RESUMEN
The aim of the study was to assess interdoctorvariation and validity in death certification by forensic physicians using 19 written scenarios. The scenarios described typical cases from forensic-medical practice. Physicians were asked to determine the manner of death (natural/unnatural) and to provide an ICD-10 code for the cause of death. In contrast to most studies on this topic, the measure of agreement among physicians was chance-corrected and a standard was used to assess the correctness of the assigned cause and manner of death. Forty-seven physicians participated in the survey. The study demonstrated that forensic physicians varied widely in their conclusions. With respect to manner of death, adequate agreement (defined as kappa>0.70) was achieved in six scenarios (32% of all scenarios). Concerning the underlying cause of death, adequate agreement was reached in three cases (16% of all scenarios). Furthermore, predictors for the correctness of manner and cause of death were studied using logistic regression. Years of experience as a forensic physician significantly predicted the correctness of cause of death (p < 0.05). Other predictors remained insignificant. With regard to manner of death, none of the studied predictors proved to be significant. To conclude, there appears to be a lack of consistency among forensic physicians regarding death certification. The ICD-10 coding of causes of death applied by forensic physicians is questionable. Less experienced physicians need supervision by more experienced colleagues when making judgments concerning the cause of death. Altogether, there is an urgent need to work out consensus-based guidelines for forensic physicians on how to certify deaths.
Asunto(s)
Certificado de Defunción , Medicina Legal/normas , Adulto , Causas de Muerte , Femenino , Humanos , Clasificación Internacional de Enfermedades , Modelos Logísticos , Masculino , Persona de Mediana Edad , Países Bajos , Variaciones Dependientes del Observador , Competencia Profesional , Encuestas y CuestionariosRESUMEN
PURPOSE: The goal of this study was to ascertain accordance between cause of death established by the forensic physician and autopsy results in young sudden death victims in the Netherlands. METHODS: Sudden death victims aged 1-45 years examined by forensic physicians operating in the participating regions which also underwent an autopsy between January 2006 and December 2011 were included (n = 70). Cause of death established by the forensic physician based on the external medicolegal examination was compared with autopsy findings using the ICD10-classification. RESULTS: Autopsy findings revealed that the majority of sudden death victims have died from a cardiac disease (n = 51, 73%). Most of the presumed heart disease related cases were confirmed by autopsy (n = 13, 87%). On the contrary, a large number of deaths caused by circulatory diseases were not recognised by the forensic physician (n = 38, 75%). In most of these cases, the forensic physician was forced to report an undetermined cause due to the lack of a solid explanation for death. Cause of death reported by the forensic physician appeared to be in agreement with the autopsy results in 12 cases (17%). CONCLUSIONS: Cause of death determination in young sudden death victims is a difficult task for forensic physicians due to the limited tools available during the medicolegal examination. An effort should be made to standardize extensive post-mortem investigation after sudden death in the young. Autopsy can provide valuable information regarding the cause of death, which is of great importance in view of the identification of inheritable diseases among decedents and their families.
Asunto(s)
Causas de Muerte , Muerte Súbita/etiología , Errores Diagnósticos , Medicina Legal , Adolescente , Adulto , Niño , Preescolar , Muerte Súbita/patología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Países Bajos , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
BACKGROUND: In many countries, forensic physicians function as primary care providers for detainees in police custody. Their task is comparable to the tasks of general practitioners. Nevertheless, problems presented by both patient populations may differ. We therefore aimed to systematically compare presented problems and medication use in a population of police detainees to those of regular patients in general practice. METHODS: Health problems and prescription medications of 3232 detainees seen by the Amsterdam Forensic Medical Service were compared to those of general practice patients (n = 78,975) adjusted for age and gender during a 12-month period. RESULTS: Among those obtaining medical attention (28% of all detainees), almost 50% were diagnosed with mental health problems, with substance abuse as the leading reason for consultation. Forty-two percent received at least one prescription affecting the nervous system. In general practice, 17% (P < 0.001) of patients consulting their GP were diagnosed with mental health problems and 22% (P < 0.001) were prescribed medications affecting the nervous system. CONCLUSION: The magnitude of mental health problems among police detainees has significant implications for the qualifications of police health staff and those who provide health care in the police setting especially concerning substance abuse.
Asunto(s)
Fármacos del Sistema Nervioso Central/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Trastornos Mentales/epidemiología , Prisioneros/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Femenino , Medicina General , Humanos , Masculino , Trastornos Mentales/diagnóstico , Países Bajos/epidemiología , Policia , Atención Primaria de SaludRESUMEN
The Forensic Medical Service of the Public Health Service offers health care to detainees in police cells in Amsterdam. This study describes the registered mental health, addiction and social problems and compares them to the self-reported problems among a sample of detainees. Registers of the Forensic Medical Service are related to information from registers of police detention episodes. A general assessment of substance use, mental health and social problems is obtained by interviewing a sample of 264 detainees. The Forensic Medical Service was contacted in 24% of the 17,321 detention episodes. In 14% of the episodes mental or substance related disorders were observed. Within the sample 59% scored positively on indicators of substance abuse or mental health problems, 35% had additional social problems (debts, unemployment, housing). This proportion increased with age. It is concluded that substance abuse and mental health problems combined with social problems are highly prevalent among detainees, especially among the older ones. This urges for a close cooperation between Public Mental Health Care and Forensic Medical Services.
Asunto(s)
Trastornos Mentales/epidemiología , Prisioneros/estadística & datos numéricos , Adulto , Factores de Edad , Femenino , Personas con Mala Vivienda/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Policia , Problemas Sociales , Desempleo/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: Research on the mental health of police detainees is scarce. This study aimed to identify the proportion of persons detained by the Police Service Amsterdam-Amstelland who screened positive for a serious mental condition. METHODS: A survey conducted in 2009 among 264 randomly selected detainees assessed demographic characteristics and general medical and mental health and included use of the Brief Jail Mental Health Screen (BJMHS) (N=248). RESULTS: Almost 40% of survey respondents screened positive on the BJMHS, indicating a need for further evaluation. This rate was lower than the rate reported for police detainees in Australia but substantially higher than the rates reported for persons incarcerated in U.S. jails. CONCLUSIONS: More systematic research is needed to examine reasons for reports of different rates of mental illness among detainees in different countries.
Asunto(s)
Crimen/psicología , Trastornos Mentales/diagnóstico , Adulto , Crimen/estadística & datos numéricos , Femenino , Humanos , Entrevista Psicológica , Masculino , Trastornos Mentales/epidemiología , Países Bajos/epidemiología , Policia , Escalas de Valoración PsiquiátricaRESUMEN
The use of narrow-banded visible light sources in improving the visibility of injuries has been hardly investigated, and studies examining the extent of this improvement are lacking. In this study, narrow-banded beams of light within the visible light spectrum were used to explore their ability in improving the visibility of external injuries. The beams of light were induced by four crime-lites(®) providing narrow-banded beams of light between 400 and 550 nm. The visibility of the injuries was assessed through specific long-pass filters supplied with the set of crime-lites(®) . Forty-three percent of the examined injuries improved in visibility by using the narrow-banded visible light. In addition, injuries were visualized that were not visible or just barely visible to the naked eye. The improvements in visibility were particularly marked with the use of crime-lites(®) "violet" and "blue" covering the spectrum between 400-430 and 430-470 nm. The simple noninvasive method showed a great potential contribution in injury examination.
Asunto(s)
Luz , Iluminación/instrumentación , Heridas y Lesiones/patología , Adolescente , Adulto , Niño , Femenino , Medicina Legal/instrumentación , Hematoma/patología , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
AIM: Body packing is a way to deliver packets of drugs across international borders by ingestion. The aim of the study was to provide an estimate of the medical risks of body packing, describe predictors for hospital referral in detained body packers and provide an estimate for the prevalence of body packing in the Amsterdam area. METHODS: From May 2007 to December 2008, we studied medical records of body packers immediately detained after arrival at Amsterdam Schiphol airport, hospital records of both detained body packers and self-referrers at two emergency departments of hospitals in Amsterdam and records kept by forensic physicians in charge of post-mortem examinations of all unnatural deaths in the area (years 2005-2009). RESULTS: In airport detainees, the hospital referral rate was 4.2% (30 out of 707 detained body packers), the surgery rate was 1.3%. Significant predictors of hospital referral were delayed production of drug packets after arrest, cigarette smoking and country of departure. The surgery rate in self-referrers was comparable to the rate observed in those referred from the detention centre to hospital (30% vs. 31%). In addition, from 2005 to 2009, 20 proven cases of lethal body packing were identified. Based on our data, it is estimated that minimally 38% of all incoming body packers were missed by airport controls. CONCLUSION: The risk for lethal complications due to body packing is low on a population basis and comparable to other studies. This also applies for the hospital referral and surgery rates found in this study. Cigarette smoking has not yet been described in the literature as a potential predictor for hospital referral in detained body packers and therefore deserves attention in future research. A substantial fraction of body packers manages to remain undiscovered.
Asunto(s)
Crimen , Cuerpos Extraños , Drogas Ilícitas , Estómago , Viaje , Adulto , Aeropuertos , Servicio de Urgencia en Hospital , Femenino , Patologia Forense , Toxicología Forense , Humanos , Drogas Ilícitas/envenenamiento , Obstrucción Intestinal/etiología , Masculino , Países Bajos , Prisioneros , Derivación y Consulta/estadística & datos numéricos , Fumar/epidemiologíaRESUMEN
Epidemiological research on the physical health status of police detainees is scarce. The present study fills this gap by first studying the somatic reasons for consultation (n = 4396) and related prescriptions (n = 4912) as assessed by the forensic medical service during police detainment. Secondly, a health interview survey was conducted among randomly selected police detainees (n = 264) to collect information regarding their recent disease history and use of health care. Somatic health problems, medical consumption and health risk measures of the detainees were compared with those seen in the general population using general practitioner records and community health survey data. The study showed that, in police detainment, several chronic health conditions more often were the reason for consultation than in the general practice setting. In addition, the health interview survey data demonstrated that after adjustment for age and gender, the police detainees were 1.6 times more likely to suffer from one or more of the studied chronic diseases than the members from the general population. Furthermore, differences in several health risk measures, including body mass index, smoking and alcohol habits and health-care use were observed between the interviewed police detainees and the general population. These results provide insight into the variety of physical health problems of police detainees and are essential to develop optimal treatment strategies in police custody.
Asunto(s)
Enfermedad Crónica/epidemiología , Estado de Salud , Prisioneros/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Índice de Masa Corporal , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Medicina Legal , Encuestas Epidemiológicas , Cardiopatías/epidemiología , Humanos , Hipertensión/epidemiología , Artropatías/epidemiología , Enfermedades Pulmonares/epidemiología , Masculino , Fumar Marihuana/epidemiología , Persona de Mediana Edad , Países Bajos/epidemiología , Policia , Fumar/epidemiologíaRESUMEN
BACKGROUND: As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care. METHODS: This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records. RESULTS: Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands. CONCLUSION: The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants.
Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Migrantes/estadística & datos numéricos , Adulto , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Países Bajos , Investigación Cualitativa , Negativa al Tratamiento/estadística & datos numéricos , Migrantes/legislación & jurisprudencia , Migrantes/psicologíaRESUMEN
This study evaluated standard toxicology screening by forensic physicians during external post-mortem examination. Collected urine samples of decedents were screened on-site for the presence of 10 commonly used drugs by means of a rapid multidrug test. Urine samples of 53% of the cases appeared to be positive for one or more compounds. Importantly, several cases were revealed which were positive for toxicology screening without indications for use of these drugs at the scene of death or from medical history. Based on these (preliminary) results, further action to incorporate routine post-mortem toxicology as a tool in forensic death investigation is recommended.