Retrospective analysis of 172 cases of custodial deaths in China between 1999 and 2016: forensic experience in China

Death in detention in the Northern part of Tunisia: a 15-year study (2005-2019)

PURPOSE

This study aims to analyze the pattern of deaths in detention in Northern Tunisia as well as the causes of death.

DESIGN/METHODOLOGY/APPROACH

The authors conducted a cross-sectional retrospective study including all the casualties of death in detention examined in the legal medicine Department in the main teaching hospital from 2005 to 2019. The department covers 10 out of the 11 governorates of Northern Tunisia and 13 prisons.

FINDINGS

Of a total of 197 casualties, only 2 were females. The mean age was 45.39 ± 14.43 years. A known medical history was reported in 63.5%, mainly cardiovascular disease, mental health disorders and diabetes. Half of the deaths occurred at the hospital. A total of 53 victims spent less than one year in custody before their death. Most deaths occurred due to disease-related causes (78.7%; n = 155); among these, 69 victims died from cardiovascular disease. Suicide accounted for 3.6% of the casualties and homicides for four cases.

RESEARCH LIMITATIONS/IMPLICATIONS

Several missing data regarding the details of the detention circumstances as well as the absence in some cases of the toxicological and histopathology analysis results, which could bias the study findings.

PRACTICAL IMPLICATIONS

Death in detention in Northern Tunisia involved mainly males between their 30s and their 50s who died mainly from cardiovascular or pulmonary disease. These results underscore the importance of empowering the penitentiary health system.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this study is one of largest studies with regard to the number of decedents and the number of prisons from the Arab countries allowing to draw a pattern of casualties of death in prison.

Modification of the examination of fitness for custody as a result of external factors in the period 2013–2018

Background and objectives

Previous studies have shown that the assessment of fitness for custody is influenced by external factors. In this study, we analyzed whether the changes that occurred in the period 2015–2016 (predominant involvement of forensic medicine, significant increase in the proportion of the population with a migration background) had an impact on the examination of fitness for custody in the Halle/Saale area (Germany).

Material and methods

A retrospective analysis of 1271 examinations of fitness for custody from the period 2013–2018 was carried out. Therefore, two periods (2013–2015 and 2016–2018) were considered and the various parameters were evaluated using several statistical programs.

Results

In terms of the reasons for examination, there was a significant decrease in alcohol intoxication and a significant increase in psychiatric illnesses (p = 0.016) in the period 2016–2018. Regardless of the time period there was an increase in examination time of approximately 3.5 min for examinations of people with a migration background. In comparison of the two time periods, fewer persons examined were fit for custody without restrictions and significantly more were fit for custody with restrictions only (p = <0.001).

Discussion and conclusion

The present study confirmed the influence of external factors on examination of fitness for custody. With the predominant involvement of forensic medicine, there was a significant increase in persons with limited fitness for custody. The increased proportion of persons with a migration background resulted in a broader variety of indications as well as an increase in examination time and the involvement of interpreters. For the future guarantee of the examinations, these changed circumstances must be taken into account, also including appropriate payment.

HIV/AIDS, hepatitis and tuberculosis-related mortality among incarcerated people: a global scoping review

Purpose

People in prison are at a higher risk of preventable mortality from infectious disease such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) than those in the community. The extent of infectious disease-related mortality within the prison setting remains unclear. The purpose of this paper was to collate available information on infectious disease-related mortality, including the number of deaths and calculate the person-time death rate.

Design/methodology/approach

The authors searched databases between 1 January 2000 and 18 November 2020 for studies reporting HIV, HBV, HCV, TB and/or HIV/TB-related deaths among people in prison.

Findings

The authors identified 78 publications drawn from seven Joint United Nations Programme on HIV/AIDS’ regions encompassing 33 countries and reporting on 6,568 deaths in prison over a 20-year period. HIV/AIDS (n = 3,305) was associated with the highest number of deaths, followed by TB (n = 2,892), HCV (n = 189), HIV/TB (n = 173) and HBV (n = 9). Due to the limitations of the available published data, it was not possible to meta-analyse or in any other way synthesise the available evidence.

Research limitations/implications

To inform targeted efforts to reduce mortality, there is a need for more, better quality data to understand infectious disease-related mortality in custodial settings. Increased investment in the prevention and management of infectious diseases in custodial settings, and in documenting infectious disease-related deaths in prison, is warranted and will yield public health benefits.

Originality/value

To the authors’ best knowledge, this is the first scoping review focussed on deaths due to these infections among people in prison internationally. The gaps identified form recommendations to improve the future collection and reporting of prison mortality data.

[A retrospective mortality analysis of natural deaths of the 65+ generation based on postmortem autopsies performed at the Institute of Legal Medicine in Frankfurt am Main during two periods]

BACKGROUND AND AIM OF THE STUDY

In Germany, a constant demographic change is taking place, which leads to an increasing aging of the society. The present study aimed to analyze natural deaths occurring at an age of ≥ 65 years, since health vulnerability in this age group is gaining importance.

MATERIAL AND METHODS

Autopsy reports of the Institute of Forensic Medicine, University Hospital of the Goethe University Frankfurt/Main, Germany, were retrospectively evaluated regarding natural death cases of ≥ 65-year-olds in a time comparison (period I: 2000-2002; period II: 2013-2015).

RESULTS

During both periods, a total of 1206 autopsies concerning this age group were performed. Among these, 404 cases (33.5%) of unnatural death and 39 cases (3.2%) of a combination of natural and unnatural death were recorded; in 94 cases (7.8%), the manner of death could not be elucidated. The majority (n = 669; 55.5%) included cases of natural death. In the largest group of these (n = 350; 52.3%), cardiac causes of death were predominant, followed by 132 (19.7%) respiratory and 47 (7.0%) abdominal causes of death. In addition, 37 (5.5%) cases of malignant neoplasms, 33 (4.9%) of ruptures of large vessels, 33 (4.9%) of cerebral, and 37 (5.5%) other cases of natural death were noted. A significant decrease of cardiac causes of death was observed in the comparison of periods I and II. In particular, there was a significant decrease in high-grade occlusive coronary sclerosis. Moreover, there were significant differences between both sexes. Men had significantly more bypasses, stents and heart scars and suffered a myocardial infarction about 10 years earlier than women.

CONCLUSION

The results of the present study are largely consistent with the literature. The decrease in numbers of cardiac deaths may be attributed to increasingly better medical care and to a significantly higher rate of stent implantation. Especially in times of pandemics, the role of forensic gerontology will become more important.