Goals adopted by the United Nations General Assembly in 2015. All forms of child corporal punishment have been outlawed in 50 countries as of October 2016. Using data from 56,371 caregivers in eight countries that participated in UNICEF's Multiple Indicator Cluster Survey, we examined change from Time 1 (2005-6) to Time 2 (2008-13) in national rates of corporal punishment of 2- to 14-year-old children and in caregivers' beliefs regarding the necessity of using corporal punishment. One of the participating countries outlawed corporal punishment prior to Time 1 (Ukraine), one outlawed corporal punishment between Times 1 and 2 (Togo), two outlawed corporal punishment after Time 2 (Albania and Macedonia), and four have not outlawed corporal punishment as of 2016 (Central African Republic, Kazakhstan, Montenegro, and Sierra Leone). Rates of reported use of corporal punishment and belief in its necessity decreased over time in three countries; rates of reported use of severe corporal punishment decreased in four countries. Continuing use of corporal punishment and belief in the necessity of its use in some countries despite legal bans suggest that campaigns to promote awareness of legal bans and to educate parents regarding alternate forms of discipline are worthy of international attention and effort along with legal bans themselves.

Defining reasonable force: Does it advance child protection?

Fifty-two countries have abolished all physical punishment of children, yet Canada has retained its criminal defense to 'reasonable' corrective force. In 2004, Canada's Supreme Court attempted to set limits on punitive acts that can be considered reasonable under the law. In the present study, we examined the validity of these limits. If the court's limits provide adequate protection to children, most substantiated child maltreatment cases should exceed those limits. We operationalized each limit and applied it to a provincially representative sample of substantiated child physical maltreatment cases. We found that the majority of substantiated physical abuse cases fell within each of the court's limits. In more than one in four substantiated physical abuse cases, not even one of the court's limits was exceeded. The best predictor of whether a report was substantiated was whether spanking was typical in the child's home. The findings suggest that abolition of physical punishment would provide greater protection to children than attempts to set limits on its use.

[Epidemiological, clinical and forensic physical violence against women in Tambacounda (Senegal)]. / Aspects épidémiologiques, cliniques et judiciaires des violences physiques faites aux femmes dans la région de Tambacounda (Sénégal).

INTRODUCTION: To contribute to the fight against physical violence against women, this work aimed to make a 10-year review of cases treated at the Regional Court of Tambacounda. METHODOLOGY: This observational, retrospective, descriptive and analytical study was conducted from 15 October 2014 to 15 April 2015. It covered all the court records of victims of intentional injury from 2006 to 2015. The data was entered and analyzed using Epi info 3.3.2 software. RESULTS: In all, 113 cases were treated. The mean age was 26.5±10.08 years for victims versus 32.5±13.8 years for the aggressors. The victims were all female, and 77.9% of offenders were male. The assaults took place mostly during the day (57.5%), and especially in the homes of victims (61.0%), in the street (16.8%) in the bush (12.4%). The consultation period was less than 24hours for 54.9% of the victims. Clinical examination differentiated: fractures (15%); contusions (13.5%); penetrating wounds (10.6%); bruises (9.7%); eye injuries (7.9%); broken teeth (7.9%); diffuse pains (7.1%), 6.2% polytrauma (6.2%), and 5.3% of trauma on pregnancies. Among the violence, 33.6% were domestic; 11.5% were associated with rape (7.1%); psychological violence (3.6%); rape and death threat (1.8%). Rape was statistically more common among child victims [OR=10.7 (3.2-35.5)] and/or educated victims [OR=5.8 (1.7-19.9)] and aggression in the bush [OR=7.5 (2.2 to 14.2)]. The attackers were lonely and imprisoned in 94.7% and 73.5% of cases respectively. The sentence was firm imprisonment for 89.2% of cases. CONCLUSION: In Tambacounda, health and judicial authorities should enhance public awareness concerning the risk of violence. The extension of this type of study to the national level would have enabled better orientation of control strategies against this scourge.

Does the forensic physician have a role beyond injury documentation and specimen collection in Australia? A personal view.

Clinical forensic medicine (CFM), as a single discipline, encompasses a number of areas of medico-legal practice including injury interpretation, management of sexual and physical assault cases (both adult and child; alleged victim and offender), mental health issues, traffic medicine, custodial medicine and toxicology. The cases are usually alive but in some jurisdictions the forensic practitioner also engages in death investigation with some undertaking autopsies. During the last 20-30 years, the discipline has fragmented with areas being hived off to other medical specialist disciplines and, importantly, to nurses. Any user of forensic services wants the best value for money particularly when under financial pressure. To this end, governments have sought savings through privitisation of services and/or the utilisation of less qualified personnel to undertake some or all of the tasks. This places CFM at a crossroads. To ensure survival, the discipline needs to reconsider its direction and performance, convince stakeholders of its relevance and importance, and lift its profile within the legal, academic and medical world. It will need to think outside the square, place greater emphasis on the 'clinical' and relinquish those activities that are better undertaken by less expensive and qualified personnel. The establishment of meaningful research and academic centres are essential. The loss of and/or failure to grow CFM will result in the loss of a skills base and the subsequent potential for the miscarriages of justice.

Childhood animal cruelty, bestiality, and the link to adult interpersonal violence.

Animal cruelty has been a concern of the legal and psychiatric communities for many years. Beginning in the early 1800s, state legislatures in the United States established laws to protect the basic safety and security of animals in their jurisdictions. Legislatures have differed in opinion on the animals to receive protection under the law and have instituted differing penalties for infractions of anti-cruelty measures. In the 1960s, the psychiatric community took notice of childhood animal cruelty as a potential risk factor for violent acts against humans. Since that time there has been increasing evidence that children who engage in animal cruelty may be at increased risk of interpersonal offenses in adulthood. Less is known about children and adults who engage in bestiality and the potential risk that these individuals may pose for interpersonal sexual or nonsexual violent acts. We review the legal status of animal cruelty in the United States, summarize the history of psychiatric interest in and research of animal cruelty, describe current knowledge regarding the link between animal cruelty and violence, and propose a novel classification scheme for individuals who engage in bestiality to assist forensic psychiatric examiners in determining the risk that such behavior poses for future interpersonal offending.

Restraining good practice: Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK).

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman, or degrading treatment, and having the right to liberty, security, respect, and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature, findings revealed that restraint can be a form of abuse, it's inappropriate use often being a consequence of fear, neglect, and lack of using de-escalation techniques. Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike.