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  • 1.
    Allen, Marie
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Divne, Anna-Maria
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Universal tag arrays in forensic SNP analysis.2005In: Methods in Molecular Biology, ISSN 1064-3745, E-ISSN 1940-6029, Vol. 297, p. 141-154Article in journal (Refereed)
    Abstract [en]

    Microarray-based single nucleotide polymorphism (SNP) genotyping enables simultaneous and rapid detection of a large number of markers and is thus an attractive method for forensic individual acid identification. This assay relies on a one-color detection system and minisequencing in solution before hybridization to universal tag arrays. The minisequencing reaction is based on incorporation of a fluorescent dideoxynucleotide to a primer containing a tag-sequence flanking the position to be interrogated. This one-color system detects C and T polymorphisms in separate reactions on multiple polymerase chain reaction targets with the fluorophore TAMRA coupled to the respective dideoxynucleotide. After incorporation, tagged primer sequences are hybridized through their complementary sequence on the array, and positive signals are detected by a confocal laser-scanner.

  • 2.
    Andersson, M. Gunnar
    et al.
    Natl Vet Inst, Dept Chem Environm & Feed Hyg, SE-75189 Uppsala, Sweden.
    Pålsson, Ann-Sofie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Natl Board Forens Med, Dept Forens Med, Box 1024, SE-75140 Uppsala, Sweden.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Natl Board Forens Med, Dept Forens Med, Box 1024, SE-75140 Uppsala, Sweden.
    Mostad, Petter
    Chalmers Univ Technol, Math Sci, Gothenburg, Sweden;Univ Gothenburg, Gothenburg, Sweden.
    Application of the Bayesian framework for forensic interpretation to casework involving postmortem interval estimates of decomposed human remains2019In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 301, p. 402-414Article in journal (Refereed)
    Abstract [en]

    We demonstrate how the Bayesian framework for forensic interpretation can be adapted for casework involving postmortem intervals (PMI) utilizing taphonomic data as well as how to overcome some of the limitations of current approaches for estimating and communicating uncertainty. A model is implemented for indoor cases based on partial body scores from three different anatomical regions as correlated functions of accumulated temperature (AT). The multivariate model enables estimation of PMI for human remains also when one or two local body scores are missing or undetermined, e.g. as a result of burns, scars or covered body parts. The model was trained using the expectation maximization algorithm, enabling us to account for uncertainty of PMI and/or ambient temperature in the training data. Alternative approaches reporting the results are presented, including the likelihood curve, likelihood ratios for competing hypotheses and posterior probability distributions and credibility intervals for PMI. The applicability or the approaches in different forensic scenarios is discussed.

  • 3. Budowle, B.
    et al.
    Gyllensten, Ulf
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Chakraborty, R.
    Allen, Marie
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Forensic analysis of the mitochondrial coding region and association to disease.2005In: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 119, no 5, p. 314-315Article in journal (Refereed)
  • 4.
    Bus, Magdalena M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Nilsson, Martina
    Swedish Police Author, Div Invest, Forens Sect, S-10675 Stockholm, Sweden..
    Allen, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Analysis of Mitochondrial DNA from a Burned, Ninhydrin-Treated Paper Towel2016In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 61, no 3, p. 828-832Article in journal (Refereed)
    Abstract [en]

    Contact-based evidence is likely to have limited quantities of DNA and may yield mixed profiles due to preexisting or contaminating DNA. In a recent arson investigation, a paper towel was collected and used as circumstantial evidence. The paper towel was partially burned and was likely set on fire with flammable liquid. As part of the investigation, the paper towel was treated with ninhydrin to visualize fingerprint evidence. Initial DNA analysis of two swabs was negative for short tandem repeat (STR) markers and revealed a mixture of mitochondrial DNA (mtDNA). Analysis of 13 additional cuttings yielded four more mixed profiles, but also two samples with a common single-source profile. The single-source mtDNA profile matched that of the primary suspect in the case. Thus, even if initial mtDNA analysis yields a mixed profile, a sampling strategy involving multiple locations can improve the chance of obtaining valuable single-source mtDNA profiles from compromised evidence in criminal casework.

  • 5.
    Ceciliason, Ann-Sofie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Natl Board Forens Med, Dept Forens Med, Box 1024, SE-75140 Uppsala, Sweden.
    Andersson, M Gunnar
    The National Veterinary Institute, Uppsala, Sweden.
    Lindström, Anders
    The National Veterinary Institute, Uppsala, Sweden.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Natl Board Forens Med, Dept Forens Med, Box 1024, SE-75140 Uppsala, Sweden.
    Quantifying human decomposition in an indoor setting and implications for postmortem interval estimation2018In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 283, p. 180-189Article in journal (Refereed)
    Abstract [en]

    This study's objective is to obtain accuracy and precision in estimating the postmortem interval (PMI) for decomposing human remains discovered in indoor settings. Data were collected prospectively from 140 forensic cases with a known date of death, scored according to the Total Body Score (TBS) scale at the post-mortem examination. In our model setting, it is estimated that, in cases with or without the presence of blowfly larvae, approximately 45% or 66% respectively, of the variance in TBS can be derived from Accumulated Degree-Days (ADD). The precision in estimating ADD/PMI from TBS is, in our setting, moderate to low. However, dividing the cases into defined subgroups suggests the possibility to increase the precision of the model. Our findings also suggest a significant seasonal difference with concomitant influence on TBS in the complete data set, possibly initiated by the presence of insect activity mainly during summer. PMI may be underestimated in cases with presence of desiccation. Likewise, there is a need for evaluating the effect of insect activity, to avoid overestimating the PMI. Our data sample indicates that the scoring method might need to be slightly modified to better reflect indoor decomposition, especially in cases with insect infestations or/and extensive desiccation. When applying TBS in an indoor setting, the model requires distinct inclusion criteria and a defined population.

  • 6.
    Divne, Anna-Maria
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Allen, Marie
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    A DNA microarray system for forensic SNP analysis2005In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 154, no 2-3, p. 111-121Article in journal (Refereed)
    Abstract [en]

    Forensic DNA analysis is routinely performed using polymorphic short tandem repeat (STR) markers. However, for degraded or minute DNA samples, analysis of autosomal single nucleotide polymorphisms (SNPs) in short fragments might be more successful. Furthermore, sequencing of mitochondrial DNA (mtDNA) is often performed on highly degraded or scarce samples due to the high copy number of mtDNA in each cell. Due to the increasing number of complete mtDNA genome sequences available, the limited discrimination power of an mtDNA analysis, may be increased by analysis of coding region polymorphisms in addition to the non-coding variation. Since sequence analysis of the coding region would require more material than generally present in forensic samples, an alternative SNP analysis approach is required. We have developed a one-colour microarray-based SNP detection system for limited forensic materials. The method is based on minisequencing in solution prior to hybridisation to universal tag-arrays. In a first outline of a forensic chip, a combination of 12 nuclear and 21 mitochondrial SNP markers are analysed simultaneously. The mitochondrial markers on the chip are polymorphisms within the hypervariable region as well as in the coding region. Even though the number of markers in the current system is limited, it can easily be extended to yield a greater power of discrimination. When fully developed, microarray analysis provides a promising system for efficient sensitive SNP analysis of forensic samples in the future.

  • 7.
    Divne, Anna-Maria
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Nilsson, Martina
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Calloway, Cassandra
    Reynolds, Rebecca
    Erlich, Henry
    Allen, Marie
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Molecular Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Forensic casework analysis using the HVI/HVII mtDNA linear array assay.2005In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 50, no 3, p. 548-554Article in journal (Refereed)
    Abstract [en]

    The mitochondrial hypervariable regions I and II have proven to be a useful target for analysis of forensic materials, in which the amount of DNA is limited or highly degraded. Conventional mitochondrial DNA (mtDNA) sequencing can be time-consuming and expensive, limitations that can be minimized using a faster and less expensive typing assay. We have evaluated the exclusion capacity of the linear array mtDNA HVI/HVII region-sequence typing assay (Roche Applied Science) in 16 forensic cases comprising 90 samples. Using the HVI/HVII mtDNA linear array, 56% of the samples were excluded and thus less than half of the samples require further sequencing due to a match or inconclusive results. Of all the samples that were excluded by sequence analysis, 79% could be excluded using the HVI/HVII linear array alone. Using the HVI/HVII mtDNA linear array assay, we demonstrate the potential to decrease sequencing efforts substantially and thereby reduce the cost and the turn-around time in casework analysis.

  • 8.
    Gedeborg, Rolf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Svennblad, Bodil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Prediction of mortality risk in victims of violent crimes2017In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 281, p. 92-97Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To predict mortality risk in victims of violent crimes based on individual injury diagnoses and other information available in health care registries.

    METHODS: Data from the Swedish hospital discharge registry and the cause of death registry were combined to identify 15,000 hospitalisations or prehospital deaths related to violent crimes. The ability of patient characteristics, injury type and severity, and cause of injury to predict death was modelled using conventional, Lasso, or Bayesian logistic regression in a development dataset and evaluated in a validation dataset.

    RESULTS: Of 14,470 injury events severe enough to cause death or hospitalization 3.7% (556) died before hospital admission and 0.5% (71) during the hospital stay. The majority (76%) of hospital survivors had minor injury severity and most (67%) were discharged from hospital within 1day. A multivariable model with age, sex, the ICD-10 based injury severity score (ICISS), cause of injury, and major injury region provided predictions with very good discrimination (C-index=0.99) and calibration. Adding information on major injury interactions further improved model performance. Modeling individual injury diagnoses did not improve predictions over the combined ICISS score.

    CONCLUSIONS: Mortality risk after violent crimes can be accurately estimated using administrative data. The use of Bayesian regression models provides meaningful risk assessment with more straightforward interpretation of uncertainty of the prediction, potentially also on the individual level. This can aid estimation of incidence trends over time and comparisons of outcome of violent crimes for injury surveillance and in forensic medicine.

  • 9.
    Gravensteen, Ida Kathrine
    et al.
    Oslo Univ Hosp, Dept Forens Sci, Box 4950 Nydalen, N-0424 Oslo, Norway.
    Ekeberg, Öivind
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1111 Blindern, N-0317 Oslo, Norway;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4956 Nydalen, Oslo, Norway.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Helweg-Larsen, Karin
    Univ Copenhagen, Dept Social Med, Copenhagen, Denmark.
    Hem, Erlend
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1111 Blindern, N-0317 Oslo, Norway;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4956 Nydalen, Oslo, Norway.
    Rogde, Sidsel
    Oslo Univ Hosp, Dept Forens Sci, Box 4950 Nydalen, N-0424 Oslo, Norway;Univ Oslo, Inst Clin Med, Box 1072 Blindern, N-0316 Oslo, Norway.
    Töllefsen, Ingvild Maria
    Oslo Univ Hosp Ullevaal, Div Med, Dept Acute Med, Box 4950 Nydalen, N-0424 Oslo, Norway.
    Psychoactive substances in natural and unnatural deaths in Norway and Sweden: a study on victims of suicide and accidents compared with natural deaths in psychiatric patients2019In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 19, article id 33Article in journal (Refereed)
    Abstract [en]

    Background: The extent of post-mortem detection of specific psychoactive drugs may differ between countries, and may greatly influence the national death register's classification of manner and cause of death. The main objective of the present study was to analyse the magnitude and pattern of post-mortem detection of various psychoactive substances by the manner of death (suicide, accidental, undetermined and natural death with a psychiatric diagnosis) in Norway and Sweden.

    Methods: The Cause of Death Registers in Norway and Sweden provided data on 600 deaths in 2008 from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of death and 200 as natural deaths in individuals with a diagnosis of mental disorder as the underlying cause of death. We examined death certificates and forensic reports including toxicological analyses.

    Results: The detection of psychoactive substances was commonly reported in suicides (66 and 74% in Norway and Sweden respectively), accidents (85 and 66%), undetermined manner of deaths (80% in the Swedish dataset) and in natural deaths with a psychiatric diagnosis (50 and 53%). Ethanol was the most commonly reported substance in the three manners of death, except from opioids being more common in accidental deaths in the Norwegian dataset. In cases of suicide by poisoning, benzodiazepines and z-drugs were the most common substances in both countries. Heroin or morphine was the most commonly reported substance in cases of accidental death by poisoning in the Norwegian dataset, while other opioids dominated the Swedish dataset. Anti-depressants were found in 22% of the suicide cases in the Norwegian dataset and in 29% of suicide cases in the Swedish dataset.

    Conclusions: Psychoactive substances were detected in 66 and 74% of suicides and in 85 and 66% of accidental deaths in the Norwegian and Swedish datasets, respectively. Apart from a higher detection rate of heroin in deaths by accident in Norway than in Sweden, the pattern of detected psychoactive substances was similar in the two countries. Assessment of a suicidal motive may be hampered by the common use of psychoactive substances in suicide victims.

  • 10.
    Johansson, Anna
    et al.
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Lindstedt, Daniel
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Roman, Markus
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Thelander, Gunilla
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Nielsen, Elisabet I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Lennborn, Ulrica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Natl Board Forens Med, Dept Forens Med, Uppsala, Sweden.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Ahlner, Johan
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Div Drug Res, Linkoping, Sweden..
    Kronstrand, Robert
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Div Drug Res, Linkoping, Sweden..
    Kugelberg, Fredrik C.
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Div Drug Res, Linkoping, Sweden..
    A non-fatal intoxication and seven deaths involving the dissociative drug 3-MeO-PCP2017In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 275, p. 76-82Article in journal (Refereed)
    Abstract [en]

    Introduction: 3-methoxyphencyclidine (3-MeO-PCP) appeared on the illicit drug market in 2011 and is an analogue of phencyclidine, which exhibits anesthetic, analgesic and hallucinogenic properties. In this paper, we report data from a non-fatal intoxication and seven deaths involving 3-MeO-PCP in Sweden during the period March 2014 until June 2016. Case descriptions: The non-fatal intoxication case, a 19-year-old male with drug problems and a medical history of depression, was found awake but tachycardic, hypertensive, tachypnoeic and catatonic at home. After being hospitalized, his condition worsened as he developed a fever and lactic acidosis concomitant with psychomotor agitation and hallucinations. After 22 h of intensive care, the patient had made a complete recovery. During his hospitalization, a total of four blood samples were collected at different time points. The seven autopsy cases, six males and one female, were all in their twenties to thirties with psychiatric problems and/or an ongoing drug abuse. Methods: 3-MeO-PCP was identified with liquid chromatography (LC)/time-of-flight technology and quantified using LC-tandem mass spectrometry. Results: In the clinical case, the concentration of 3-MeO-PCP was 0.14 mu g/g at admission, 0.08 mu g/g 2.5 h after admission, 0.06 mu g/g 5 h after admission and 0.04 mu g/g 17 h after admission. The half-life of 3-MeO-PCP was estimated to 11 h. In the autopsy cases, femoral blood concentrations ranged from 0.05 mu g/g to 0.38 mu g/g. 3-MeO-PCP was the sole finding in the case with the highest concentration and the cause of death was established as intoxication with 3-MeO-PCP. In the remaining six autopsy cases, other medications and drugs of abuse were present as well. Conclusion: Despite being scheduled in January 2015, 3-MeO-PCP continues to be abused in Sweden. Exposure to 3-MeO-PCP may cause severe adverse events and even death, especially if the user does not receive life-supporting treatment.

  • 11.
    Li, Xiaogai
    et al.
    Royal Inst Technol KTH, Sch Technol & Hlth, Div Neuron Engn, S-14152 Huddinge, Sweden.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. National Board of Forensic Medicine, Uppsala, Sweden.
    Kleiven, Svein
    Royal Inst Technol KTH, Sch Technol & Hlth, Div Neuron Engn, S-14152 Huddinge, Sweden.
    Infant skull fractures: Accident or abuse? Evidences from biomechanical analysis using finite element head models2019In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 294, p. 173-182Article in journal (Refereed)
    Abstract [en]

    Abusive Head Trauma (AHT) is considered by some authors to be a leading cause of traumatic death in children less than two years of age and skull fractures are commonly seen in cases of suspected AHT. Today, diagnosing whether the observed fractures are caused by abuse or accidental fall is still a challenge within both the medical and the legal communities and the central question is a biomechanical question: can the described history explain the observed fractures? Finite element (FE) analysis has been shown a valuable tool for biomechanical analysis accounting for detailed head geometry, advanced material modelling, and case-specific factors (e.g. head impact location, impact surface properties). Here, we reconstructed two well-documented suspected abuse cases (a 3- and a 4-month-old) using subject-specific FE head models. The models incorporate the anatomical details and age-dependent anisotropic material properties of infant cranial bones that reflect the grainy fibres radiating from ossification centres. The impact locations are determined by combining multimodality images. The results show that the skull fracture patterns in both cases of suspected abuse could be explained by the described accidental fall history, demonstrating the inherent potential of FE analysis for providing biomechanical evidence to aid forensic investigations. Increased knowledge of injury mechanisms in children may have enormous medico-legal implications world-wide.

  • 12. Li, Xiaogai
    et al.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. National Board of Forensic Medicine, Uppsala, Sweden.
    Kleiven, Svein
    The importance of nonlinear tissue modelling in finite element simulations of infant head impacts2017In: Biomechanics and Modeling in Mechanobiology, ISSN 1617-7959, E-ISSN 1617-7940, Vol. 16, no 3, p. 823-840Article in journal (Refereed)
    Abstract [en]

    Despite recent efforts on the development of finite element (FE) head models of infants, a model capable of capturing head responses under various impact scenarios has not been reported. This is hypothesized partially attributed to the use of simplified linear elastic models for soft tissues of suture, scalp and dura. Orthotropic elastic constants are yet to be determined to incorporate the direction-specific material properties of infant cranial bone due to grain fibres radiating from the ossification centres. We report here on our efforts in advancing the above-mentioned aspects in material modelling in infant head and further incorporate them into subject-specific FE head models of a newborn, 5- and 9-month-old infant. Each model is subjected to five impact tests (forehead, occiput, vertex, right and left parietal impacts) and two compression tests. The predicted global head impact responses of the acceleration-time impact curves and the force-deflection compression curves for different age groups agree well with the experimental data reported in the literature. In particular, the newly developed Ogden hyperelastic model for suture, together with the nonlinear modelling of scalp and dura mater, enables the models to achieve more realistic impact performance compared with linear elastic models. The proposed approach for obtaining age-dependent skull bone orthotropic material constants counts both an increase in stiffness and decrease in anisotropy in the skull bone-two essential biological growth parameters during early infancy. The profound deformation of infant head causes a large stretch at the interfaces between the skull bones and the suture, suggesting that infant skull fractures are likely to initiate from the interfaces; the impact angle has a profound influence on global head impact responses and the skull injury metrics for certain impact locations, especially true for a parietal impact.

  • 13.
    Lundholm, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Substance Use and Violence: Influence of Alcohol, Illicit Drugs and Anabolic Androgenic Steroids on Violent Crime and Self-directed Violence2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Interpersonal violence and suicide are major health concerns, leading to premature death, extensive human suffering and staggering monetary costs. Although violent behaviour has multiple causes, it is well known that acute substance intake and abuse increase the risks of both interpersonal and self-directed violence. This association is quite well established for alcohol, while a more ambiguous literature exists for other common drugs of abuse. For example, anabolic androgenic steroids (AAS), synthetic analogues to the “male” sex hormone testosterone are suggested to elicit violent and aggressive behaviour. Two studies (I and III) in the present thesis addressed the association between AAS use and being suspected or convicted of a violent crime among remand prisoners and in a general population sample, respectively. Further, using the case-crossover design to control for confounders stable within individuals, I also investigated the triggering (short-term risk) effect of alcohol and drugs such as benzodiazepines and AAS, on violent crime (Study II). Finally, a fourth study (IV) based on a large national forensic sample of suicide completers (n=18,894) examined the risk of using a violent, more lethal, suicide method, when under acute influence of alcohol, central stimulants or cannabis.

    The results of this thesis suggested that AAS use in itself is not a proximal risk factor for violent crime; the observed risk is probably due to the co-occurrence of abuse of other substances. Alcohol is a strong triggering risk factor for violent crime, constant across males and females as well as individuals with or without behavioral and psychiatric vulnerability. Intake of high doses of benzodiazepines is associated with an increased risk for violent crime. Cannabis use is associated with an increased risk of using the lethal suicide method of jumping from a height. I conclude that mapping substance abuse patterns may inform violence risk assessment and treatment planning.

    List of papers
    1. Use of anabolic androgenic steroids in substance abusers arrested for crime
    Open this publication in new window or tab >>Use of anabolic androgenic steroids in substance abusers arrested for crime
    2010 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 111, no 3, p. 222-226Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Use of anabolic androgenic steroids (AASs) has been associated with both violent crime and the use of illicit drugs. The scientific literature on polysubstance abuse as a confounder for AAS-related violence is sparse and ambiguous. With the intent of further investigating this issue, we have gathered data concerning drug abuse and AAS experience among substance abusers who have been arrested for a variety of crimes. METHODS: Data were collected from structured interviews with substance abusers (n=3597) apprehended at two remand prisons in Sweden from 2002 through 2008. Analyses concerned type of criminal act, primary drug used during the past year, and experience of AAS use. RESULTS: Those stating AAS experience (n=924, 20 women and 904 men) were more often apprehended for violent crimes (OR=1.65). This association remained significant after controlling for age and sex (OR=1.28). AAS users and non-users claimed similar primary substances of use during the past year, with the exception of benzodiazepine use, which was more common in the AAS group (OR=2.30), although this did not affect the frequency of violent crime. Among AAS-experienced participants, there was no difference in violent crime incidence between current users and former users. CONCLUSIONS: Study results suggest that AASs do not function as a proximal trigger for violence but still involve an increased risk for violence in users of illicit drugs. These findings also suggest that AAS use is highly overrepresented in women who commit crimes.

    Keywords
    Anabolic androgenic steroids; Violent crime; Substance abuse
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-130376 (URN)10.1016/j.drugalcdep.2010.04.020 (DOI)000283969900006 ()20627426 (PubMedID)
    Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2017-12-12Bibliographically approved
    2. The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study
    Open this publication in new window or tab >>The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study
    Show others...
    2013 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 129, no 1-2, p. 110-115Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    The association between substance abuse, particularly alcohol abuse, and violence has been well established. However, since substance abuse co-occurs with several other risk factors for violence, the causal link between substance abuse and violence and the extent to which the acute influence of alcohol, illicit drugs, benzodiazepines, and anabolic androgenic steroids have a triggering effect on violent behavior are more uncertain.

    METHODS:

    Case-crossover design was used based on data from structured face to face interviews with remand prisoners (n=194; 172 men, 22 women) suspected of violent crimes. Main outcome measure: odds ratio (OR 95% CI) for a violent crime, 24h after exposure to different substances, compared to periods of no exposure was calculated using conditional logistic regression and a Mantel-Haenszel estimator with confidence intervals for sparse data.

    RESULTS:

    Intake of alcohol (OR 6.41 CI 4.24-9.67) and large doses of benzodiazepines (OR 36.32 CI 7.14-183.65) triggered interpersonal violence. Stratified analyses of possible effect modifiers were sex, conduct/behavioral problems, trauma experiences; psychiatric vulnerability did not reveal any substantial differences.

    CONCLUSION:

    Influences of alcohol and unusually high doses of benzodiazepines are proximal risk factors for violent crime. Improved knowledge of short-term (and dose-related) risk factors may contribute to treatment planning and risk assessment of violence.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-188722 (URN)10.1016/j.drugalcdep.2012.09.019 (DOI)000316827600015 ()23102731 (PubMedID)
    Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2017-12-06Bibliographically approved
    3. Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men
    Open this publication in new window or tab >>Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men
    2015 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 1, p. 100-108Article in journal (Refereed) Published
    Abstract [en]

    Background and AimsAnabolic androgenic steroid (AAS) use is associated with aggressive and violent behaviour, but it remains uncertain if this relationship is causal in humans. We examined the link between AAS use and violent crime while controlling for polysubstance abuse and additional suggested risk factors for violence. DesignCross-sectional study of a population-based sample. SettingIn 2005, all Swedish-born male twins aged 20-47 years were invited to participate in the Swedish Twin Adults: Genes and Environment (STAGE) survey of the Swedish Twin Register (response rate=60%). ParticipantsA total of 10365 male survey participants with information on AAS use. MeasurementData on self-reported use of AAS, alcohol and other substances, attention deficit hyperactivity disorder (ADHD) and personality disorder symptoms were linked to nation-wide, longitudinal register information on criminal convictions, IQ, psychological functioning and childhood socio-economic status (SES) covariates. FindingsAny life-time use of AAS was associated strongly with conviction for a violent crime [2.7 versus 0.6% in convicted and non-convicted men, respectively; odds ratio (OR)=5.0, 95% confidence interval (CI)=2.7-9.3]. However, this link was substantially reduced and no longer significant when controlling for other substance abuse (OR=1.6, 95% CI=0.8-3.3). Controlling for IQ, psychological functioning, ADHD, personality disorder symptoms and childhood SES did not reduce the risk further. ConclusionIn the general population, co-occurring polysubstance abuse, but not IQ, other neuropsychological risks or socio-economic status, explains most of the relatively strong association between any anabolic androgenic steroid use and conviction for a violent crime.

    Keywords
    Anabolic androgenic steroids; general population; polysubstance abuse; psychiatry; survey; violent crime
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-193290 (URN)10.1111/add.12715 (DOI)000346699700017 ()25170826 (PubMedID)
    Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2017-12-06
    4. Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study
    Open this publication in new window or tab >>Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study
    Show others...
    2014 (English)In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 59, no 2, p. 436-440Article in journal (Refereed) Published
    Abstract [en]

    Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC) or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the non-violent method self-poisoning and alcohol/illicit drugs negative suicide decedents. Multivariate analysis was conducted and the results revealed that acute influence of THC was related to using the violent suicide method; jumping from a height (RR 1.62; 95%CI 1.01-2.41). Alcohol intoxication was not related to any violent method, while the central stimulants positive suicide decedent had a higher, albeit not significant, risk for several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.

     

    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-193294 (URN)10.1111/1556-4029.12353 (DOI)000332307900020 ()
    Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2017-12-06Bibliographically approved
  • 14.
    Mostad, Petter
    et al.
    Chalmers Univ Technol, Math Sci, Gothenburg, Sweden;Gothenburg Univ, Math Sci, Gothenburg, Sweden.
    Tamsen, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Error rates for unvalidated medical age assessment procedures2019In: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 133, no 2, p. 613-623Article in journal (Refereed)
    Abstract [en]

    During 2014-2015, Sweden received asylum applications from more than 240,000 people, of which more than 40,000 were termed unaccompanied minors. In a large number of cases, claims by asylum seekers of being below 18 years were not trusted by Swedish authorities. To handle the situation, the Swedish national board of forensic medicine (Rattsmedicinalverket, RMV) was assigned by the government to create a centralized system for medical age assessments. RMV introduced a procedure including two biological age indicators; x-ray of the third molars and magnetic resonance imaging of the distal femoral epiphysis. In 2017, a total of 9617 males and 337 females were subjected to this procedure. No validation study for the procedure was however published, and the observed number of cases with different maturity combinations in teeth and femur were unexpected given the claims originally made by RMV. We present a general stochastic model enabling us to study which combinations of age indicator model parameters and age population profiles are consistent with the observed 2017 data for males. We find that, contrary to some RMV claims, maturity of the femur, as observed by RMV, appears on average well before maturity of teeth. According to our estimates, approximately 15% of the tested males were children. These children had an approximate 33% risk of being classified as adults. The corresponding risk for an adult to be misclassified as a child was approximately 7%. We determine uncertainties and ranges of estimates under reasonable perturbations of the prior.

  • 15.
    Nilsson, Martina
    et al.
    Swedish Police Author, Div Invest, Forens Sect, S-10675 Stockholm, Sweden..
    Grånemo, Joakim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Bus, Magdalena M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Havsjö, Mikael
    AlphaHelix Technol AB, Penarp 1150, S-26491 Klippan, Sweden..
    Allen, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Comparison of DNA polymerases for improved forensic analysis of challenging samples2016In: Forensic Science International: Genetics, ISSN 1872-4973, E-ISSN 1878-0326, Vol. 24, p. 55-59Article in journal (Refereed)
    Abstract [en]

    Inhibitors of polymerase chain reaction (PCR) amplification often present a challenge in forensic investigations of e.g., terrorism, missing persons, sexual assaults and other criminal cases. Such inhibitors may be counteracted by dilution of the DNA extract, using different additives, and selecting an inhibitory resistant DNA polymerase. Additionally, DNA in forensic samples is often present in limited amounts and degraded, requiring special analyses of short nuclear targets or mitochondrial DNA. The present study evaluated the enzymes AmpliTaq Gold, HotStarTaq Plus, KAPA3G Plant, and KAPA2G Robust, with regard to their ability to overcome inhibitory effects. Our data showed that diluting the extracts and adding bovine serum albumin may increase the yield of the PCR product. However, the largest impact was observed when alternative enzymes were utilized, instead of the commonly used AmpliTaq Gold. KAPA2G Robust presented the highest amplification efficiency in the presence of the inhibitor ammonium nitrate. Moreover, the KAPA3G Plant enzyme had the highest efficiency in amplifying degraded DNA from old buried bone material. KAPA3G Plant and KAPA2G Robust may thus be useful for counteracting inhibitors and improving the analysis of challenging samples.

  • 16.
    Nilsson, Martina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Possnert, Göran
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Ion Physics.
    Edlund, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Budowle, Bruce
    Kjellström, Anna
    Allen, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Analysis of the putative remains of a European patron saint--St. Birgitta2010In: PLoS ONE, ISSN 1932-6203, Vol. 5, no 2, p. e8986-Article in journal (Refereed)
    Abstract [en]

    Saint Birgitta (Saint Bridget of Sweden) lived between 1303 and 1373 and was designated one of Europe's six patron saints by the Pope in 1999. According to legend, the skulls of St. Birgitta and her daughter Katarina are maintained in a relic shrine in Vadstena abbey, mid Sweden. The origin of the two skulls was assessed first by analysis of mitochondrial DNA (mtDNA) to confirm a maternal relationship. The results of this analysis displayed several differences between the two individuals, thus supporting an interpretation of the two skulls not being individuals that are maternally related. Because the efficiency of PCR amplification and quantity of DNA suggested a different amount of degradation and possibly a very different age for each of the skulls, an orthogonal procedure, radiocarbon dating, was performed. The radiocarbon dating results suggest an age difference of at least 200 years and neither of the dating results coincides with the period St. Birgitta or her daughter Katarina lived. The relic, thought to originate from St. Birgitta, has an age corresponding to the 13(th) century (1215-1270 cal AD, 2sigma confidence), which is older than expected. Thus, the two different analyses are consistent in questioning the authenticity of either of the human skulls maintained in the Vadstena relic shrine being that of St. Birgitta. Of course there are limitations when interpreting the data of any ancient biological materials and these must be considered for a final decision on the authenticity of the remains.

  • 17.
    Norlin, Stina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Nilsson, Martina
    Heden, Per
    Allen, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Evaluation of the Impact of Different Visualization Techniques on DNA in Fingerprints2013In: Journal of Forensic Identification, ISSN 1556-4029, Vol. 63, no 2, p. 189-204Article in journal (Refereed)
    Abstract [en]

    More than 200 latent fingerprints were deposited on various surfaces under controlled conditions and then developed using nine different visualization techniques. DNA was extracted from the fingerprints and the samples were subsequently quantified for nuclear and mitochondrial DNA content, using real-time PCR. The results show that several of the evaluated visualization techniques (e.g., Wet Powder and black fingerprint powder) do not damage DNA and allow DNA analysis to a large extent. However, some of the visualization techniques (e.g., physical developer and silver nitrate) seem to eliminate DNA completely, highly degrade DNA, or introduce inhibitors, preventing subsequent analysis. Furthermore, the results demonstrate great variation in DNA amounts detected in samples developed with the same method.

  • 18.
    Petersson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Characteristics and Consequences of Use of Anabolic Androgenic Steroids in Poly Substance Abuse2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The use of anabolic androgenic steroids (AAS) has been associated with use of illegal or unprescribed prescription drugs, as well as different adverse psychiatric effects, such as ma-nia, psychosis and hostility. Further, there is an association between use of AAS and other different risk behaviours, including carrying guns and reckless driving. Taken together, these data suggest that there is a group of AAS users that are not elite athletes, but rather young men at risk for psychiatric illness and criminality, and who use AAS primarily for their aes-thetic effects and possibly for their psychoactive effects. The aim of this thesis is to investi-gate further the connection between use of AAS and use of other drugs, and to investigate whether the proposed side effects of AAS cause an increase in morbidity and mortality.

    The first study (Paper I) investigates morbidity and mortality in persons testing positive for AAS compared to persons testing negative for AAS at a doping laboratory. Paper II of this thesis studies the presence of psychoactive drugs in diseased men who tested positive for AAS upon autopsy and whether there is any difference between deceased users of AAS and deceased users of heroin or amphetamine (control group). The third article (Paper III) dis-cusses a surprising finding in paper I of increased seizures NOS in users of AAS. Paper IV and V are interview studies from an out-patient substance abuse clinic.

    The main findings in Paper I was that the majority of deceased users of AAS were also positive for other drugs and/or alcohol on autopsy, and that users of AAS more often than the control group had died from intentional death (suicide or homicide). The main finding of Paper II was that users of AAS were severely at risk for premature death compared to both the control group and the general population. Paper III concluded that the high prevalence of Convulsion NOS in users of AAS most likely was the result of concomitant substance abuse and withdrawal from such use. Paper IV concluded that twelve percent of the patients at the substance abuse clinic had used AAS for at least one cycle. Users of AAS had a higher risk of having been convicted of a violent offence, and users of AAS more often reported having been physically abused. In Paper V, long-terme users of AAS were found to have an increased risk for developing depression in connection with cessation of AAS use. AAS was also re-ported to be used in preparation for crime.

    In summary, this thesis concludes that there is a solid association between use of AAS and use of other psychotropic drugs in certain subpopulations, and that users of AAS are at risk for premature death due to unnatural causes that may be secondary to use of AAS.

    List of papers
    1. Morbidity and mortality in patients testing positively for the prsesence of anabolic androgenic steroids in connecion with receiving medical care: A controlled retrospective cohort study
    Open this publication in new window or tab >>Morbidity and mortality in patients testing positively for the prsesence of anabolic androgenic steroids in connecion with receiving medical care: A controlled retrospective cohort study
    2006 In: Drug and Alcohol Dependence, ISSN 0376-8716/S, Vol. 81, no 3, p. 241-249Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-97488 (URN)
    Available from: 2008-09-04 Created: 2008-09-04Bibliographically approved
    2. Toxicological findings and manner of death in autopsied users of anabolic adrogenic steroids
    Open this publication in new window or tab >>Toxicological findings and manner of death in autopsied users of anabolic adrogenic steroids
    Show others...
    2006 In: Drug and Alcohol Dependence, Vol. 81, no 3, p. 215 220-Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-97489 (URN)
    Available from: 2008-09-04 Created: 2008-09-04Bibliographically approved
    3. Convulsions in users of anabolic androgenic steroids: Possible explanations
    Open this publication in new window or tab >>Convulsions in users of anabolic androgenic steroids: Possible explanations
    2007 (English)In: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 27, no 6, p. 723-725Article in journal, Letter (Refereed) Published
    Keywords
    Adult, Anabolic Agents, Androgens, Fatal Outcome, Humans, Male, Seizures, Status Epilepticus, administration & dosage, adverse effects, chemically induced, diagnosis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97490 (URN)10.1097/JCP.0b013e31815a883c (DOI)000251181600032 ()
    Available from: 2008-09-04 Created: 2008-09-04 Last updated: 2017-12-14Bibliographically approved
    4. Use of anabolic androgenic steroids at an outpatient substance abuse clinic in Stockholm, Sweden
    Open this publication in new window or tab >>Use of anabolic androgenic steroids at an outpatient substance abuse clinic in Stockholm, Sweden
    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97491 (URN)
    Available from: 2008-09-04 Created: 2008-09-04 Last updated: 2013-08-15Bibliographically approved
    5. The significance of anabolic androgenic steroids in a Swedish prison population
    Open this publication in new window or tab >>The significance of anabolic androgenic steroids in a Swedish prison population
    2010 (English)In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 51, no 3, p. 312-318Article in journal (Refereed) Published
    Abstract [en]

    Use of anabolic androgenic steroids (AAS) has been associated with adverse psychiatric effect, violent behavior, and criminality. The aim of this study was to further investigate the motives for and consequences of AAS use, with focus on violent and antisocial behavior. Fifty-nine prisoners were interviewed on their use of AAS, and their history was mapped with Addiction Severity Index interviews. Of these prisoners, 56% admitted previous use of AAS, of whom 24% declared to have committed violent crimes in connection with use of AAS. However, the only significant difference between users and nonusers with regard to criminal history when measured with the Addiction Severity Index was that the AAS users more often stated that they had been prosecuted for crimes labeled as “other crimes,” which did not include violent crimes. The reported side effects of AAS corresponded well to those previously reported. These results indicate that use of AAS is common among Swedish prisoners and that the motives and consequences of such use are similar to what has been observed in other AAS-using populations. Furthermore, this study supports earlier notions that misuse of AAS might cause violent behavior, but only in certain individuals and mainly in combination with other substances.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96842 (URN)10.1016/j.comppsych.2009.05.007 (DOI)000277112700013 ()
    Available from: 2008-03-14 Created: 2008-03-14 Last updated: 2017-12-14Bibliographically approved
  • 19. Rammer, L
    et al.
    Gerdin, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Dilution of blood in fresh water drowning. Post-mortem determination of osmolarity and electrolytes in blood, cerebrospinal fluid and vitreous humor.1976In: Forensic science, ISSN 0300-9432, Vol. 8, no 3Article in journal (Refereed)
    Abstract [en]

    In an attempt to detect signs of dilution of blood 38 autopsy cases of drowning in fresh water and 35 cases with other causes of death were investigated. Osmolarity and sodium and potassium concentrations were determined in serum from the right and left sides of the heart, cerebrospinal fluiid and vitreous humor...

  • 20. Romelsjö, Anders
    et al.
    Engdahl, Barbro
    Stenbacka, Marlene
    Fugelstad, Anna
    Davstad, Ingrid
    Leifman, Anders
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Were the changes to Sweden's maintenance treatment policy 2000-06 related to changes in opiate-related mortality and morbidity?2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 9, p. 1625-1632Article in journal (Refereed)
    Abstract [en]

    Aims To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006. Design We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden. Setting Sweden. Participants Patients in maintenance treatment. Measurements Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations. Findings The surveys showed a marked change to a less restrictive policy, with increased use of 'take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County. Conclusions The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

  • 21.
    Samuel, Gabrielle
    et al.
    Kings Coll London, Dept Global Hlth & Social Med, London, England.
    Howard, Heidi Carmen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Cornel, Martina
    Amsterdam UMC, Amsterdam Publ Hlth Res Inst, Dept Clin Genet, Sect Community Genet, Amsterdam, Netherlands.
    van El, Carla
    Amsterdam UMC, Amsterdam Publ Hlth Res Inst, Dept Clin Genet, Sect Community Genet, Amsterdam, Netherlands.
    Hall, Alison
    PHG Fdn, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Forzano, Francesca
    Guys & St Thomas NHS Fdn Trust, Clin Genet Dept, London, England.
    Prainsack, Barbara
    Kings Coll London, Dept Global Hlth & Social Med, London, England;Univ Vienna, Dept Polit Sci, Vienna, Austria.
    A response to the forensic genetics policy initiative's report "Establishing Best Practice for Forensic DNA Databases"2018In: Forensic Science International: Genetics, ISSN 1872-4973, E-ISSN 1878-0326, Vol. 36, p. E19-E21Article in journal (Other academic)
  • 22.
    Strobl, Christina
    et al.
    Med Univ Innsbruck, Inst Legal Med, Mullerstr 44, A-6020 Innsbruck, Austria.
    Eduardoff, Mayra
    Med Univ Innsbruck, Inst Legal Med, Mullerstr 44, A-6020 Innsbruck, Austria.
    Bus, Magdalena M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Allen, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Parson, Walther
    Med Univ Innsbruck, Inst Legal Med, Mullerstr 44, A-6020 Innsbruck, Austria;Penn State Univ, Forens Sci Program, University Pk, PA 16802 USA.
    Evaluation of the precision ID whole MtDNA genome panel for forensic analyses2018In: Forensic Science International: Genetics, ISSN 1872-4973, E-ISSN 1878-0326, Vol. 35, p. 21-25Article in journal (Refereed)
    Abstract [en]

    Mitochondrial DNA (mtDNA) amplification and Massively Parallel Sequencing (MPS) using an early access version of the Precision ID Whole MtDNA Genome Panel (Thermo Fisher Scientific) and the Ion Personal Genome Machine (PGM) were evaluated using 15 forensically relevant samples. Samples were selected to represent typical forensic specimens for mtDNA analysis including hairs, hair shafts, swabs and ancient solid tissue samples (bones and teeth) that were stored in the freezer for up to several years after having been typed with conventional Sanger-type Sequencing and Capillary Electrophoresis. The MPS haplotypes confirmed the earlier results in all samples and provided additional sequence information that improved discrimination power and haplogroup estimation. The results raised the appetite for further experiments to validate and apply the new technology in forensic practice.

  • 23.
    Tamsen, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Homicide Injury Quantification: Measures of injury severity in homicide victims and associations with homicide characteristics2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Some previous studies have found that the amount and severity of injuries in homicide victims correlate with different homicide characteristics, such as the victim-offender relationship and drug influence of the offender. If such relationships exist, they may be used by homicide investigators as part of an offender profiling.

    Furthermore, injury severity may be helpful in understanding the nature of lethal violence. If the injuries change over time or differ between regions, this may say something about the underlying causes and thus help society to take preventive measures. However, measures of injury severity are often missing in homicide epidemiology. This may in part be due to a lack of standardized and accessible ways to quantify injuries in homicide victim.

    To address these issues, there is a need for methods to quantify injury severity in homicide victims. The aim of the current thesis was to investigate different types of injury measures and their applicability to homicide victims. The aim was also to use such measures to address research questions related to offender profiling.

    Starting off with injury scores used in trauma research and two scores developed specifically for homicide victims, these measures were applied to a general homicide population. Since there is no obvious “gold standard” for injury severity quantification on homicide victims, one had to be defined to validate the applied methods. Out of forensic experience and rational reasoning, the Sum of all AIS scores (SAIS) was proposed as a reference measure. The other scores were then evaluated through their correlations with the SAIS.

    In the following study, the injury severity in homicides from different time periods was measured. There were statistically significant increases over time with respect to excessive injuries and the number of lethal injuries per victim. These changes can reflect both a brutalization of homicidal violence, improved trauma care, or shifts in the methods by which people are killed.

    Next, the associations between injury severity and homicide characteristics were analysed. No relevant associations between injury severity and victim-offender relationship were found. Neither were there any connections between benzodiazepine influence in the offender and injury severity on the victim. Thus, the studies do not support the use of injury severity scores for offender profiling in a general homicide population.

    List of papers
    1. Homicide Injury Quantification: Correlations and Reliability of Injury Severity Scores Applied to Homicide Victims
    Open this publication in new window or tab >>Homicide Injury Quantification: Correlations and Reliability of Injury Severity Scores Applied to Homicide Victims
    2015 (English)In: Homicide Studies, ISSN 1088-7679, E-ISSN 1552-6720, Vol. 19, no 1, p. 88-100Article in journal (Refereed) Published
    Abstract [en]

    No generally accepted method exists for quantifying the degree of injury in homicide victims. This study explores six different injury severity scores with the goal to recommend a valid method that is reliable and easy to use. To investigate this issue, 103 homicides are examined regarding the correlations between these scores. This study concludes that the Homicide Injury Scale is valid, easy to use, and has a satisfactory inter-rater reliability.

    Keywords
    homicide, lethal violence, injury severity score, quantification
    National Category
    Forensic Science
    Identifiers
    urn:nbn:se:uu:diva-243424 (URN)10.1177/1088767914558142 (DOI)000346910300005 ()
    Available from: 2015-02-17 Created: 2015-02-09 Last updated: 2019-05-21Bibliographically approved
    2. Quantifying Homicide Injuries:: A Swedish Time Trend Study Using the Homicide Injury Scale
    Open this publication in new window or tab >>Quantifying Homicide Injuries:: A Swedish Time Trend Study Using the Homicide Injury Scale
    2017 (English)In: Scandinavian Journal of Forensic Science, ISSN 2353-0707, Vol. 23, no 2Article in journal (Refereed) Published
    Abstract [en]

    Studies report that the homicide rate has decreased considerably in most Western countries since the 1990s. However, few studies have examined the level of injury in homicides. The injury severity in homicide victims was studied in the Stockholm area using both the Homicide Injury Scale (HIS) and the number of lethal injuries per victim. Cases were included from four periods; 1976-78, 1986- 88, 1996-98, and 2006-08. The number of homicides with overkill according to the HIS was significantly higher in 1996-98 compared to 1976-78. Compared with 1976-78, the number of lethal injuries per victim was significantly higher both in 1986-88 and 1996-98. There are various possible reasons for the changes, including a brutalization of lethal violence or a more effective trauma care. More in-depth analysis of individual cases together with research on victims of attempted homicides is needed to explain these shifts in injury severity.

    National Category
    Forensic Science
    Identifiers
    urn:nbn:se:uu:diva-383632 (URN)10.1515/sjfs-2017-0005 (DOI)
    Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-09-03Bibliographically approved
    3. Homicide injury severity in association with the victim-offender relationship
    Open this publication in new window or tab >>Homicide injury severity in association with the victim-offender relationship
    2019 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 300, p. 151-156Article in journal (Refereed) Published
    Abstract [en]

    There are previous studies that have found associations between specific injury patterns and different victim-offender relationships (VORs) in homicides. We have used quantitative injury severity scores to further investigate this issue. The amount and severity of injuries were assessed in 178 Swedish homicide victims, retrospectively included from the years 2007-2009. We analyzed whether different injury measures could be used to predict the VOR. In addition to a deeper understanding of violent behavior, such associations may be of help to homicide investigators for offender profiling. The victims' injuries were assessed with eleven different methods. The cases with known VORs were divided into four categories: partner, relative, acquaintance, and stranger. The injury seventies were then compared between these categories. No relevant differences were found. Thus, the current study does not support the claim that the VOR can be predicted from the injury severity in a general homicide population. These findings are in contrast to the results of some previous studies but confirm those of others.

    Keywords
    Homicide, Injury score, Injury quantification, Offender profiling
    National Category
    Forensic Science
    Identifiers
    urn:nbn:se:uu:diva-383634 (URN)10.1016/j.forsciint.2019.05.012 (DOI)000470903500030 ()
    Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-07-05Bibliographically approved
    4. Homicide injury severity in association with benzodiazepine influence
    Open this publication in new window or tab >>Homicide injury severity in association with benzodiazepine influence
    (English)Manuscript (preprint) (Other academic)
    National Category
    Forensic Science
    Identifiers
    urn:nbn:se:uu:diva-383635 (URN)
    Note

    Submitted to Homicide Studies

    Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-05-21
  • 24.
    Tamsen, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Logan, Fia Klötz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Addendum to "Homicide Injury Quantification: Correlations and Reliability of Injury Severity Scores Applied to Homicide Victims."€ Volume 19, Issue 1, pp. 88-1002016In: Homicide Studies, ISSN 1088-7679, E-ISSN 1552-6720, Vol. 20, p. 342-343Article in journal (Other academic)
  • 25.
    Tamsen, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Logan, Fia Klötz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Homicide Injury Quantification: Correlations and Reliability of Injury Severity Scores Applied to Homicide Victims2015In: Homicide Studies, ISSN 1088-7679, E-ISSN 1552-6720, Vol. 19, no 1, p. 88-100Article in journal (Refereed)
    Abstract [en]

    No generally accepted method exists for quantifying the degree of injury in homicide victims. This study explores six different injury severity scores with the goal to recommend a valid method that is reliable and easy to use. To investigate this issue, 103 homicides are examined regarding the correlations between these scores. This study concludes that the Homicide Injury Scale is valid, easy to use, and has a satisfactory inter-rater reliability.

  • 26.
    Tamsen, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Sturup, Joakim
    Swedish Police Authority.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Homicide injury severity in association with benzodiazepine influenceManuscript (preprint) (Other academic)
  • 27.
    Tamsen, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Sturup, Joakim
    Swedish Police Author, Stockholm, Stockholm Regio, Sweden;Swedish Natl Board Forens Med, Dept Forens Psychiat, Stockholm, Sweden.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Swedish Natl Board Forens Med, Dept Forens Med, Stockholm, Sweden.
    Homicide injury severity in association with the victim-offender relationship2019In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 300, p. 151-156Article in journal (Refereed)
    Abstract [en]

    There are previous studies that have found associations between specific injury patterns and different victim-offender relationships (VORs) in homicides. We have used quantitative injury severity scores to further investigate this issue. The amount and severity of injuries were assessed in 178 Swedish homicide victims, retrospectively included from the years 2007-2009. We analyzed whether different injury measures could be used to predict the VOR. In addition to a deeper understanding of violent behavior, such associations may be of help to homicide investigators for offender profiling. The victims' injuries were assessed with eleven different methods. The cases with known VORs were divided into four categories: partner, relative, acquaintance, and stranger. The injury seventies were then compared between these categories. No relevant differences were found. Thus, the current study does not support the claim that the VOR can be predicted from the injury severity in a general homicide population. These findings are in contrast to the results of some previous studies but confirm those of others.

  • 28.
    Tamsen, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Sturup, Joakim
    Karolinska Institute, Stockholm, Sweden.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Quantifying Homicide Injuries:: A Swedish Time Trend Study Using the Homicide Injury Scale2017In: Scandinavian Journal of Forensic Science, ISSN 2353-0707, Vol. 23, no 2Article in journal (Refereed)
    Abstract [en]

    Studies report that the homicide rate has decreased considerably in most Western countries since the 1990s. However, few studies have examined the level of injury in homicides. The injury severity in homicide victims was studied in the Stockholm area using both the Homicide Injury Scale (HIS) and the number of lethal injuries per victim. Cases were included from four periods; 1976-78, 1986- 88, 1996-98, and 2006-08. The number of homicides with overkill according to the HIS was significantly higher in 1996-98 compared to 1976-78. Compared with 1976-78, the number of lethal injuries per victim was significantly higher both in 1986-88 and 1996-98. There are various possible reasons for the changes, including a brutalization of lethal violence or a more effective trauma care. More in-depth analysis of individual cases together with research on victims of attempted homicides is needed to explain these shifts in injury severity.

  • 29.
    Thiblin, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Fugelstad, Anna
    Felaktiga slutsatser om narkotikadödsfall2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, article id EC63Article in journal (Other academic)
  • 30.
    Thiblin, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Michard, Jean-Francois
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Rättsmedicin i teori och praktik: En guide för läkare och jurister2014 (ed. 1)Book (Refereed)
    Abstract [sv]

    Rättsmedicin är en medicinsk vetenskap, men samtidigt väsentligt skild från den terapeutiskt inriktade kliniska medicinen. Syftet med rättsmedicin är sakkunnigverksamhet på vetenskaplig grund till gagn för rättsväsendet och rättssäkerheten. Rättsmedicin i teori och praktik belyser dessa skillnader i förhållningssätt och förmedlar principiella frågor och kunskaper på ett lättillgängligt sätt. Boken ger även praktisk handledning i att skriva rättsintyg och att göra skadetolkningar och bedömningar.

    I första delen av boken beskrivs läkarens roll i förhållande till rättsväsendet samtidigt som de vetenskapliga begreppen och tankemodellerna reds ut och kopplas till den kliniska verkligheten. Vanliga fallgropar och missräkningar förmedlas också. Den andra delen av boken är en handbok i hur man skriver rättsintyg och utlåtanden samt hur man bedömer och tolkar skador. Boken är rikligt försedd med fallbeskrivningar som på ett pedagogiskt sätt applicerar teorierna i praktiken.

    Målgruppen är främst blivande och praktiserande läkare och jurister. Även naturvetenskapligt orienterade experter som avger utlåtanden till rätten, till exempel kriminaltekniker, och de som i sin profession kommer i kontakt med rättsmedicinska bedömningar, till exempel socialtjänsten, har nytta av boken, liksom politiska beslutsfattare och personer med intresse för rättssäkerhetsfrågor.

  • 31. Tøllefsen, Ingvild Maria
    et al.
    Helweg-Larsen, Karin
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Hem, Erlend
    Kastrup, Marianne C
    Nyberg, Ullakarin
    Rogde, Sidsel
    Zahl, Per-Henrik
    Østevold, Gunvor
    Ekeberg, Øivind
    Are suicide deaths under-reported? Nationwide re-evaluations of 1800 deaths in Scandinavia.2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 11, article id e009120Article in journal (Refereed)
    Abstract [en]

    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.

  • 32.
    Tøllefsen, Ingvild Maria
    et al.
    Oslo Univ Hosp Ullevaal, Dept Acute Med, Box 4950, N-0424 Oslo, Norway.;Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Dept Acute Med, Div Med, Box 4950, N-0424 Oslo, Norway..
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Helweg-Larsen, Karin
    Univ Copenhagen, Dept Social Med & Publ Hlth Res, Norregade 10, DK-1165 Copenhagen K, Denmark..
    Hem, Erlend
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4950, N-0424 Oslo, Norway..
    Kastrup, Marianne
    Amalievej 23, DK-1875 Frederiksberg, Denmark..
    Nyberg, Ullakarin
    Karolinska Inst, Stockholm Ctr Psychiat Res & Educ, Dept Clin Neurosci, Stockholm, Sweden.;Norra Stocholms Psychiat, St Gorans Sjukhus, S-11281 Stockholm, Sweden..
    Rogde, Sidsel
    Norwegian Inst Publ Hlth, Box 4404, N-0403 Oslo, Norway.;Univ Oslo, Inst Clin Med, Box 1072, N-0316 Oslo, Norway..
    Zahl, Per-Henrik
    Norwegian Inst Publ Hlth, Box 4404, N-0403 Oslo, Norway..
    Ostevold, Gunvor
    Norwegian Inst Publ Hlth, Box 4404, N-0403 Oslo, Norway..
    Ekeberg, Oivind
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4950, N-0424 Oslo, Norway..
    Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 449Article in journal (Refereed)
    Abstract [en]

    Background: National mortality statistics should be comparable between countries that use the World Health Organization's International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences. Methods: The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports. Results: In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts reclassified 22 and 51 %, respectively, to accidents. Conclusion: There was moderate agreement in reclassification of accidents between the official mortality statistics and the experts. In the majority of cases where there was disagreement, accidents were reclassified as undetermined manner of death, and only a small proportion as suicides.

1 - 32 of 32
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