Karin Helweg-Larsen

The value of the medico-legal examination in sexual offences

A review is presented of medico-legal examinations performed on two series of rape and attempted rape in 1975 and 1980 with a total of 74 victims. Judicial outcome was known in 93% of the cases and is compared with the results of the medico-legal examinations. Between the two series, public discussions and pressure from feminist movements concerning the procedure in rape cases together with modifications of civil penal code resulted in alterations of police practice. Eighteen percent of known offenders in 1975 and 42% in 1980 were charged, 50% and 90%, respectively, of these were convicted. A correlation between the judicial outcome and the results of the medico-legal examination was not found in all cases. The importance of psychological guidance to the victim at the medico-legal examination is stressed.

Chlamydia and sudden infant death syndrome. A study of 166 SIDS and 30 control cases.

SummaryChlamydia inclusions could be demonstrated by an immunofluorescence assay in formalin-fixed lung sections in 32 of 166 cases (19.4%) of Sudden Infant Death Syndrome (SIDS) and in the lungs of only 1 of 30 infants with a known cause of death (3.3%). The difference is statistically significant (P = 0.04).Chlamydia trachomatis is an agent of pneumonia in 1–4 month-old infants who have acquired the disease from an infected cervix during birth, but other chlamydia species are also capable of causing pneumonia. The lung sections of the 32 chlamydia positive SIDS cases did not show typical histological signs of pneumonia. Even though chlamydia inclusions were detected in the lungs of 32 SIDS cases a causal relation between chlamydia infection and SIDS could not be demonstrated.ZusammenfassungChlamydia-Einschlüsse konnten mit Hilfe eines Immunfluoreszenz-Ansatzes in formalinfixierten Lungenschnitten in 32 von 166 Fällen (19,4%) des Syndroms des plötzlichen Kindstodes und in lediglich einem von 30 Fällen von Kindern mit bekannter Todesursache (3,3%) festgestellt werden. Der Unterschied ist statistisch significant (P - 0,04). Chlamydia trachomatis ist ein Erzeuger von Pneumonien bei 1–4 Monate alten Kindern, die die Erkrankung während der Geburt aufgrund einer infizierten Cervix acquiriert haben, aber andere Chlamydia-Arten sind auch imstande, eine Pneumonic zu verursachen. Die Lungenschnitte von 32 Chlamydia-positiven SIDS-Fällen zeigten keine typischen histologischen Zeichen der Pneumonie. Obwohl jedoch Chlamydia-Einschlüsse in den Lungen von 32 SIDS-Fällen gefunden wurden, konnte eine kausale Beziehung zwischen Chlamydia-Infektion und SIDS nicht nachgewiesen werden.

Injuries due to deliberate violence in areas of Denmark. V. Violence against women and children. Copenhagen Study Group.

As part of an European-South American study of deliberate violence cases of violence against women greater than or equal to 15 years of age and violence against and among children under the age of 15 years were registered at 3 Danish emergency wards and at the Institute of Forensic Medicine in Copenhagen. 352 cases of violence against women and 46 cases of violence against children were registered in the three emergency wards corresponding to rates of about 1.6/1000 per year for women, 0.6/1000 per year for boys and 0.7/1000 per year for girls in a provincial/rural district, the catchment region of Holbaek County Hospital, 3.4/1000 per year for women, 2.8/1000 per year for boys and 0.6/1000 per year for girls in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 4.0/1000 per year for women, 4.0/1000 per year for boys and 0.9/1000 per year for girls in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. Nineteen live adult female victims and 17 dead adult female victims of violence were registered in the Institute of Forensic Medicine in Copenhagen, where also one was registered as a victim of homicide. Nearly half of the adult live female victims of violence had been injured at home while this was the case for approximately three fourth of the dead victims. In 35% of the live cases the husband was the aggressor and in 12% a former cohabitant. In 71% of the homicide cases the husband was the aggressor. The live women appeared to have fewer but more serious lesions than men. The pattern of deliberate violence against women appears to be associated with socio-economic and cultural factors. In cases with a preceding quarrel there is statistically a link to alcohol intoxication. In half of the cases of violence against children the aggressor was known to the victim, in 15% the aggressor was one of the parents, while 42% of the cases were violence among children. The pattern of violence according to sex, and the distribution and severity of lesions for 10-14 years old children showed resemblance to the situation for adults. The lesions were more serious in young infant victims, especially boys, than in adult victims.

Injuries due to deliberate violence in areas of Denmark. III. Lesions

As part of a transcultural investigation of violent behavior in Denmark and South America, the lesions from accidents involving deliberate violence registered in three Danish emergency wards during a 1-year period were studied. A quantity of 2211 lesions were diagnosed in 1316 patients (953 male and 363 female patients). Sixty-five percent of the lesions were in the head/neck region, 13% in truncus, 18% in the upper extremities and 5% in the lower extremities. The most frequent diagnosis was an open wound in the head/neck region. Adding contusions and fractures in the same region this amounted to more than half of the total number of lesions. In the upper extremities 62% of the lesions were contusions or open wounds. Serious lesions of internal arteries were few, however always caused by sharp instruments (knives). Serious lesions due to firearms were not recorded/reported. Strangulation had been used against 1.1% of the victims, the male/female ratio being 1:6. The main part of the lesions were of minor severity when assessed on the basis of the scores in the Abbreviated Injury Scale (AIS). The lesions were, however, more serious compared to other recent studies, and it appeared that the female victims had fewer but more serious lesions than the male victims. The need for treatment and hospitalization was in the range of other recent studies.

Are suicide deaths under-reported? Nationwide re-evaluations of 1800 deaths in Scandinavia

Objective Valid mortality statistics are important for healthcare planning and research. Suicides and accidents often present a challenge in the classification of the manner of death. The aim of this study was to analyse the reliability of the national suicide statistics by comparing the classification of suicide in the Scandinavian cause of death registers with a reclassification by 8 persons with different medical expertise (psychiatry, forensic pathology and public health) from each of the 3 Scandinavian countries. Methods The cause of death registers in Norway, Sweden and Denmark retrieved available information on a sample of 600 deaths in 2008 from each country. 200 were classified in the registers as suicides, 200 as accidents or undetermined and 200 as natural deaths. The reclassification comprised an assessment of the manner and cause of death as well as the level of certainty. Results In total, 81%, 88% and 90% of deaths registered as suicide in the official mortality statistics were confirmed by experts using the Swedish, Norwegian and Danish data sets, respectively. About 3% of deaths classified as accidents or natural deaths in the cause of death registers were reclassified as suicides. However, after a second reclassification based on additional information, 9% of the natural deaths and accidents were reclassified as suicides in the Norwegian data set, and 21% of the undetermined deaths were reclassified as suicides in the Swedish data set. In total, the levels of certainty of the experts were 87% of suicides in the Norwegian data set, 77% in the Swedish data set and 92% in Danish data set; the uncertainty was highest in poisoning suicides. Conclusions A high percentage of reported suicides were confirmed as being suicides. Few accidents and natural deaths were reclassified as suicides. Hence, reclassification did not increase the overall official suicide statistics of the 3 Scandinavian countries.

Injuries due to deliberate violence in areas of Denmark. II. Victims of homicide in the Copenhagen area

As part of a transcultural investigation of injuries due to deliberate violence in Denmark and South America, homicides in the Copenhagen area were studied for a 1-year period. Forty-five cases corresponding to a rate of approximately 2/10(5) per year were recorded. The rate seems to be increasing and the pattern changing with a higher frequency of stabbing and with an increasing frequency of high blood-alcohol concentrations in the victims. The highest number were killed at home. In the majority of cases the aggressor and the victim knew each other. A reduction in alcohol consumption is indicated as a possible preventive measure.

Differing Procedures for Recording Mortality Statistics in Scandinavia

Background: There may be various reasons for differences in suicide rates between countries and over time within a country. One reason can be different registration practices. Aims: The purpose of this study was to describe and compare the present procedures for mortality and suicide registration in the three Scandinavian countries and to illustrate potential sources of error in the registration of suicide. Method: Information about registration practices and classification procedures was obtained from the cause of death registers in Norway, Sweden, and Denmark. In addition, we received information from experts in the field in each country. Results: Sweden uses event of undetermined intent more frequently than Denmark does, and Denmark more frequently than Norway. There seems to be somewhat more uncertainty among deaths classified as ill-defined and unknown cause of mortality in Norway, compared with the other two countries. Sweden performs more forensic autopsies than Norway, and Norway more than Denmark. In Denmark, in cases of a suspected unnatural manner of death, a thorough external examination of the deceased is performed. Conclusion: Differences in the classification of causes of death and in postmortem examinations exist in Scandinavian countries. These differences might influence the suicide statistics in Scandinavia.