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In the past few years there has been concern in Western Europe and in the US about the rise in abuse of phenazepam, a benzodiazepine that was originally developed in the USSR in the mid- to late 1970s. 1-4 Although phenazepam is o...
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In the past few years there has been concern in Western Europe and in the US about the rise in abuse of phenazepam, a benzodiazepine that was originally developed in the USSR in the mid- to late 1970s. 1-4 Although phenazepam is one of the most widely prescribed benzodiazepines in Russia and other commonwealth of independent state (CIS) countries, it has not been licensed elsewhere in the world. Due to very limited licensed geographical distribution, there is very little peer-reviewed literature that is not written in Russian. In this article, we review the current state of what is currently known about phenazepam. This information on phenazepam and how it can be detected in biological specimens should assist the forensic community in identifying phenazepam in routine toxicology screening and interpreting any phenazepam concentrations that are obtained.
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A national mixed-methods study of English Serious Case Reviews (SCRs) was carried out to better understand the characteristics and circumstances of maternally perpetrated filicides, to compare these with paternally perpetrated cas...
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A national mixed-methods study of English Serious Case Reviews (SCRs) was carried out to better understand the characteristics and circumstances of maternally perpetrated filicides, to compare these with paternally perpetrated cases, and to identify learning points for mental health professionals. Published reports for all SCRs of children in England dying as a result of abuse or neglect from 2011 to 2014 were subject to qualitative analysis using a system of layered reading and inductive thematic analysis, along with descriptive and comparative quantitative analysis. There were 86 deaths directly attributable to child maltreatment within the immediate family. The mother was the suspected perpetrator in 20. Twelve of the mother perpetrators were victims of domestic violence, while 15 of the father perpetrators were known to be perpetrators of domestic violence. Those deaths resulting from impulsive violence or severe, persistent cruelty are almost exclusively perpetrated by males, while those with an apparent intent to kill the child are slightly more likely to be perpetrated by mothers. Four key themes were identified through the qualitative analysis: domestic violence, maternal mental illness, separation and maternal isolation, and the invisibility of the child. These findings highlight the important role of domestic violence and its interaction with maternal mental health. Professionals working with mothers with mental health problems need to adopt a supportive but professionally curious stance, to be alert to signs of escalating stress or worsening mental ill-health, and to provide supportive and accessible structures for at-risk families.
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Abstract While child welfare scholars and caseworkers have acquired a better understanding of risk factors associated with occurrences of child fatalities due to maltreatment over the past 20 years, little is known about the organ...
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Abstract While child welfare scholars and caseworkers have acquired a better understanding of risk factors associated with occurrences of child fatalities due to maltreatment over the past 20 years, little is known about the organisational and system‐level characteristics that impact efforts to prevent or intervene in these cases. As part of a collaborative agreement between a university‐affiliated centre and a state child welfare agency, we conducted interviews by phone with 19 case managers, middle managers and regional leaders who were assigned to manage or oversee a near fatality or fatality case. They illuminated five major themes: 1) their perceived stressors and sources of support; 2) client and perpetrator risk factors; 3) system‐level risk and protective factors; 4) case descriptions; and 5) lessons learned. Relying upon their lived experiences, we offer practice and policy recommendations to Child Abuse Review to support their efforts to prevent and respond to child fatality cases. Efforts should be devoted to evaluating strategies to reduce risk for all families before the child welfare system is involved, supporting workers when they are assigned to fatality cases by reducing caseloads and preparing them for the fatality review process, and embracing a culture of collaboration across and within child‐serving systems. Key Practitioner Messages To respond effectively to child fatality and near fatality cases, child welfare caseworkers and leaders should be assigned fewer cases in the interim, and receive guidance, consultation, and time to prepare for the fatality review process. Embracing a culture of collaboration across and within child‐serving systems may also prevent fatalities and facilitate an efficient investigative process if/when they do occur.
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Filicide mainly refers to the murder of a child by his/her parents. Even though filicide is a rare event, outcome of filicide is more severe compared to other types of murders. In this report, we aim to discuss the factors in whic...
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Filicide mainly refers to the murder of a child by his/her parents. Even though filicide is a rare event, outcome of filicide is more severe compared to other types of murders. In this report, we aim to discuss the factors in which the case of a woman who attempted to kill her 2.5-year-old daughter along with the demographical characteristics. Twenty-nine-year-old mother attempted to kill her daughter by hanging. Even though the victim did not die as the mother, regretted her action the triggers and the plot of the case discussed within the filicide framework. Therefore, the presented case report would contribute to the understanding of the nature of the filicide, and it might bring a different perspective, because of the different development process of filicide, sharing the disorder and interwoven motivations between the child and mother. In this respect, we aim to draw attention of pediatricians, child psychiatrists and forensic pathologists about the importance of filicide.
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Child abuse in its various types such as physical, emotional, sexual, and neglect has been document throughout history. However, before the mid-20th century, inflicted injuries to children was overlooked in part because children w...
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Child abuse in its various types such as physical, emotional, sexual, and neglect has been document throughout history. However, before the mid-20th century, inflicted injuries to children was overlooked in part because children were often viewed as property. According to the World Health Organization, 57,000 children were the victims of homicide in the year 2000. In this paper we present the skeletal and radiological manifestation of physical abuse and fatal neglect and provide recommendations to assess child maltreatment from past populations. Pediatric biomechanical factors and healing are discussed as it is important to keep in mind that children are not just small adults. Skeletal and radiological indicators of nonaccidental or inflicted injuries are reviewed from the literature. Inflicted injuries are presented based on specificity to identify child abuse. In addition, skeletal indicators that could help assess fatal starvation are also reviewed and metabolic diseases are proposed as potential evidence of neglect. A recent child homicide is presented and used to illustrate the difficulty in assessing child maltreatment. Present-day clinical child abuse protocols are used to provide recommendations to assess child abuse in a bioarchaeological context. Clin. Anat. 29:844-853, 2016. (c) 2016 Wiley Periodicals, Inc.
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Buprenorphine (BPN) medication for opioid maintenance treatment in Finland consists predominantly of buprenorphine-naloxone (BNX). Both BPN and BNX are associated with diversion, abuse and non-medically supervised use worldwide. O...
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Buprenorphine (BPN) medication for opioid maintenance treatment in Finland consists predominantly of buprenorphine-naloxone (BNX). Both BPN and BNX are associated with diversion, abuse and non-medically supervised use worldwide. Our purpose was to estimate the proportion of BNX to all BPN-related fatalities. The material consisted of 225 deceased drug abusers in Finland from January 2010 to June 2011 with a positive BPN and/or norbuprenorphine (NOR) and/or naloxone (NX) finding in urine. The data were divided into three groups based on the urine NX and BPN concentrations. The "Parenteral BNX" group (>100. μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>50. μg/l BPN, 0. μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤100. μg/l NX, or ≤50. μg/l BPN combined with 0. μg/l NX) was presumed to consist of mainly sublingual BNX or BPN users. In 12.4% of cases the NX urine concentration was higher than the threshold 100. μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4%. In the "Parenteral BNX", "Parenteral BPN" and "Other BNX or BPN" groups, the proportion of fatal BPN poisonings was 67.9, 31.0 and 22.6%, respectively. BNX abuse can be fatal. Among the 225 BPN-related fatalities, parenteral abuse of BNX was shown to be common (12.4%) and BNX poisoning was the underlying cause of death in 8.4%. Parenteral BNX caused fatal BPN poisoning proportionally more often than parenteral BPN.
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Better understanding of the causes and circumstances of maltreatment deaths of children is needed to prevent tragedy. The purpose of this article is to facilitate understanding of child maltreatment fatality review processes and t...
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Better understanding of the causes and circumstances of maltreatment deaths of children is needed to prevent tragedy. The purpose of this article is to facilitate understanding of child maltreatment fatality review processes and their outcomes. A literature review was conducted through searches of the databases PubMed, PsycINFO, and EMBASE and through citations in publications. Over 165 publications were reviewed and 55 were selected for inclusion. Papers were from the United States, England, Ireland, Northern Ireland, Netherlands, France, Canada, Australia, South Africa, Switzerland, Saudi Arabia, Japan, and China. These were included if they described fatality review goals, authority, procedures, and outcomes. Although we searched databases on a continual basis during the preparation of this review, we could have missed publications, particularly those in newspapers and journals that are not included in large-scale databases or cited in other articles. Improvement of fatality review requires diligence by individuals and organizations that provide information to the reviewers. Among challenges to the review process are varying criteria for review, misclassifications of the manner of death, inadequate or incomplete forensic and medical investigations, lack of information about the perpetrator, diversity of the community, concealment of the cause of death by parents or other caregivers, and disagreement among reviewers about the results of their inquiries. Institutional challenges are also present, which include the need for funding, privacy issues on obtaining information, updating reviewer training, lack of follow-up by institutional authorities on the recommendations of the reviews, and research facilitating the review of maltreatment fatalities.
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The challenges associated with determining causes of fatal child maltreatment have been documented by multiple professional fields and by the US government. This study explored these challenges, as well as the relative lethality o...
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The challenges associated with determining causes of fatal child maltreatment have been documented by multiple professional fields and by the US government. This study explored these challenges, as well as the relative lethality of determinations of general neglect, medical neglect and physical abuse. Existing sources of information were used for this study: (1) data from the US National Child Abuse and Neglect Data System (NCANDS) data set extracted from annual Child Maltreatment reports published by the US Department of Health and Human Services; and (2) information published in recent state-level child death review team (CDRT) reports. Results from the NCANDS data set indicated that more children died from general neglect (x = 70.9%) than abuse (x = 44.8%) or medical neglect (x = 8.2%). Children who experienced medical neglect died at the highest rate (6.82 per 1000 medical neglect victims), making it the most lethal, followed by physical abuse and general neglect. The findings from CDRT reports were inconsistent, with some states indicating that more children died from abuse than neglect, which is in direct contrast to national statistics. The inconsistent and confusing use of language and constructs from CDRTs has important implications for multiple child-serving fields.
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Objective: The objective of our study was to determine the prevalence of alcohol and drug intoxication among fatally injured motorcyclists in a wide urban area of Zagreb, Croatia. Methods: We conducted a single-center observationa...
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Objective: The objective of our study was to determine the prevalence of alcohol and drug intoxication among fatally injured motorcyclists in a wide urban area of Zagreb, Croatia. Methods: We conducted a single-center observational retrospective study over a 10-year period (2007-2016) in 3 counties covering an area including 1.2 million residents. We reviewed the records on fatally injured motorcyclists, collecting information relating to sex, age, cause of death, time of death in relation to the time of the crash, and the circumstances of the crash (time of day, day of the week, season). Blood alcohol concentration (BAC) and toxicology analysis results were collected and analyzed. Results: We identified 163 deaths (95.7% males, 4.3% females). Overall, 64.2% of the victims were 20 to 39 years old. The majority (50.9%) of those fatally injured were responsible for causing the traffic crash; the rest were determined not to be responsible or the responsibility could not be determined. The most frequent causes of death were multiple injuries (55.8%) and isolated head trauma (23.3%). The rider's BAC was above the legal limit for driving (>0.50 g/kg) in 53.8% of cases, with a mean BAC of 1.91 g/kg. There was no difference in riding a motorcycle with a BAC above the legal limit between groups defined as younger (= 40 years of age). The number of people with an illegal BAC was significantly higher during weekends than during the work week. The BAC of riders who were responsible for the crash was significantly higher than that of those who were not responsible or whose responsibility could not be determined. Use of illegal drugs or nontherapeutic use of legal drugs was not common and was detected in 10.4% of fatally injured riders. Conclusions: Alcohol intoxication has a major role in motorcycle crash-related mortality. A significant difference in BAC between fatally injured riders responsible for the accident and those who were not responsible implies that measures directed toward prevention of drinking and driving behavior could lower the number of fatal motorcycle crashes. Weekend measures, especially during spring and summer, could have particularly significant effects.
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Background: Trauma is a leading cause of death among children worldwide. Detailed knowledge of the epidemiology of childhood fatal injuries is necessary for preventing injuries. Objective: To determine clinical differences between...
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Background: Trauma is a leading cause of death among children worldwide. Detailed knowledge of the epidemiology of childhood fatal injuries is necessary for preventing injuries. Objective: To determine clinical differences between children who were treated in an emergency department for accidental or abusive injuries. Methods: A retrospective review of all deceased patients who were treated in two urban pediatric emergency departments between 1998 and 2010 was performed. Patients were categorized into two groups, accidental and abusive, for comparison. Results: A total of 1498 patients died during the study period, with 124 deaths being attributable to injury for a rate of 9.5 injury-related deaths per year. Most fatal injuries were accidental. Children with abusive fatal injuries were younger and more likely to have been seen for an injury in a clinic or emergency department within 2 months of their death. Eighty-two percent of abusive fatal injuries had documented subdural hematomas, whereas only 7.2% of accidental fatal injuries had a subdural hema-toma documented. Nearly 50% of abusive fatal injuries had retinal hemorrhages reported, although no child with an accidental fatal injury had this type of injury documented. Conclusion: Younger children, especially those previously seen in an emergency department or clinic for injury, are more likely to sustain an abusive fatal injury. Sentinel physical findings associated with abusive fatal injuries include subdural hematomas and retinal hemorrhages, and the presence of these findings should prompt an investigation into the circumstances of injury.
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