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Tambuzzi S, Crudele G, Maggioni L, Collini F, Tunesi S, Decarli A, Russo AG, Cattaneo C. Are autopsies on minors a taboo?: The experience of Milan in a 19-year retrospective study. Int J Legal Med 2024; 138:639-649. [PMID: 37934209 PMCID: PMC10861724 DOI: 10.1007/s00414-023-03114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023]
Abstract
Forensic autopsy is an important tool for the proper management of non-natural deaths in minors. However, it seems that autopsy in minors is a practice which may not be performed routinely. In this framework, we conducted a study analyzing autopsies of minors (under 18 years of age in Italy) performed at the Institute of Forensic Medicine in Milan in the period 2001-2019. For the period 2015-2019, we extrapolated all deaths due to non-natural causes in minors to investigate how many and which of these deaths were not subjected to forensic autopsy. Of the total, 344 minors (235 males and 109 females) underwent autopsies, with an overall downward trend of about 80% since 2004. Most autopsies occurred between the ages of 0 and 1 year, and the fewest between the ages of 5 and 9 years. The place of death was home in most cases, and accidental death was most common, followed by natural death, suicide, and homicide, with prevalence varying by age group. Blunt force trauma predominated among accidental death in all age groups, followed by asphyxia. Similar findings were observed for suicides, although there was a more differentiated pattern for suicides between the ages of 15 and 17 years. Among homicides, blunt force trauma, asphyxia, and gunshot wounds were fairly evenly distributed across all age groups. Between 2015 and 2019, a total of 86 minors died of a non-natural cause, and a forensic autopsy was performed in only 33 cases (38%). Our data shows that fewer and fewer autopsies are being performed over the last years, which indicates a dangerous lack of forensic investigation of children and adolescent deaths, with enormous implications for prevention of child abuse.
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Affiliation(s)
- Stefano Tambuzzi
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy.
| | - Graziano Crudele
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy
| | - Lidia Maggioni
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy
| | - Federica Collini
- Department of Health Sciences, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Sara Tunesi
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Adriano Decarli
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | | | - Cristina Cattaneo
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy
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Kruckow L, Basit S, Nordentoft M, Banner J, Boyd HA. Factors associated with medico-legal autopsy of decedents with psychiatric disorders. Forensic Sci Int 2024; 355:111940. [PMID: 38290227 DOI: 10.1016/j.forsciint.2024.111940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/01/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Autopsy rates are declining worldwide, resulting in increasing selectivity in referral for forensic autopsy and increased uncertainty about the validity of assigned causes of death. Persons with psychiatric disorders have high rates of premature death but not all are referred for forensic autopsies. Knowledge is needed on which decedents with psychiatric disorders are chosen for forensic autopsy to determine whether causes of death are at risk of being misclassified among certain subgroups of decedents. METHODS We conducted a nationwide register-based case-control study including all decedents with psychiatric disorders in Denmark in the period 1998-2015. Using multivariate logistic regression, we examined associations between demographic and socioeconomic factors, comorbidities, healthcare utilization, and referral for forensic autopsy, overall and stratified by age at death (<45, 45-64, ≥65 years). RESULTS Of the 152,799 decedents in the study population, 7043 (4.61 %) had a forensic autopsy. Decedents referred for forensic autopsy were more likely to be young, have a history of substance use, and have schizophrenia or an affective disorder (factors listed in diminishing order of strength of association). Increasing severity of comorbidities as measured by the Charlson comorbidity index was associated with decreasing likelihood of being autopsied. Patterns of association with sex, alcohol use, habitation and education did not vary by age at death. Schizophrenia and drug use were most strongly associated with forensic autopsy in decedents < 45 years of age, whereas death early in the study period was more strongly associated with autopsy in the oldest age groups. DISCUSSION The decision to refer a decedent for forensic autopsy was predominantly based on the decedent's age, history of drug use, and the absence of non-psychiatric comorbidities. Causes of death in decedents with comorbidities or recent contact with the healthcare system and decedents > 65 years may be more likely to be inaccurate, particularly in drug users.
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Affiliation(s)
- Line Kruckow
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen, Denmark.
| | - Saima Basit
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Heather Allison Boyd
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
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Tunesi S, Tambuzzi S, Decarli A, Cattaneo C, Russo AG. Trends in mortality from non-natural causes in children and adolescents (0-19 years) in Europe from 2000 to 2018. BMC Public Health 2023; 23:2223. [PMID: 37950237 PMCID: PMC10638782 DOI: 10.1186/s12889-023-17040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Non-natural mortality in children and adolescents is a global public health problem that varies widely from country to country. Data on child and adolescent maltreatment are not readily available, and mortality due to violent causes is also underestimated. METHODS Injury-related mortality rates (overall and by specific causes) from 2000 to 2018 in selected European countries were analysed to observe mortality patterns in children and adolescents using data from the Eurostat database. Age-standardized mortality rates per 100,000 person-years were calculated for each country. Joinpoint regression analysis with a significance level of 0.05 and 95% confidence intervals was performed for mortality trends. RESULTS Children and adolescent mortality from non-natural causes decreased significantly in Europe from 10.48 around 2005 to 5.91 around 2015. The Eastern countries (Romania, Bulgaria, Poland, Slovakia, Czech Republic) had higher rates; while Spain, Denmark, Italy, and the United Kingdom had the lowest. Rates for European Country declined by 5.10% per year over the entire period. Larger downward trends were observed in Ireland, Spain and Portugal; smaller downward trends were observed for Eastern countries (Bulgaria, Czech Republic, Poland, Slovakia) and Finland. Among specific causes of death, the largest decreases were observed for accidental causes (-5.9%) and traffic accidents (-6.8%). CONCLUSIONS Mortality among children and adolescents due to non-natural causes has decreased significantly over the past two decades. Accidental events and transport accidents recorded the greatest decline in mortality rates, although there are still some European countries where the number of deaths among children and adolescents from non-natural causes is high. Social, cultural, and health-related reasons may explain the observed differences between countries.
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Affiliation(s)
- Sara Tunesi
- Epidemiology Unit, Agency for Health Protection of Milan, Via Conca del Naviglio, 45, 20123, Milano, (MI), Italy
| | - Stefano Tambuzzi
- Bureau of Legal Medicine and Insurance, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Adriano Decarli
- Epidemiology Unit, Agency for Health Protection of Milan, Via Conca del Naviglio, 45, 20123, Milano, (MI), Italy
| | - Cristina Cattaneo
- Bureau of Legal Medicine and Insurance, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Antonio Giampiero Russo
- Epidemiology Unit, Agency for Health Protection of Milan, Via Conca del Naviglio, 45, 20123, Milano, (MI), Italy.
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Tambuzzi S, Maciocco F, Gentile G, Boracchi M, Bailo P, Marchesi M, Zoja R. Applications of microbiology to different forensic scenarios - A narrative review. J Forensic Leg Med 2023; 98:102560. [PMID: 37451142 DOI: 10.1016/j.jflm.2023.102560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
In contrast to other forensic disciplines, forensic microbiology is still too often considered a "side activity" and is not able to make a real and concrete contribution to forensic investigations. Indeed, the various application aspects of this discipline still remain a niche activity and, as a result, microbiological investigations are often omitted or only approximated, in part due to poor report in the literature. However, in certain situations, forensic microbiology can prove to be extremely effective, if not crucial, when all other disciplines fail. Precisely because microorganisms can represent forensic evidence, in this narrative review all the major pathological forensic applications described in the literature have been presented. The goal of our review is to highlight the versatility and transversality of microbiology in forensic science and to provide a comprehensive source of literature to refer to when needed.
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Affiliation(s)
- Stefano Tambuzzi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy
| | - Francesca Maciocco
- Azienda Ospedaliera "San Carlo Borromeo", Servizio di Immunoematologia e Medicina Trasfusionale (SIMT), Via Pio II°, n. 3, Milano, Italy
| | - Guendalina Gentile
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy.
| | - Michele Boracchi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy
| | | | - Matteo Marchesi
- ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy
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