Spatial-temporal distribution of maxillofacial injuries resulting from intimate partner violence against women.

BACKGROUND/AIM: Maxillofacial trauma resulting from intimate partner violence (IPV) represents an important oral health problem. In this sense, the aim of this study was to investigate the spatial-temporal distribution of maxillofacial trauma resulting from IPV against women, using a geostatistical approach. MATERIALS AND METHODS: An ecological study was carried out including the analysis of confirmed IPV cases against women treated at a Center for Forensic Medicine and Dentistry over a four-year observation period, as well as the evaluation of population data from the victims' places of residence extracted from the last demographic census of the Brazilian Institute of Geography and Statistics. Statistical analysis included: (i) finite mixture modeling to establish incidence trajectory patterns; (ii) Getis-Ord indicator (Gi*) for spatial autocorrelation; (iii) spatial regression analysis (p < .05). RESULTS: Two distinct trajectory patterns (TP1 and TP2) related to IPV incidence were identified using finite mixture modeling, suggesting spatial-temporal disparities at the regional level. In TP1, it was observed that IPV incidence was relatively low and remained stable over time, covering almost two-thirds (62.0%) of investigated spatial units. TP2 was characterized by higher IPV incidence with a tendency to increase in the last year, including more than one-third of neighborhoods (38.0%). Autocorrelation analysis showed a predominance of hot areas (hotspots) in the Eastern zone (p < .05) and in the Western zone (p < .05); and cold areas (coldspots) in the Northern zone (p < .05). In addition, statistically significant association was observed among neighborhoods with higher percentage of households with family householder without income and higher incidence of maxillofacial trauma resulting from IPV against women (ß = 5.305; SE = 1.741; p = .002). CONCLUSIONS: The findings indicate an association between higher IPV incidence against women, maxillofacial trauma, and socio-spatial vulnerability.

Identificação de corpo macerado por meio de fotografias intraorais exigidas por um plano de saúde odontológico: relato de caso pericial / Identification of macerated body by means of intraoral photographs required by a dental health plan: forensic case report

Introdução: Diante de casos de identificação humana, vários são os registros odontológicos que podem ser utilizados a fim de possibilitar a comparação Post-mortem para identificação. Objetivo: Por meio de um relato de caso pericial, demonstrar a possibilidade da identificação odontolegal a partir de registros odontológicos exigidos por plano de saúde. Relato do Caso: Em 2020, um cadáver do sexo masculino, com uma suspeita de identidade, chegou a um Instituto Oficial de Perícias do Nordeste brasileiro, em estado avançado de decomposição, com características do fenômeno de maceração. A família forneceu, após contato com o dentista do indivíduo, imagens do sistema de um plano odontológico no qual era beneficiário e exigia fotografias para auditoria e consequente liberação de tratamentos odontológicos. Após a disponibilização com poucas horas da descoberta do corpo, prosseguiu-se com o confronto dos dados Ante-mortem (AM) e Post-mortem (PM) para identificação odontolegal. Na ausência de pontos divergentes e havendo congruências relativas quanto ao formato da arcada, tratamentos odontológicos, presença e ausências dentárias, forma e posições dentárias, lesões de cárie, foi possível associar a identidade da vítima desaparecida ao corpo examinado. Conclusão: O caso evidencia a confiabilidade, rapidez e baixo custo do processo de identificação odontolegal por meio do confronto de características individualizadoras AM e PM, que só foi possível pela exigência de imagens intraorais pelo plano odontológico da vítima.

Introduction: In cases of human identification, various dental records can be used in order to help in the comparison of postmortem evidence. Objective: The aim of this study was to demonstrate by the forensic report that dental records, which are required by health insurance, could be utilized to obtain a positive identification of an individual. Case report: In 2020, the body of a male individual was referred to the Official Forensic Institute of Northeast Brazil, his body arrived in advanced stage of decomposition and shows signs of maceration. After contact the dentist of the individual, the family provide his teeth images from dental insurance plan that using them to authorize any dental treatment and for audit purposes. Afterwards the identification was made matching ante-mortem (AM) and post-mortem (PM) data. There are no irreconcilable discrepancies and the available data achieve a positive identification then the body examined matched with the missing victim. Conclusion: The case shows the reliability, rapid and cost-effective identification process through comparing AM data to PM evidences. This has only been possible due to the requirement for intraoral images by the victim's dental insurance plan

Firearms, Violence-Related Injuries, and Victimization Profiles: An Approach Using Cluster Analysis.

The aim of this study was to characterize the profile of nonlethal victims of urban violence by firearms and to describe traumas suffered by victims, according to a medical-legal and forensic perspective. A cross-sectional and exploratory study was conducted at the Center of Forensic Medicine and Dentistry in northeastern Brazil. The sample consisted of 233 victims of urban violence by firearm who presented some type of trauma. Descriptive and multivariate statistics using cluster analysis (CA) were performed. The TwoStep Cluster method was chosen to characterize the profile of victims. The night shift (56.8%) and the period corresponding to Saturdays (20.0%) and Sundays (20.4%) concentrated the largest number of occurrences. Cases of trauma in more than one region of the body simultaneously prevailed (31.8%). Based on the CA results, the formation of two clusters with distinct victimization profiles was verified. Cluster 1 was mostly characterized by younger single victims who suffered violence by firearm in the urban area perpetrated by an unknown perpetrator, resulting in greater occurrence of isolated upper and lower limb traumas. In contrast, Cluster 2 consisted essentially of older, married, or stable-union victims who experienced firearm violence in the suburban area, perpetrated by a known aggressor, resulting in greater occurrence of multiple traumas, that is, affecting several regions of the body at the same time. These findings reveal different risk groups for urban violence by firearms and traumas, contributing to the planning of strategies with emphasis on health care, prevention, and promotion.

Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS-based modelling application.

BACKGROUND: Physical violence against children and adolescents comprises a serious public health problem and often results in oral and maxillofacial traumas. Social determinants may favour the occurrence of these events, but few studies have critically evaluated the interaction between social and geographical risk factors. AIMS: To investigate the spatiotemporal distribution of oral and maxillofacial traumas resulting from violence against children and adolescents through geostatistical techniques. METHODS: This study was an ecological analysis of cases of trauma caused by violence against Brazilian children and adolescents using aggregated data from victims attended at a Center of Forensic Medicine and Forensic Dentistry between January 2012 and December 2015. Data were analysed through modelling based on geographic information system (GIS). RESULTS: Two distinct patterns of longitudinal trajectory of oral and maxillofacial trauma related to violence against children and adolescents were identified (TP1 and TP2, P < 0.05). The spatial regression analysis revealed a statistically significant association between higher incidence of cases and areas with worse socioeconomic conditions (ß = 0.047, SE = 0.020, P < 0.05). CONCLUSION: Neighbourhoods with considerable socio-spatial vulnerability for violence against children and adolescents and maxillofacial traumas were identified.

Traffic accidents, maxillofacial injuries and risk factors: A systematic review of observational studies.

AIM: This study aimed to evaluate the scientific evidence regarding the risk factors for maxillofacial injuries among victims of traffic accidents. METHOD: A systematic review of articles published until February 2017 was carried out in the following databases: PubMed, Web of Science, Scopus, and Cochrane Library. Studies were selected by two independent reviewers (Ï° = 0.841). The risk of bias in the selected studies was assessed using an adapted version of the Newcastle-Ottawa Scale for observational studies. RESULTS: A total of 2703 records were found, of which only three articles fulfilled the inclusion criteria and were analyzed, including 422 244 patients. The male/female ratio ranged from 3.4: 1 to 6: 1. All eligible studies performed the multivariate statistical analysis. Eleven risk factors for maxillofacial traumas were identified: victim's gender (P < 0.05), age group (P < 0.05), residence region (P < 0.05), impact characteristics (P < 0.05), increased net change in velocity due to collision (P < 0.05), increase in occupant's height (P < 0.05), nonuse of protective equipment (P < 0.05), type of accident (P < 0.05), time of occurrence (P < 0.05), lesion severity (P < 0.05), and occurrence of concomitant lesions (P < 0.05). CONCLUSION: The results suggest that sociodemographic characteristics, as well as those related to the collision patterns and circumstances of traffic accidents, may influence the occurrence of maxillofacial injuries. However, the results should be interpreted with caution due to the high heterogeneity among studies.

Spatial distribution of maxillofacial injuries caused by urban violence: An ecological analysis to identify high-risk areas.

OBJECTIVES: To investigate the spatial and spatial-temporal distribution of oral and maxillofacial injuries caused by urban violence, as well as to identify underlying disparities at regional level through a geostatistical approach. METHODS: This was a historical ecological cohort study of trauma cases caused by urban violence using aggregate data from victims assisted in a Brazilian medical-forensic service between January 2012 and December 2015. The longitudinal patterns of change observed in each geographic area (neighbourhoods) were evaluated using the finite mixture model (FMM). The spatial autocorrelation of events was investigated using the Getis-Ord Indicator (Gi*) to identify significant hot and cold spatial clusters. With a spatial regression model, it was also found when socioeconomic variables, residential infrastructure and neighbourhood infrastructure were associated with high incidence rates. The significance level was set at P ≤ 0.05. RESULTS: The finite mixture model revealed three different patterns of longitudinal trajectory of the incidence of oral and maxillofacial trauma caused by urban violence (TP1 to TP3, P < 0.05). TP1 was characterized by an incidence that remained stable and high over time, comprising 17.4% of the city's neighbourhoods. In TP2, it was observed that the incidence was moderate, with a slightly increasing trend in the last year evaluated, representing around 41.8% of the sample. In contrast, in TP3, it was found that the incidence was relatively low and remained stable over time, accounting for about 40.8% of the sample. The Getis-Ord (Gi*) statistic identified significant high-risk clusters in the western (P < 0.05), southern (P < 0.05), and eastern regions (P < 0.05) and low risk in the northern region (P < 0.05). The spatial regression model indicated significant association between areas with unfavourable socioeconomic conditions and higher incidence of events (ß = 0.178, SE = 0.046, P < 0.001). CONCLUSIONS: Clusters demarcating areas with high socio-spatial vulnerability for urban violence and oral and maxillofacial injuries were identified. The findings highlight the need to improve living conditions in segregated urban areas and develop intersectoral actions to improve living conditions, employment, public safety, social support, health care and prevention.

Temporal trends in physical violence, gender differences and spatial vulnerability of the location of victim's residences.

The aim of study was to describe trends in physical violence among Brazilian victims and investigate spatial vulnerability of the location of victim's residences. This study performed an ecological-level longitudinal analysis, examining violence rates over 4 years. Cases of 4795 victims of physical aggression attended at a Center of Legal Medicine were investigated. Trend analysis was used to evaluate the data, with the creation of polynomial regression models (p < 0.05). Violence rates showed significant temporal variations according to sociodemographic characteristics of victims (p < 0.05) and the circumstances of aggressions (p < 0.05). Moreover, there was a significant increase in violence rate in the North (R2 = 16.1%; p = 0.019) and South (R2 = 18.4%; p = 0.010), whereas the rural zone (R2 = 10.1%; p = 0.028) presented a decrease. The findings highlight the need for protection policies that address spatial-temporal aspects.

Intimate partner violence against women, circumstances of aggressions and oral-maxillofacial traumas: A medical-legal and forensic approach.

INTRODUCTION: Intimate partner violence (IPV) is a serious public health problem that frequently results in oral-maxillofacial traumas, generating high social and economic costs. The aim of this study was to describe the profile of women victims of IPV and determine the pattern of oral-maxillofacial traumas, according to a medical-legal and forensic perspective. An exploratory study of 1361 suspected cases of women victims of IPV was carried out based on database of an Institute of Legal Medicine and Forensic Dentistry of Northeastern Brazil during a period of 4 years. Medico-legal and social records of victims were searched for information related to sociodemographic data, circumstances of aggressions and trauma patterns. Descriptive and multivariate statistics and Multiple Correspondence Analysis (MCA) were performed. MAIN RESULTS: Almost half of victims exhibited some oral-maxillofacial trauma resulting from IPV (45.8%). Lesions affecting more than one third of the face (41.3%), especially in soft tissues (96.1%) were the most common. Based on the MCA results, two distinct victimization profiles (P1 and P2) have been identified. P1 was mainly characterized by women aged less than 28 years, living in the urban area, with higher education and working. They were assaulted using physical force in community settings perpetrated by former partner or ex-boyfriend during the night and weekends, resulting in oral-maxillofacial traumas. P2 was mainly composed of women aged over 28 years, living in the suburban or rural areas, with low schooling and who did not work. They were assaulted by firearm or weapon in their own home, perpetrated by their partner or boyfriend during the day and weekdays, resulting in trauma to other body parts. CONCLUSIONS: Oral and maxillofacial traumas are very common among women victims of IPV who searched for medical-legal service. In this context, forensic dentists can play a key role during the diagnostic process and should always work together with medical, biochemical and toxicological experts. The findings of this study may contribute to the formulation of evidence-based policies.

Pattern of oral-maxillofacial trauma from violence against women and its associated factors.

BACKGROUND/AIM: Violence against women is a global public health problem. The aim of this study was to characterize the profile of women victims of violence and identify factors associated with maxillofacial injuries. MATERIAL AND METHODS: A cross-sectional study was performed based on an evaluation of 884 medico-legal and social records of women victims of physical aggression treated at the Center of Forensic Medicine and Dentistry in Brazil. The variables investigated were related to the sociodemographic characteristics of victims, circumstances of aggressions, and patterns of trauma. Descriptive and multivariate statistics using decision tree analysis by the Chi-squared automatic interaction detector (CHAID) algorithm, as well as univariate and multivariate Poisson regression analyses were performed. RESULTS: The occurrence of maxillofacial trauma was 46.4%. The mean age of victims was 29.38 (SD=12.55 years). Based on decision tree, the profile of violence against women can be explained by the aggressor's gender (P<.001) and sociodemographic characteristics of victims, such as marital status (P=.001), place of residence (P=.019), and educational level (P=.014). Based on the final Poisson regression model, women living in suburban areas were more likely to suffer maxillofacial trauma (PR=1.752; CI 95%=1.153-2.662; P=.009) compared to those living in rural areas. Moreover, aggression using a weapon resulted in a lower occurrence of maxillofacial trauma (PR=0.476; CI 95%=0.284-0.799; P=.005) compared to cases of aggression using physical force. CONCLUSIONS: The prevalence of oral-maxillofacial trauma was high, and the main associated factors were place of residence and mechanism of aggression.

Facial trauma among victims of terrestrial transport accidents.

INTRODUCTION: In developing countries, terrestrial transport accidents - TTA, especially those involving automobiles and motorcycles - are a major cause of facial trauma, surpassing urban violence. OBJECTIVE: This cross-sectional census study attempted to determine facial trauma occurrence with terrestrial transport accidents etiology, involving cars, motorcycles, or accidents with pedestrians in the northeastern region of Brazil, and examine victims' socio-demographic characteristics. METHODS: Morbidity data from forensic service reports of victims who sought care from January to December 2012 were analyzed. RESULTS: Altogether, 2379 reports were evaluated, of which 673 were related to terrestrial transport accidents and 103 involved facial trauma. Three previously trained and calibrated researchers collected data using a specific form. Facial trauma occurrence rate was 15.3% (n=103). The most affected age group was 20-29 years (48.3%), and more men than women were affected (2.81:1). Motorcycles were involved in the majority of accidents resulting in facial trauma (66.3%). CONCLUSION: The occurrence of facial trauma in terrestrial transport accident victims tends to affect a greater proportion of young and male subjects, and the most prevalent accidents involve motorcycles.

Characterization of victims of aggression and transportation accidents treated at the Forensic Medicine and Dentistry Institute - Campina Grande, Paraíba, Brazil - 2010.

The objective of this cross-sectional census study was to characterize agression and land-based transport accidents in a city in the Northeast of Brazil. Data was analyzed from live victims who were treated at a forensic service (N = 2.379). In the descriptive analysis, the majority of events were represented by aggression (71.6%); which occurred on weekdays (65%), with 35.1% at night. Trauma occurred to the whole body (63.6%) and to soft tissue (74.2%). On the basis of multiple correspondence analysis, two dimensions were formed: the first dimension (internal reliability = 0.654) was formed by the cause of the event, the trauma and the age group and the second dimension (reliability = 0.514), by age group, occupation and civil status. Three groups with distinct profiles were formed for accidents and aggression: young women who suffered aggression, with trauma to the face and soft tissues during the evening and at weekends; adult men who suffered car accidents, in the morning and on work days; and retired elderly widowers, who were run over.