Current status of undergraduate teaching in forensic & legal medicine in Europe.

The European Council of Legal Medicine (ECLM) is the body established in 1992 to represent practitioners forensic & legal medicine and is composed of delegates of the countries of the European Union (EU) and from other countries which form part of Europe to a current total of 34 member countries. The aims of this study were to determine the current status of undergraduate forensic & legal medicine teaching in the curriculum of medical studies in ECLM countries and to use the results of this study to determine whether it would be appropriate to develop new guidelines and standards for harmonising the content of undergraduate forensic medicine training across ECLM member countries. A detailed questionnaire was sent to all individuals or organisations listed on the ECLM contact database. Responses were received from 21 of 33 countries on the database. These responses showed considerable emphasis on undergraduate teaching of forensic medicine in all countries with the exception of Belgium and the United Kingdom. There was great general consistency in the subjects taught. The data from this survey provide a baseline which should assist in developing a strategy to harmonise forensic & legal medicine undergraduate training in member countries of the ECLM. The ECLM is now in a good position to establish a pan-European working group to coordinate a consensus document identifying an appropriate and modern core undergraduate forensic medicine curriculum that can be presented to the medical education authorities in each country, and which can be adapted for local requirements, based on available personnel, the forensic medicine structure in the country, and most importantly, the needs of the local population.

The obligation of the physician to save the life of the detainee on a hunger strike: the opinion of the Italian National Bioethics Committee.

Abstract: The Cospito case has highlighted a widely debated bioethical issue regarding the need to choose between safeguarding the life of a detainee and their right to self-determination through the practice of a hunger strike. Recently, the Italian National Bioethics Committee has been called upon to give an opinion on this matter. On the other hand, the media resonance of this case has shed light on the need to pose an ethical and social question regarding such situations: does the physician have an obligation to protect the detainee's health at the expense of their free choice? To be able to answer, it is necessary to understand whether law no. 219/17 is applicable to this context.

Telehealth Intervention: A Proposal for a Telemedicine Manual to Ascertain the Civil Disability Status in Italy.

(1) This paper aims to propose a telematic method for assessing the state of disability by a social worker member of the Medico-Legal Commissions of INPS. (2) We have proceeded to delve into and compare the current methods with new strategies to enhance the experience linked to the assessment of the status of disability in terms of timing and accessibility, eliminating the need for a direct visit. (3) The proposed protocol can be applied in cases where patients cannot be physically moved, following a medical visit at home, and when the mere evaluation of documents is sufficient. In both cases, a remote session with the Commission is necessary to fill in the required information about the socio-environmental section. This protocol can be applied to different platforms such as Skype™ since it is free and widely used throughout the country. (4) It should be noted that telemedicine solutions cannot completely replace face-to-face interaction; however, in some limited cases, they can optimize the process and timing, avoiding the need to move or interact only by telephone.

Mood disorders among adolescents in conflict with the law and in custody.

The high prevalence of psychiatric symptoms among juvenile delinquents is a well-replicated international finding. This study aimed to find the prevalence of mood disorders and their relationship with serious criminal acts in a population of adolescents in conflict with the law and in custody. A total of 123 male inmates aged 14 to 17 years were interviewed and assessed. Mood disorders were diagnosed in 15% of the sample for current episode and 31% for lifetime, making them third most prevalent after dependence disorders and disruptive disorders. The psychopathological profile of the adolescents who had committed violent crimes corroborates other studies reporting a high prevalence of mood disorders in this population. Several factors have been found to influence the formation of juvenile delinquency, including absence of family structure, social inequality, lack of quality school education, alcohol and drug abuse/addiction and disruptive disorders. The present results confirm mood disorders as another such factor.

Dental color measurement to estimate age in adults: a systematic review and meta-analysis.

Age estimation is a major challenge in anthropology and forensic odontology laboratories, as well as in judicial settings, as one of the tools used in human identification. The aim of this study was to evaluate the usefulness of age estimation methods based on the accurate measurement of tooth color changes. A systematic review was carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and in compliance with Cochrane criteria recommendations (PROSPERO registration number CRD 42022343371). An electronic search was performed in the following databases: Pubmed, Web of Science, Medline, Current Contents Connect, SciELO, KCI-Korean Journal Database, Derwent Innovations Index and Russian Citation Index. The search strategy yielded a total of 18 articles. A randomized meta-analysis model of the results for the CIE L*a*b* color variables stratified by age (less than 30 years, 30-60 years, 60 years and older) was performed with 9 of the 18 studies included in this systematic review. According to our results, sex and location of color measurement are the most influential factors in color estimation. All studies were carried out in healthy anterior teeth by spectrophotometry as the most commonly used method for color measurement, with CIE L*a*b* being the most commonly analyzed parameters. Studies based on age as a dependent variable showed R2 values between 0.28 and 0.56, being higher in ex vivo teeth. Studies based on age as an independent variable showed R2 values ranging from 0.10 to 0.48. The random model showed high heterogeneity for the L*, a* and b* parameters in all age groups, which is explained by discrepancies in age range and non-standardized conditions for color measurement. This systematic review highlights the need to protocolize age estimation studies that measure tooth color, in order to apply this method in different forensic settings.

Reflections about Blockchain in Health Data Sharing: Navigating a Disruptive Technology.

A comprehensive analysis was performed, considering blockchain technology (BT) properties in digital health, addressing medicolegal, privacy, and regulatory considerations. Adherence to personal data protection and healthcare regulatory guidelines were analyzed and compared for GDPR (Europe), HIPAA (United States), CCPA (California), PIPEDA (Canada), the Privacy Act of 1988 (Australia), APPI (Japan), and LGPD (Brazil). Issues such as health systems, strengthening and aligning policy orientations and initiatives, and emphasizing the role of data analysis in shaping health policies were explored. The study addressed conflicts between the legal frameworks and blockchain, comparing and suggesting solutions like the revision of laws and the integration of compliance mechanisms. Additionally, it sought to enhance IT-health literacy by integrating the healthcare and legal domains. Ongoing collaboration between legal, health, and IT experts is essential for designing systems that effectively balance privacy rights and data protection while maximizing the benefits of disruptive technologies like blockchain.

Validation of the Collett-Lester fear of death scale in occupational therapy students: psychometric testing and implications for palliative care education.

BACKGROUND: The fear of death is a common experience among healthcare students and professionals that may impact the quality of care provided to patients, particularly those receiving palliative care. The Collett-Lester Fear of Death Scale is a widely used instrument to assess this fear, although its psychometric properties have not been extensively studied in Occupational Therapy students. The present study aimed to validate the Collett-Lester Fear of Death Scale (CL-FODS) in a sample of Occupational Therapy students and to explore its implications for palliative care education. METHOD: A cross-sectional study was conducted to perform psychometric testing of the CL-FODS in Occupational Therapy undergraduate students. Structural validity, internal consistency, and test-retest reliability were analysed. A total of 195 Occupational Therapy students were included in this study. Additionally, the participants completed a brief survey on their experiences and attitudes towards palliative care. RESULTS: The internal consistency was satisfactory (α = 0.888). The exploratory factor analysis to evaluate the internal structure yielded four factors. The model fit indices were: comparative fit index = 0.89, and root mean square error of approximation = 0.06). The test-retest reliability was satisfactory and demonstrated an intraclass correlation coefficient of 0.939. CONCLUSION: The Spanish version of the CL-FODS showed satisfactory psychometric properties; therefore, assessing fear of death in Occupational Therapy students is helpful. This study highlights the importance of addressing fear of death and palliative care education in Occupational Therapy undergraduates to improve future professional attitudes and, consequently, the quality of patient care at the end of life.

Artificial intelligence in healthcare: why not apply the medico-legal method starting with the Collingridge dilemma?

Technology has greatly influenced and radically changed human life, from communication to creativity and from productivity to entertainment. The authors, starting from considerations concerning the implementation of new technologies with a strong impact on people's everyday lives, take up Collingridge's dilemma and relate it to the application of AI in healthcare. Collingridge's dilemma is an ethical and epistemological problem concerning the relationship between technology and society which involves two approaches. The proactive approach and socio-technological experimentation taken into account in the dilemma are discussed, the former taking health technology assessment (HTA) processes as a reference and the latter the AI studies conducted so far. As a possible prevention of the critical issues raised, the use of the medico-legal method is proposed, which classically lies between the prevention of possible adverse events and the reconstruction of how these occurred.The authors believe that this methodology, adopted as a European guideline in the medico-legal field for the assessment of medical liability, can be adapted to AI applied to the healthcare scenario and used for the assessment of liability issues. The topic deserves further investigation and will certainly be taken into consideration as a possible key to future scenarios.

On tackling abuse of older people: The forensic challenges in fatal cases investigation.

The World Health Organization recently presented the priorities for tackling abuse of older people in a coordinated and strategic way. However, data on the forensic scenario is still lacking. In this context, the aim of the present work was to provide a comprehensive literature review of this inherently complex phenomenon in the post-mortem setting, in order to better characterize it from a forensic point of view. A comprehensive literature search was performed in three electronic databases following the PRISMA guidelines. Sociodemographic and medical data of victims and perpetrators, post-mortem data, types of abuse and risk factors were extracted from non-aggregated data. Forty-eight papers dealing with abuse in the post-mortem setting were included, with a predominance of case reports and case series. The review showed that neglect was the most common type of abuse and victims are predominantly older women who are abused in a domestic setting by trusted family member. To generate more and better data, expanded research in the forensic field requires standardized methods and the raise of professional awareness about abuse of older people.

Characterization of male sexual assault in the state of São Paulo, Brazil: an epidemiological study from 2014 to 2017.

Sexual violence is a pervasive global issue that affects individuals of all genders. However, the experiences of male survivors have often been marginalized and inadequately represented. Male rape, which encompasses several forms of sexual violence against men, remains a sensitive and under-discussed topic in academic literature and public discourse. This study presents a descriptive cross-sectional analysis based on data collected from the Legal Medicine Institute (IML-São Paulo, Brazil) between 2014 and 2017. The analysis includes 7386 reports of sexological examinations performed on male victims of alleged rape. The analysis reveals that a significant majority of rape reports involved victims under the age of 12 or 14, which is considered vulnerable rape by the Brazilian legislation. Regarding the examination of reported cases of abuse against men, it was observed that only the minority of these cases exhibited visible injuries consistent with rape or tested positive for the presence of spermatozoa in the perianal region. Since the absence of visible injuries or spermatozoa does not negate the possibility of rape, this work highlights the challenges in obtaining conclusive evidence, necessitating a comprehensive approach to investigate and prosecute these crimes, creating a more inclusive and supportive environment for all survivors of rape, irrespective of their gender.

From Deutsche Zeitschrift to International journal of legal medicine-100 years of legal medicine through the lens of journal articles, Part 4: International journal of legal medicine from 1990 to 2022.

This is the fourth and final paper in a series related to the analysis of articles published in this journal during its first 100 years of activity. This article covers the time span from 1990 to 2022. It is important to note that, given the period covered by this analysis, it does not aim to provide a historical overview but rather an examination of the most recent trends in our discipline compared to the past. Between 1990 (Volume 104) and 2022 (Volume 136), 4004 articles were published in the International Journal of Legal Medicine (IJLM) across 33 volumes. This corresponds to 53% of all the articles published since the launch of the journal. When compared to the period from 1970 to 1990, some categories no longer appear to be as relevant (e.g., sexual medicine, 1 article; social medicine, 0 articles; biography, 3 articles; history, 4 articles). Conversely, the most recent period has shown an increasing importance in forensic genetics (1388 articles) and the emergence of new significant topics that merit their own classification, such as age estimation (286 articles), forensic anthropology (189 articles), forensic imaging (150 articles), and forensic entomology (90 articles).

Medically assisted suicide in Italy: Recent legal developments on a controversial topic.

On 16th June 2022, the first case of lawful 'medically assisted suicide' took place on Italian soil. This event is a result of decade-long debates on informed consent and end-of-life care stimulated by medical jurisprudence. The authors first retrace the crucial moments that allowed this to happen and underline the problems still to be solved. The cases of DJ Fabo, Davide Trentin, Mario and Fabio Ridolfi are discussed, signalling how they influenced the path implemented by Italian jurisprudence.

Assessing O.K.N.V.I. RESIST­5 performance for post­mortem biological samples: A prospective pilot study.

In recent years, the emergence of carbapenem-resistant strains has been increasing worldwide, including in Romania. Rapid tests for post-mortem examinations have been researched and currently have several applications. In the present study, we aimed to test the performance of O.K.N.V.I. RESIST-5 tests on impure post-mortem biological samples compared with a standard of pure cultures. When a death occurs during hospitalization and the issue of malpractice arises, the medico-legal practice would benefit from rapid tests applicable to post-mortem samples. Thus, detection and differentiation of the five targeted carbapenemases, namely oxacilinase-48, Klebsiella pneumoniae carbapenemase, New Delhi metallo-ß-lactamase, Verona integron-encoded metallo-ß-lactamase and imipenemase, could be useful in guiding sampling for third-party microbiological assessment and could also be an asset from an epidemiological standpoint. The present prospective and observational pilot study included medico-legal autopsy cases performed at Mina Minovici National Institute of Legal Medicine (Romania) between June and July 2022. A total of two sets of O.K.N.V.I. RESIST-5 tests were performed: Test I, which was performed on-site from biological samples obtained during autopsy; and Test II, which was performed on pure cultures after sample inoculation and incubation. Total of 39 O.K.N.V.I. RESIST-5 rapid tests were performed on 19 biological samples, at least one sample per case. The O.K.N.V.I. RESIST-5 tests performed on-site showed an overall sensitivity of 92.3% with a 100% specificity. The results obtained through rapid tests using post-mortem impure samples were comparable to the results obtained from sample cultures with good sensitivity and specificity. Through post-mortem screening for carbapenem resistance, it would be possible to narrow down the number of cases that require further bacteriological assessment.

Traumatic injuries by conducted electrical weapons: Case report of self-injury to the hand during stun gun training.

The use of non-lethal weapons has spread worldwide, being introduced as an alternative to firearms in many countries such as the United States or the United Kingdom. Among non-lethal weapons, conducted electrical weapons have been adopted worldwide, to control unruly suspected criminals or to neutralise violent situations. The stun gun belongs to this category and is the most widely available, with more than 140,000 units in use by police officers in the field in the US, and an additional 100,000 electrical stun guns owned by civilians worldwide. In Italy, the use of conducted electrical weapons by law enforcement has only recently been introduced, with private use and commercialisation still prohibited, mainly due to controversies related to the potential dangers of such devices.Before the official adoption, several experiments had to be carried out, with mechanisms that reproduced the ballistics of the stun gun. Here we present the case of a man who suffered a self-injury trauma to his hand during a ballistics exercise with a crossbow loaded with stun gun probes.

Artificial Intelligence and Diagnostics in Medicine and Forensic Science.

Diagnoses in forensic science cover many disciplinary and technical fields, including thanatology and clinical forensic medicine, as well as all the disciplines mobilized by these two major poles: criminalistics, ballistics, anthropology, entomology, genetics, etc. A diagnosis covers three major interrelated concepts: a categorization of pathologies (the diagnosis); a space of signs or symptoms; and the operation that makes it possible to match a set of signs to a category (the diagnostic approach). The generalization of digitization in all sectors of activity-including forensic science, the acculturation of our societies to data and digital devices, and the development of computing, storage, and data analysis capacities-constitutes a favorable context for the increasing adoption of artificial intelligence (AI). AI can intervene in the three terms of diagnosis: in the space of pathological categories, in the space of signs, and finally in the operation of matching between the two spaces. Its intervention can take several forms: it can improve the performance (accuracy, reliability, robustness, speed, etc.) of the diagnostic approach, better define or separate known diagnostic categories, or better associate known signs. But it can also bring new elements, beyond the mere improvement of performance: AI takes advantage of any data (data here extending the concept of symptoms and classic signs, coming either from the five senses of the human observer, amplified or not by technical means, or from complementary examination tools, such as imaging). Through its ability to associate varied and large-volume data sources, but also its ability to uncover unsuspected associations, AI may redefine diagnostic categories, use new signs, and implement new diagnostic approaches. We present in this article how AI is already mobilized in forensic science, according to an approach that focuses primarily on improving current techniques. We also look at the issues related to its generalization, the obstacles to its development and adoption, and the risks related to the use of AI in forensic diagnostics.

Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis.

Background and Objectives: The diagnosis of anaphylaxis comprehensively depends on both situational information and laboratory investigations. For this purpose, serum tryptase concentration is examined as an indicator of systemic mast cell mediator release, linked to an underlying anaphylactic process. Increased levels of tryptase may occur in some events different from anaphylaxis, but usually information from crime scene investigations is lacking and autoptic findings are not specific. For legal reasons, it is required to achieve a definite diagnosis of mast cell degranulation that can lead to a certain diagnosis of death from anaphylaxis. Immunohistochemistry seems to be a relatively simple, reliable, and easily repeatable method that can assist the forensic pathologist in the differential diagnosis of death from anaphylaxis. Materials and Methods: This work provides an overview of the current literature on immunohistochemical methods useful in the determination process of anaphylactic-related deaths. A systematic search, according to the PRISMA statement, was performed in databases to identify studies investigating immunohistochemical targets related to anaphylaxis death. Results: This work underscores the importance of anaphylaxis mediators such as tryptase, CD117, and chymase in the immunohistochemical analysis of anaphylactic deaths. Conclusions: According to the reviewed literature, the diagnosis of death due to anaphylaxis should depend not just on the suspicion of an anaphylactic reaction but also on confirming mast cell degranulation through the identification of IHC positivity for inflammatory mediators, particularly in the respiratory tract.

Consideraciones médico-legales laborales de la fórmula de Balthazard / Occupational medical-legal considerations of the Balthazard formula

La determinación del porcentaje de pérdida en pacientes lesionados con múltiples secuelas por riesgos de trabajo resulta un verdadero reto para el perito, esto adquiere mayor relevancia cuando en el fuero judicial se pueden presentar discrepancias en los criterios para el uso o no de fórmulas matemáticas para el cálculo. La fórmula de suma combinada, creada por el Médico Forense Víctor Balthazard, no es más que un ordenamiento de una regla de tres que ordena los porcentajes otorgados a cada secuela de mayor a menor para evitar que el porcentaje final sobrepase el 100%, o bien que resulte en un porcentaje mayor que una secuela única puntuada en el baremo y que por gravedad en la intensidad de la misma resulte con un porcentaje menor al calculado por la secuela múltiple y que se ha utilizado en fueros laborales y de seguridad social alrededor del mundo. El Baremo contenido en el Código de Trabajo no establece explícitamente la forma en que se calcula el porcentaje de pérdida por secuelas múltiples, lo cual brinda libertad al perito para utilizar fórmulas, como lo es la fórmula de suma combinada, que permite calcular de forma congruente las pérdidas sucesivas sin sobrepasar a la persona más allá de su capacidad general total del 100% o de otorgar porcentajes mayores a secuelas de mayor gravedad que la suma de las pérdidas por el evento que se está valorando.

The determination of the percentage of loss in injured patients with multiple sequelae due to occupational hazards is a real challenge for the expert, this becomes even more relevant when in the judicial system there may be discrepancies in the criteria for the use or not of mathematical formulas for the calculation. The combined sum formula, created by the Forensic Physician Victor Balthazard, is nothing more than an arrangement of a rule of three that orders the percentages given to each sequel from highest to lowest to avoid that the final percentage exceeds 100%, or that it results in a higher percentage than a single sequel scored in the scale and that due to the severity in the intensity of the same results in a lower percentage than that calculated for the multiple sequel and that has been used in labor and social security courts around the world. The Schedule contained in the Labor Code does not explicitly establish the way in which the percentage of loss for multiple sequelae is calculated, which gives the expert the freedom to use formulas, such as the combined sum formula, which allows a congruent calculation of the successive losses without exceeding the person's total general capacity of 100% or to grant higher percentages to sequelae of greater severity than the sum of the losses for the event being valued.

Características sociodemográficas y personales de la víctima - feminicida en Lima Metropolitana

Introducción. El feminicidio es un problema de salud mundial. América Latina presenta altas tasas, el Perú implementó su legislación, normativas, sanciones penales y programas preventivos; pero las estadísticas y desaparición de las mujeres siguen en aumento. Objetivo. Determinar las características sociodemográficas y personales en los protagonistas del feminicidio. Métodos. Se realizó un diseño descriptivo, de recolección de datos secundarios. Se analizó documentación forense del Instituto de Medicina Legal y Ciencias Forenses del Perú constituido por 46 protocolos de necropsia médico legal de víctimas de feminicidio en Lima Metropolitana durante los años 2019 al 2020 e informes periciales físicos y psiquiátricos de los feminicidas. Resultados. El perfil común de las víctimas fue tener 18 a 29 años, soltera, secundaria con un trabajo formal, la causa muerte fue por proyectil de arma de fuego y el lugar de muerte fue en su domicilio. El perfil de los feminicidas incluyó ser esposo/conviviente, con antecedentes policiales, familia disfuncional y tener hijos con la víctima. Conclusión. Se encontraron principales características de víctimas y sus homicidas como la edad, grado de instrucción, el domicilio de la víctima, antecedentes policiales, familias disfuncionales. En caso de los homicidas eran disociales y el argumento del homicidio fueron los celos.

Introduction. Femicide is a global health problem, Latin America presents high rates, Peru has implemented its legislation, regulations, criminal sanctions and preventive programs; but the statistics and disappearance of women continue to rise. Objectives. Determine the sociodemographic and personal characteristics of the protagonists of Femicide. Methods. Forensic documentation from the Institute of Legal Medicine and Forensic Sciences of Peru was analyzed, consisting of 46 medical legal autopsy protocols for victims of intimate femicide in Metropolitan Lima during the years 2019 to 2020, physical and psychiatric expert reports from the murderers. Descriptive design, census sampling of secondary data collection. Results. The common profile of the victims was to be 18 to 29 years old, single, high school with a formal job and the cause of death was by firearm projectile and the place of death was at his home. The profile of the murderers included being a husband/partner with a police record and a dysfunctional family and have children with the victim. Conclusion. The main characteristics of the victims and their homicides were found, such as age, level of education, the victim's address, police records, dysfunctional families. In the case of the homicides, they were dissocial and the argument for the homicide was jealousy.

Post-mortem Imaging of Brain/Spine Injuries: The Importance of a Comprehensive Forensic Approach.

In forensic investigations, the limitations of the traditional purely autoptic approach can be overcome through post-mortem imaging (virtopsy). Virtospy has several applications to the investigation of brain and spinal injuries, whose analysis can be of forensic interest, especially in cases of suspected malpractice. In this scoping review, we briefly describe the main applications of the two most common post-mortem radiological techniques (computed tomography (CT) and magnetic resonance imaging (MRI)) to the forensic investigation of brain and spinal injuries in cases of medical malpractice or traumatic (accidental/homicidal/suicidal) deaths. Although CT represents the traditional approach to post-mortem imaging, MRI is proving to be a valuable tool to investigate brain and spinal injuries and lesions. These post-mortem radiological techniques can also be used to guide the surgeons in simulated surgical procedures on corpses in the context of training programs, thus helping operators to improve technical and non-technical skills and to reduce the risk of avoidable errors.

Awareness of forensic anthropology in Switzerland: a survey among forensic practitioners, police, and prosecutors.

Forensic anthropology (FA) as a specialized discipline has been practised in multi-lingual Switzerland for over a decade. A variety of expertise regarding osteological assessments as well as facial image comparison (FIC) is provided by different centres. Nevertheless, information is lacking about the awareness of FA and its benefits for forensic investigations among forensic stakeholders. Therefore, a survey was sent to Swiss anthropologists (AN) and related professions (police officers, prosecutors, and forensic pathologists) to assess three main aspects: (1) the experience of working (biological/forensic) anthropologists within FA; (2) how FA is perceived by other professions within the legal system; and (3) identify gaps (if any) in understanding of FA with the aim to suggest avenues for improvement if necessary. The results show that awareness of FA varies by occupation and cantonal regions. In areas where close collaborations between forensic anthropologists (FAs) and other stakeholders have been formally established, be it with focus on osteological analyses or FIC, the awareness of FA competencies was superior to areas where this was not the case. An overwhelming majority of forensic actors expressed interest in continuing education related to the role of FA. These findings indicate that facilitation of communication and collaboration leads to improvement in the awareness of the competencies of FAs and their contribution to forensic investigations.