Dead Bodies Found in Wells

The burden, risk factors and prevention strategies for drowning in Türkiye: a systematic literature review

INTRODUCTION

Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies.

METHODS

Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design.

RESULTS

From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions.

DISCUSSION

There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning.

PRACTICAL APPLICATIONS

There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry.

TRIAL REGISTRATION

#CRD42022382615.

Deadly falls into wells: A retrospective study of 72 autopsy cases from Kairouan, Tunisia

Falls are a traumatic event that represents a major public health problem worldwide. The literature is rich in published studies of falls from heights, but only a few articles have focused on falls into wells. The region of Kairouan, in central Tunisia, is characterized by an arid climate, hence the abundance of wells for watering crops. In this study, 72 cases of deadly falls into wells were retrospectively investigated at the Department of Forensic Medicine in Kairouan over eight years (01/01/2008 to 31/12/2015). A male predominance was found (sex ratio of 2.42), with a mean age of 29 ± 16.1 years. Sixty-five cases (90.3%) were from rural areas, 62.5% had a low level of education, and 50% were unemployed. In our series, the deceased fell from a distance between 3 and 70 meters with an average of 28.3 m. The falls occurred into functional wells in 61.1%, which were filled with water in 51.4%, and were unprotected in 88.9%. Autopsy findings showed bone fractures in 51.4% of cases of which 44.4% were rib fractures. Visceral injuries were identified in 55.6% of cases. The predominant manner of death was suicide (73.2%), and severe polytrauma was the most frequent cause of death (52.8%). This study highlights the need for increased safety measures to keep wells covered and protected in order to prevent these falls.

Homicide and concealment of the corpse. Autopsy case series and review of the literature

INTRODUCTION

The concealment of the body following a homicide undermines different moments of the forensic and medico-legal investigations. The aim of the present study is to provide an overview of the literature and the forensic casuistry of the Institute of Legal Medicine of Padova for analyzing and discussing diverse methodological approaches for the forensic pathologist dealing with covered-up homicides.

MATERIAL AND METHODS

A literature review, updated until September 2019, was performed, and a literature pool of forensic cases was built. In-house cases were included by conducting a retrospective analysis of the forensic caseworks of Padova of the last 20 years. Data regarding epidemiology, methodology of assessment, methods of concealment, and answers to medico-legal issues were extracted for both data sets.

RESULTS AND DISCUSSION

Seventy-eight papers were included in the literature review (78.2% being case reports or case series, 17% retrospective studies, and 6% experimental studies or reviews). Literature and in-house data sets consisted of 145 and 13 cases, respectively. Death scene investigation, radiology, toxicology, and additional analyses were performed in 20-54% of literature and 62-77% of in-house cases. Cover-up by multiple methods prevailed. Death was caused by head trauma in about 40% of cases (both data sets), strangulation in 21% of literature, and 7% of in-house cases, and was undetermined in 17% of literature and 7% of in-house cases.

CONCLUSIONS

The methodology of ascertainment should be case-specific and based on a multidisciplinary and multimodal evaluation of all data, including those gained through novel radiological and/or analytical techniques.