Quantitative morphological analysis framework of infant cranial sutures and fontanelles based on CT images.

Characterizing the suture morphological variation is a crucial step to investigate the influence of sutures on infant head biomechanics. This study aimed to establish a comprehensive quantitative framework for accurately capturing the cranial suture and fontanelle morphologies in infants. A total of 69 CT scans of 2-4 month-old infant heads were segmented to identify semilandmarks at the borders of cranial sutures and fontanelles.

The role of alternative hypotheses in reducing bias in forensic medical experts' decision making.

Medical opinions are often essential evidence in criminal cases but relatively little is known about the factors that impact forensic doctors' decision making. This research examines the role and impact of having an alternative hypothesis while forming a medical opinion. A scenario-based experiment with forensic doctors (n = 20) was conducted.

Oxycodone-related deaths in Sweden 2006-2018.

Aim: To identify and characterize oxycodone related deaths in Sweden from 2006 to 2018 and to compare them to other opioid-related deaths.

Methods: To assess the factors contributing to the deaths, we used multinomial logistic regression to compare oxycodone-related deaths extracted from all forensic autopsy examinations and toxicology cases in the age groups 15-34 (reference group), 35-54 and 55-74 with regard to sex, presence of benzodiazepines and alcohol at the time of death, prescription of oxycodone, benzodiazepines and antidepressants, previous substance use-related (SUD) treatment, and manner of death. The oxycodone related deaths were compared with deaths with presence of other opioids.

External Hydrocephalus as a Cause of Infant Subdural Hematoma: Epidemiological and Radiological Investigations of Infants Suspected of Being Abused.

Background: Acute subdural hematoma (ASDH) and chronic subdural hematoma (CSDH) in infants have been regarded as highly specific for abuse. Other causes of CSDH have not been investigated in a large population.

Purpose: The purpose of this study was to investigate to what extent external hydrocephalus is present in infants with ASDH and CSDH undergoing evaluation for abuse.

Retinal haemorrhage in infants investigated for suspected maltreatment is strongly correlated with intracranial pathology.

Aim: To test the two prevailing hypotheses regarding the aetiology of infant retinal haemorrhage: (a) traction forces exerted by the lens and/or corpus vitreum on the retina during infant shaking or (b) retinal vessel leakage secondary to intracranial pathology and raised intracranial pressure.

Methods: Comparison of medical findings and reported type of trauma in infants investigated for suspected physical abuse with presence (n = 29) or non-presence of retinal haemorrhage (RH) (n = 119).

Results: Intracranial pathology was recorded in 15 (13%) of the non-RH cases and in 27 (97%) of the RH cases (p < 0.

Characteristics of post-mortem beta-hydroxybutyrate-positivet cases - A retrospective study on age, sex and BMI in 1407 forensic autopsies.

Background: Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions.

Aim: To retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations.

Association between homicide injury severity and benzodiazepine influence.

There are case reports of offenders inflicting excessive injuries on their victims when under the influence of benzodiazepines. However, the potential association between benzodiazepine influence on the offender and victim injury severity in a general homicide population has not been studied. We investigated associations between offender positive testing for benzodiazepines or z-drugs (zolpidem, zopiclone and zaleplon) and victim injury severity.

Criminal mutilation in Sweden from 1991 to 2017.

We identified 43 cases of mutilation homicides in a nationwide population-based study in Sweden during the period of 1991-2017. 70% of cases were classified as defensive mutilations where the main motive was disposal of the body, while 30% were classified as offensive, that is, due to an expression of strong aggression, necro-/sexual sadism, or psychiatric illness. In comparison with a previous study covering mutilation homicides in Sweden between 1961 and 1990, we noted an increase in incidence.

A model for evaluating the economic value of prevention programs for illicit use of anabolic androgenic steroids.

Background: The illicit use of anabolic androgenic steroids (AAS) has become a societal concern. We developed a decision-analytic model for assessing the cost-effectiveness of preventive interventions targeting AAS-use. We used scenario analyses to demonstrate: a) the potential health economic consequences of AAS use in Sweden, and b) the cost-effectiveness of a hypothetical preventive intervention.

Rib fractures in infancy, case-series and register case-control study from Sweden.

Objectives: To assess cases with rib fractures in infants under observation for or with an abuse diagnosis, and to compare risk factors with that in infants with fractures but no abuse diagnosis.

Methods: Design was case-series and register case-control of infants (aged <1 year) with rib fractures. Data was clinical records for the case-series (n = 26) and from national health registers for the case-controls (n = 28 and n = 31).

The epidemiology of infant shaft fractures of femur or humerus by incidence, birth, accidents, and other causes.

Background: The purpose of this population-based registry study was to analyze both birth-related femur and humerus shaft fractures and diagnosed later in infancy, as regards incidence, perinatal characteristics, other diagnoses, and reported accidents.

Methods: Children born in 1997-2014, diagnosed with a femur or humerus shaft fracture before age 1 year, were identified in the Swedish Health Registries. Rate of birth fractures were estimated by combining femur and humerus shaft fractures coded as birth-related with femur and humerus shaft fractures diagnosed during day 1-7 without registered trauma or abuse.

Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking: A nationwide registry study.

Background: Many physicians regard the combination of encephalopathy, subdural haemorrhage (SDH), retinal haemorrhage (RH), rib fractures, and classical metaphyseal lesions (CML) as highly specific for abusive head trauma (AHT). However, without observed abuse or other criteria that are independent of these findings, bias risk is high.

Methods: Infants subjected for examination under the suspicion of maltreatment during the period 1997-2014 were identified in the National Patient Registry, International Classification of Diseases (ICD-10 SE).

Methadone-related deaths among youth and young adults in Sweden 2006-15.

Aims: To identify methadone-related deaths and determine the prevalence among youth and young adults in Sweden 2006-15.

Design, Setting And Participants: National retrospective registry study comparing data from all forensic autopsy examinations and toxicology cases involving methadone during 2006-15 in individuals aged 15-29 years with police records, previous pharmaceutical prescriptions and health-care episodes.

Measurements: Multinomial logistic regression.

Difficult birth is the main contributor to birth-related fracture and accidents to other neonatal fractures.

Aim: Specific birth-related fractures have been studied; underestimates might be a problem. We aimed to assess all fractures diagnosed as birth-related as well as other neonatal fractures.

Methods: A population-based study on all infants born in Sweden 1997-2014; data were retrieved from the Swedish Health Registers (10th version of International Classification of Diseases.

Medical diagnoses among infants at entry in out-of-home care: A Swedish population-register study.

Background And Aims: Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out-of-home care. The objective of this study was to analyse infants placed in out-of-home care in Sweden by incidence, medical diagnoses, and perinatal factors.

Methods: This was a population-based register study of infants born in Sweden 1997 to 2014.

Opioid-related deaths and previous care for drug use and pain relief in Sweden.

Aim: In 2006-2014, the rate of drug-related deaths, typically opioid poisonings, more than doubled in Sweden. Opioid prescriptions for pain control or opioid agonist therapy also increased. In this retrospective study, we compared death rates between individuals whose first recorded contact with prescribed opioids was for pain control and individuals that had received substance use disorder (SUD) treatment before their first recorded opioid prescription.

Homicide injury severity in association with the victim-offender relationship.

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.

Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study.

Background: The aim of this study was to assess the incidence of fractures in infancy, overall and by type of fracture, its association with accidents, metabolic bone disease risk factors, and abuse diagnosis.

Methods: The design was a population-based register study in Sweden. Participants: Children born 1997-2014, 0-1 years of age diagnosed with fracture-diagnosis according to International Classification of Diseases (ICD10) were retrieved from the National Patient Register and linked to the Swedish Medical Birth Register and the Death Cause Register.