Frequência e fatores associados ao registro inespecífico de óbitos por causas externas no Brasil: estudo transversal, 2017 / Frecuencia y factores asociados al registro inespecífico de óbitos por causas externas en Brasil: estudio transversal, 2017 / Frequency and factors associated with recording deaths due to unspecified external causes in Brazil: a cross-sectional study, 2017

Objetivo: Analisar a frequência e fatores associados ao registro inespecífico de óbitos por causas externas no Brasil. Métodos: Estudo transversal dos dados do Sistema de Informações sobre Mortalidade de 2017. Utilizou-se regressão logística para obter razões de chances (odds ratio [OR]) e intervalo de confiança (IC95%) de registro inespecífico pelas variáveis de explicação (óbitos hospitalares e certificados por legista). Resultados: O Brasil registrou 159.720 óbitos por causas externas; foram 38,9% de ocorrência hospitalar, 83,4% certificados por legistas e 21,7% atribuídos a causas inespecíficas. Revelaram-se fatores associados ao registro de causa externa inespecífica o óbito hospitalar (OR=2,00 - IC95% 1,96;2,05) e a certificação de médico-legista (OR=1,08 - IC95% 1,04;1,11). Conclusão: A frequência de registro de causa externa inespecífica em óbito hospitalar é superior à encontrada em certificação de legistas.

Objetivo: Analizar la frecuencia y factores asociados al registro inespecífico de óbitos por causas externas en Brasil. Métodos: Estudio transversal de datos del Sistema de Informaciones sobre Mortalidad, 2017. Se utilizó la regresión logística para obtener razones de probabilidades (odds ratio [OR]) e intervalo de confianza (IC95%) de registro inespecífico por las variables de explicación (óbitos hospitalarios y certificados por forenses). Resultados: Brasil registró 159.720 óbitos por causas externas; hubo 38,9% en hospitales, 83,4% certificado por forenses y 21,7% por causas inespecíficas. Los factores asociados al registro de causas externas inespecíficas fueron el óbito hospitalario (OR=2,00 - IC95%1,96; 2,05) y la certificación del médico forense (OR=1,08 - IC95% 1,04; 1,11). Conclusión: La causa externa inespecífica en el óbito hospitalario es mayor que la de la certificación de los forenses.

Objective: To analyze the frequency and factors associated with recording deaths due to unspecified external causes in Brazil. Methods: This was a cross-sectional study of Mortality Information System data for the year 2017. Univariate logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (95%CI) of nonspecific recording according to the explanatory variables - (hospital deaths and deaths certified by coroners). Results: Brazil registered 159,720 deaths from external causes; 38.9% occurred in hospital, 83.4% were certified by coroners and 21.7% were from unspecified causes. Factors associated with the recording of unspecified external causes were hospital death (OR=2.00 - 95%CI 1.96;2.05) and the coroner's certification (OR=1.08 - 95%CI 1.04;1.11). Conclusion: The frequency of recording unspecified external causes is greater for hospital deaths than for coroner's certification.

Avaliação de sentenças e jurisprudências relacionadas a ações judiciais envolvendo cirurgias plásticas estéticas / Evaluating judgments and decisions related to lawsuits involving aesthetic plastic surgery

Introdução: É consenso no meio jurídico que os resultados referentes às atividades médicas sejam obrigação de meio, e não de resultado. Contudo, há grande discussão quando se trata de procedimentos estéticos. A Resolução nº 1621/2001, do Conselho Federal de Medicina, define que o objetivo do ato médico na cirurgia plástica também constitui obrigação de meio. O estudo avaliou, entre novembro de 2015 a novembro de 2017, 106 casos, para verificar se o entendimento do Judiciário se alinha à Resolução do CFM [Conselho Federal de Medicina]. Foram quantificados o número de processos e a porcentagem dos casos julgados como procedentes ou improcedentes, além de verificar as principais posições doutrinárias e jurisprudenciais que embasaram as sentenças admitidas como procedentes. Foi, ainda, quantificado o número de casos cuja decisão do magistrado foi relacionada com o posicionamento do laudo pericial médico. Métodos: Foi feita busca no banco de sentenças do site do Tribunal de Justiça do Estado de São Paulo (SP), por meio da palavra-chave "Cirurgia Plástica", de todos os processos de indenização relacionados a cirurgias plásticas estéticas. Resultados: Foram sentenciados como improcedentes 61 casos (58%). Foram sentenciados como procedentes 45 casos (42%). Em 96% dos casos (102) a sentença relacionou-se positivamente com a análise pericial. Conclusão: Foram 102 sentenças concordantes aos laudos periciais e apenas quatro casos cuja sentença divergiu do entendimento do laudo. Estes dados mostram a importância crucial da análise pericial para a definição das sentenças judiciais. Analisando todas as sentenças, observou-se que em nenhum caso os juízes levaram em conta a Resolução do CFM [Conselho Federal de Medicina].

Introduction: There is a legal consensus that the results of medical activities represent obligations of means, not results. However, there is ample discussion when it comes to aesthetic procedures. Resolution 1621/2001 of the Federal Council of Medicine also defines the objective of a medical act in plastic surgery as an obligation of means. This study evaluated 106 cases between November 2015 and November 2017 to verify whether the decisions of the Judicial Power agree with the Resolution of the Federal Council of Medicine. The number of lawsuits and the percentage of claims granted or denied were quantified, and the opinions of jurists and courts that supported the claims granted were verified. The number of cases in which the judge's decision was related to the opinion of a medical expert was also quantified. Methods: The authors searched the judgment database located on the website of the Court of Justice of the State of São Paulo (SP) for damage related to aesthetic plastic surgery, using the keyword "Plastic Surgery" for all actions. Results: A total of 61 claims (58%) were denied, and 45 (42%) were granted. In 96% of cases (102) the judgment was positively related to the expert report. Conclusion: There were 102 cases in which the judgment agreed with the expert reports and only four cases in which the judgment did not agree with the reports. These data show the crucial importance of experts' reports in defining judicial judgments. The analyses of all judgments showed that there were no cases in which the judge considered the Resolution of the Federal Council of Medicine.

CiteSpace-based Document Information Visualization of Literature Published by Journal of Forensic Medicine from 1985 to 2018 / 法医学杂志

Objective To analyze a knowledge web of the literature published by Journal of Forensic Medicine from its founding in 1985 to 2018, describe the evolving process of forensic science research and explore the research hotspots and frontiers at present. Methods The literature that was published by Journal of Forensic Medicine from 1985 to 2018 was collected and analyzed in terms of elements, such as emerging research hotspots, high frequency keywords, authors, dispatching units, location of institution and funding, by CiteSpace5.3 information visualization analysis software. Results All disciplines of forensic medicine were continually developing and maturing, and the publication volume of the literature on forensic pathology had the highest weight; in research hotspots, the two categories, research and identification each had their own emphasis; as the main source of contributions to the journal, research institutes accounted for 38.99% of the total number of publications; Shanghai ranked first among all regions with 1 046 articles published. The number of funded articles was generally on the rise, with the number of funded articles published largest in 2015. Conclusion As an authoritative academic journal in the field of forensic science in China, Journal of Forensic Medicine carries the development of forensic science and witnesses the institutional reform of universities and colleges, and offers a wide range of communication and cooperation in terms of technicality and application. Many scholars and scientific research institutions have gained progress continually in various research directions in the form of teamwork; and emerging research hotspots will continue to play a huge role in future practical applications.

Caracterización del acto homicida según los informes de autopsias realizados por el servicio médico legal de Concepción, periodo 2011-2015 / Characterization of the homicidal act according to the autopsy reports released by the Legal Medical Service of Concepción, 2011-2015

Introducción: Más de la tercera parte de los homicidios reportados a nivel mundial tienen lugar en el continente Americano, siendo Chile uno de los países con las tasas más bajas de Latinoamérica. Actualmente, son escasos los estudios que caracterizan el acto homicida en nuestro país. Se caracterizó el acto homicida según las autopsias realizadas por el Servicio Médico Legal (SML) de Concepción, durante el periodo 2011-2015. Materiales y método: Se realizó un estudio transversal de informes de autopsia con causa homicidio durante los años 2011 a 2015, realizadas por el SML de Concepción, utilizándose las variables: género, edad, procedencia, lugar de ocurrencia del homicidio, estado civil, ocupación, patologías asociadas, causa de muerte, tipo de arma utilizada, alcoholemia, examen toxicológico y atención en centro asistencial. El estudio fue aprobado por comité de ética. Resultados: Del total de autopsias en el periodo 2011-2015; 5.92% (241) correspondieron a homicidios, de los cuales un 89.6% fueron víctimas de sexo masculino. Del total de homicidios estudiados la edad promedio fue de 33 años, un 58.3% del total ocurrieron en vía pública y 42.1% fallecieron por trauma torácico complicado. Finalmente del total de homicidios, un 49,2% poseían alcoholemia negativa y 49.2% examen toxicológico negativo. Discusión: En Chile, el homicidio afecta a una pequeña porción de la población, acercándose a las bajas tasas que presentan diversos países de Europa. En su mayoría, los homicidios reportados fueron hombres entre los 18 y 29 años de edad, resultado similar a lo descrito a nivel mundial.

Introduction: More than a third part of the worldwide reported homicides takes place in the whole american continent, and Chile is one the countries with the lowest rates in latin america. Only a few are the studies that characterize the homicidal act in our country. Characterize the homicide act according to the autopsies reports performed by the Legal Medical Service (SML) of Concepción, during the period 2011-2015. Materials and methods: We made a transversal study with the autopsies reports classified as homicide, performed by the SML Concepción, between the years 2011 and 2015 using variables such as: gender, age, place of residence, place of homicidal act, marital state, occupation, comorbidities, death cause, weapon, blood alcohol concentration, toxicological results and medical assistance. An ethic committee approved the study. Results: From the total autopsies between 2011 and 2015; 5.92% (241) were homicides, of which 89.4% were men. The average age of homicides victims was 33 years old, 58.3% occurred on public areas and 42.1% were died because a complicated thoracic traumatism. And finally from the total homicides, 49.2% had none alcohol in blood such as the 49.2% as well had negative toxicological test. Discussion: In Chile, homicide affects a few number of its population, approaching the low rates that some european countries have. The most of the homicides reported were men between 18 to 29 years old, similar results comparing with the worldwide statistics.

Muertes por suicidio en la Región de Tarapacá, años 1990-2013 / Suicides death in the Region of Tarapacá, years 1990-2013

Introduction: It presents the update of an epidemiologic descriptive study of deaths by suicide that took place in the Tarapacá region, Chile. The study encompasses almost a quarter of a century, between the years 1990 and 2013, and brings interesting information with respect to the tendencies of the phenomenon along an extensive period of time. Method: A retrospective epidemiologic descriptive study of type transvensal of deaths classified as violent in the autopsy protocols of the Servicio Médico Legal of the city of Iquique and the medical death certificate. Results: In a total of 565 cases, a general rate of suicide for this period of 9,18 for 100.000 hab has been noted, with variations of the annual rates between 4, 95 in the year 1995 and 13, 97 in the year 1999. It was observed that suicide was more frequent between the ages 20 and 44 years, with a relation men-women of 5,3:1. Conclusions: The previous study (2010) confirmes a tendency to the stabilization of the increasing rates observed in the past decade. In figures this rate was somehow inferior to the general rate of suicide of the country in the year 2011 (13,3 for 100.00 hab.), but it doubled the registered rates in the 90’s.

Introducción: Se presenta la actualización de un estudio epidemiológico descriptivo de las muertes por suicidio ocurridas en la región de Tarapacá, Chile, abarcando casi un cuarto de siglo, entre los años 1990 y 2013, lo que aporta una interesante información respecto del movimiento tendencial del fenómeno a lo largo de un período extenso de tiempo. Método: Estudio epidemiológico descriptivo de tipo retrospectivo transversal a partir de las muertes clasificadas como violentas en los protocolos de autopsias del Servicio Médico Legal de Iquique y del certificado médico de defunción. Resultados: En un total de 565 casos, constatamos una tasa general de suicidio para el período de 9,18 por 100.000 hab., con variaciones de tasas anuales que van entre 4,95 el año 1995 y 13,97 el año 1999; se observó que el suicidio fue más frecuente entre los 20 y los 44 años, con una relación hombre-mujer de 5,3:1. Conclusiones: Respecto del estudio anterior (2010) se confirma una tendencia a la estabilización del alza de tasas observada en la década anterior, en cifras algo inferiores a la tasa general de suicidio del país en el año 2011 (13,3 por 100.000 hab.), pero el doble respecto a las tasas registradas en los años noventa.

Caracterización de las víctimas de suicidio de las autopsias realizadas en el Servicio Médico Legal de Concepción el año 2010 / Characterization of the suicide victims of autopsies performed during 2010 at Concepción’s Forensics Medical Service

INTRODUCCIÓN: El suicidio suele ser interpretado como el fracaso de una persona para enfrentar la adversidad. En este, intervienen múltiples factores, haciendo su análisis complejo, existiendo pocos estudios respecto al tema. Así, el objetivo de este trabajo es describir el perfil de las víctimas de suicidio correspondientes a las autopsias realizadas en el Servicio Médico Legal (SML) de Concepción durante el año 2010. MATERIAL YMÉTODO: Se realizó mediante un estudio descriptivo, retrospectivo y de corte transversal, con un muestreo no probabilístico consecutivo de 64 informes de autopsia de muertes por suicidio, realizadas en el SML de Concepción el año 2010. Se consignó género, edad, ocupación, estado civil, procedencia, intentos previos, antecedente de carta y/o aviso y antecedentes mórbidos. Los datos fueron tabulados en Microsoft Excel, se realizaron tablas segmentarias y gráficos para el análisis. RESULTADOS: Del total de autopsias realizadas en el SML de Concepción el 2010, el 7,9 por ciento correspondían a suicidio, de los cuales el 89,1 por ciento eran varones y 10,9 por ciento mujeres. La edad promedio fue 41,35 años, mayormente entre 20-29 y 50-59 años; el 50,8 por ciento eran solteros y 33,3 por ciento casados; 23,4 por ciento residentes de Talcahuano y 15,6 por ciento de Concepción; 60,9 por ciento con ocupación; 21,9 por ciento había avisado, 6,3 por ciento dejó carta y 10,9 por ciento presentaba intentos anteriores; 62,5 por ciento sin antecedentes psiquiátricos y 64,1 por ciento sin antecedentes de enfermedad médica. DISCUSIÓN: Comparando con estadísticas nacionales, se repite la proporción según sexo; sin embargo, escasean los trabajos que estudien detalladamente el suicidio y entreguen información acerca de los otros factores estudiados en este trabajo.

INTRODUCTION: Suicide is usually interpreted as the failure of a person to face adversity, in which there are many other factors involved. That’s why its analysis is complex and few studies on the subject exist. Thus, the purpose of this paper is to describe the profile of suicide victims for the autopsies in the Forensic Medical Service (FMS) of Concepcion during 2010. MATERIAL AND METHOD: This is a descriptive, retrospective and cross sectional study, with a non-probability sample of 64 consecutive autopsy reports of deaths by suicide, carried out in the FMS of Concepcion in 2010. The following variables were registered: gender, age, occupation, marital status, city of origin, previous attempts, previous letter and/or notice and morbid history. Data were tabulated in Microsoft Excel, later generating tables and graphs for segmental analysis. RESULTS: Of all autopsies performed in the FMS of Concepcion in 2010, 7.9 percent were suicides, of which 89.1 percent were male and 10.9 percent women. The average age was 41.35 years, mostly between 20-29 and 50-59 years, 50.8 percent were single and 33.3 percent married, 23.4 percent from Talcahuano and 15.6 percent from Concepcion, 60.9 percent had an occupation, 21.9 percent had warned of their intentions, 6.3 percent left a letter and 10.9 percent had previous attempts, 62.5 percent didn’t have a psychiatric history and 64.1 percent didn’t have history of medical illness. DISCUSSION: Compared to national statistics, the proportion by sex is similar, but there aren’t works that study suicides in detail and provide information about the other factors studied in this work.

Muertes por suicidio en la ciudad de Constitución (Chile) entre los años 2001-2011: estudio de prevalencia acumulada / Prevalence of deaths by suicide in the city of Constitution (Chile) between the years 2001-2011

En la actualidad, Chile presenta una tasa de suicidios de 18,5 y 3,2 muertes entre hombres y mujeres, respectivamente, por cada 100.000 habitantes. En este estudio de prevalencia acumulada se revisaron todos los protocolos de autopsia realizadas en el Servicio Médico Legal de Constitución en que la causa de muerte fue suicidio, para describir su evolución entre los años 2001 y 2011. Se registró la información referente a métodos de suicidios, edades, sexos, temporalidad, sectores urbanos o rurales, estado civil y relación con tóxicos; los datos se analizaron mediante estadística descriptiva. El método por ahorcamiento fue el más prevalente, explicando el 83,3 por ciento de los suicidios, con mayor frecuencia los años 2007, 2008 y 2011, y mayor estacionalidad en marzo, octubre, noviembre y diciembre, preferentemente en personas entre los 13-22 años, hombres y solteros. Sólo el 44,55 por ciento se asoció al consumo de alcohol. El ahorcamiento sigue siendo el método de suicidio más común, y coincide con la tendencia mundial del suicidio infanto juvenil. Los meses de mayor frecuencia coinciden con una mayor luminosidad, de primavera o festivos, donde aumentan los trastornos del estado de ánimo. Es interesante que no existe una relación significativa con la ingesta de alcohol, ya que la literatura reporta una fuerte relación con el suicidio. Llama la atención que posterior al terremoto-maremoto de febrero del año 2010, no existe un incremento significativo de estos casos. En general, los datos muestran una tendencia coincidente a los del resto del país (Chile); sin embargo, en forma particular, Constitución muestra algunas diferencias, posiblemente por características población-específica.

Currently, Chile has a suicide rate of 18.5 and 3.2 deaths for men and women, respectively, per 100,000 inhabitants. In this cumulative prevalence study we reviewed all autopsies performed at the Forensic Service of Constitución city in which the cause of death was suicide, in order to describe their evolution between 2001 and 2011. We recorded information about methods of suicide, age, gender, temporality, urban or rural, marital status, and toxicology. Data were analyzed using descriptive statistics. The method by hanging was the most prevalent, accounting for 83.3 percent of suicides, occurring most often in the years 2007, 2008 and 2011, and showing increased seasonality in March, October, November and December, preferably in the 13 to 22 year-old age group and in unmarried men. Only 44.55 percent was associated with alcohol consumption. Hanging is still the most common method of suicide, and coincides with the global trend of child and adolescent suicide. The periods of greatest frequency coincide with brighter days, spring or holidays, in which mood disorders tend to increase. Interestingly, no significant relationship with alcohol intake was found, whereas the literature reports a strong relationship with suicide. It is noteworthy that after the earthquake-tsunami of February 2010, there was no significant increase in suicide rates. Overall, the data show a trend consistent with the rest of the country (Chile); however, Constitución deviates somewhat, possibly due to population-specific characteristics.

Características da violência física e sexual contra crianças e adolescentes atendidos no IML de Maceió, Alagoas, Brasil / Characteristics of physical and sexual violence against children and adolescents examined at the Forensic Medicine Institute in Maceió, Alagoas State, Brazil

The purpose of this study was to characterize cases of violence against children and adolescents examined at the Forensic Medicine Institute in Maceió, Alagoas State, Brazil. Three hundred and three cases from September, 2008 to March, 2009, were analyzed. Victims were interviewed and data were collected on the type of violence, victim's gender, age, schooling, and economic class, maternal schooling, characteristics of the aggressor and person reporting the case, location, and repeat offenses. Violence against children and adolescents in this sample was concentrated in lower income groups, and girls were victimized more frequently than boys. Most perpetrators were non-relatives, but known to the family. Sexual abuse was more common among younger children, while physical assault was more common against adolescents. The victim's home was the most frequent site of the violence. Further studies are needed to determine whether violence in other socioeconomic groups and against males actually does not occur, or whether it simply is not reported to the Forensic Medicine Institute and thus remains invisible.

O objetivo do estudo foi descrever as características da violência contra crianças e adolescentes atendidos no Instituto Médico-Legal de Maceió (IML/Maceió), Alagoas, Brasil. Entrevistaram-se 303 vítimas de violência, submetidas a exame de corpo de delito, de setembro/2008 a março/2009. Coletaram-se dados sobre tipo de violência, sexo, idade, escolaridade e classificação econômica da vítima; escolaridade da mãe; identificação do agressor e do denunciante e local da violência. A violência contra crianças e adolescentes que chegam ao IML/Maceió está concentrada nas camadas sociais mais baixas e tem nas meninas e jovens do sexo feminino as principais vítimas. Os agressores foram, na maioria, pessoas conhecidas da família. Predominaram casos de violência sexual entre as crianças e, física entre os adolescentes. A casa da vítima foi o local mais comum para a prática da violência. Estudos adicionais devem ser realizados para identificar se a violência contra crianças e adolescentes nos demais segmentos sociais não existe ou apenas não demanda exames de corpo de delito, o que contribui para sua invisibilidade.

Physical abuse of older people reported at the Institute of Forensic Medicine in Recife, Pernambuco State, Brazil / A violência física contra a pessoa idosa revelada em serviço médico-legal, Recife, Pernambuco, Brasil

Conduziu-se um estudo transversal com o objetivo de determinar o perfil da violência física em idosos submetidos à perícia traumatológica, entre 2004 e 2007, no Instituto de Medicina Legal do Recife, Pernambuco, Brasil. Os casos, cujas informações procederam de 1.027 laudos, foram descritos segundo características do evento, da vítima e do agressor. Com maior freqüência, a violência foi produzida por energia mecânica, instrumento contundente e arma natural; ocorreu num domingo, turno noturno e residência da vítima; acometeu mais de uma parte do corpo e a lesão foi leve. Prevaleceram como vítimas os homens, com idade entre 60 e 69 anos, pardos, casados/união consensual e aposentados/pensionistas. A maioria dos agressores era homem, conhecido da vítima e a agrediu desacompanhado. A transcendência social do problema torna imperativo o investimento em programas para seu enfrentamento, possibilitando uma melhor qualidade de vida para o idoso.

This cross-sectional study aimed to determine the profile of physical abuse against older people who underwent forensic examination at the Institute of Forensic Medicine in Recife, Pernambuco State, Brazil. The cases, with data from 1,027 forensic reports, were described according to characteristics of the incident, victim, and aggressor. Most cases of violence were produced by mechanical energy, either with blunt objects or by empty-handed attack; the most common day of the week was Sunday, most frequently in the evening, and in the victim's home; typical cases involved mild injuries on more than one part of the victim's body. The majority of the victims were men, 60 to 69 years of age, brown (mixed-race), married or living with a partner, and retirees/pensioners. The majority of the aggressors were men, known to the victim, and attacking alone. The social transcendence of violence against older people clearly calls for investment in programs to deal with the problem in order to ensure better quality of life for the elderly.

Prevalencia del suicidio en la Región de Tarapacá, años 1990-2008 / Prevalence of suicide in the Region of Tarapacá, years 1990-2008

Hemos llevado a cabo un estudio epidemiológico descriptivo de las muertes de tipo suicida en Tarapacá, Chile, entre los años 1990 y 2008, obteniéndose interesantes datos acerca del comportamiento de este fenómeno en una zona extrema, con indicios de una compleja adaptación social y dificultades en la integración individual. En un total de 432 casos, por ejemplo, la tasa de suicidio varió de un 6,11 por 100.000 hab. en 1990 a 13,32 por 100.000 hab. en 2008; se observó que el suicidio fue más frecuente entre los 20 a 44 años, especialmente en hombres, con una proporción cercana a 6:1, siendo el mecanismo más utilizado el ahorcamiento, tanto entre hombres como mujeres. Otro punto interesante lo constituye el hecho de que la tasa de suicidio a partir de 1996 se duplica respecto a los años precedentes, excediendo las tasas de otras regiones del país, la tasa nacional de suicidio y la de muchos países de la región y de Europa, constituyéndose en la segunda causa de muerte violenta en la provincia, lo cual nos retrotrae al complejo fenómeno biopsicosocial involucrado en la génesis del suicidio.

We carried out an epidemiological descriptive study of suicidal type deaths in Tarapacá, Chile, between 1990 and 2008, collecting interesting information about the behavior of this phenomenon in an extreme zone, with indicators of a complex social adjustment and difficulties in individual integration. In a whole of 432 cases, for example, the rate of suicide changed from 6.11 for 100.000 hab. in 1990 to 13.32 for 100.000 hab. in 2008; we observe that the suicide was more frequent in ages between 20 to 44 years, especially in men with a nearby proportion of 6:1, being the mechanism most used in both sexes, the hanging. Another interesting point constitutes the fact that the rate of suicide from 1996 doubled in relation to previous years, exceeding the rates of other regions of the country, the national rate and the rate of many American countries and even some European countries, being constituted in the second cause of violent death in our province, which makes us think about the complex phenomenon biopsicosocial involved in the genesis of the suicide.

Development of clinical forensic medicine in India A need of time.

Forensic medicine is the medical specialty that is practiced at the interface with the law. It involves the assessment and interpretation in an individual who has become involved either as a suspect or victim in some form of alleged criminal action. In practice however, the role of practitioners of forensic medicine has widened to include civil jurisdictions and matters of medical ethics. Clinical Forensic Medicine is the application of forensic medical techniques to living. To address the un-met forensic needs of victims who are survivors of violent crimes and trauma there is urgent need of examination of victims of violence by a specially trained person in medicolegal matters i.e. clinical forensic physicians. In this program, the clinical forensic physicians will evaluate adult and pediatric victims of blunt and penetrating trauma, sexual and physical abuse and collect evidentiary material when indicated. In this paper the importance of Clinical Forensic Medicine Program and recommendations made by the “Survey Committee Report on Medico-Legal Practices in India, 1964” regarding its implementation are presented.

Producto interno bruto y mortalidad por accidentes de tránsito / Gross internal product and mortality for accidents traffic

Desde el informe de Norman en 1963, los accidentes de tránsito parecen relacionarse con el "progreso". Se compararon las tasas de mortalidad por accidentes de tránsito en Venezuela, entre 1970 y 1986, con los valores del producto interno bruto (P.B.I.) de los mismos años. Un brote epidémico se registró entre dichos años con pico alrededor de 1978 y 1980. Utilizando el procedimiento estratificado se estimaron dos líneas de regresión entre el P.I.B. y las tasas, cuyos coeficientes de regresión difieren estadísticamente de cero. De acuerdo a los respectivos coeficientes de determinación, la variación del P.I.B. parece "explicar" entre el 90 y el 95 por ciento de la variación de las tasas de mortalidad por accidentes de tránsito.

Muertes por causa externa en niños. Instituto de Medicina Legal, Regional Nor-Oriente 1990-1992

El objetivo del presente trabajo es conocer la verdad, sexo, distribución mensual y diaria, mecanismo de lesión y causa de muerte de los menores de 15 años a quienes se les practicó necropsia médico legal por razón de causa externa en el Anfiteatro Municipal de Bucaramanga entre 1990 y 1992. Se revisan los protocolos de autopsia y se incluyen los casos con la información completa. Se estudiaron 170 casos, 115 varones (67.6 por ciento) y 55 mujeres (32.4 por ciento) correspondientes a 15 recién nacidos (8.8 por ciento), 12 lactantes (7.1 por ciento), 59 pre-escolares (34.7 por ciento), 47 escolares (27.6 por ciento) y 37 púberes (21.8 por ciento). Hay predominio de mujeres en los menores de 2 años y de varones en los mayores (p<0.00015), por lo que la edad promedio es menor en estas (4.7ñ 45 años) que en aquellos (7.0 ñ 4.2 años) (p<0.00143). La distribución en los tres años, a lo largo de los meses del año y de los días del mes no es uniforme, sin tendencia definida. La lesión contusa fue el mecanismo más frecuente de muerte en 91 casos (53.3 por ciento), seguido por inmersión en 20 (11.8 por ciento), quemadura en 19 (11.2 por ciento), herida con arma de fuego en 17 (19 por ciento) y sofocación en 5 casos (2.9 por ciento), siendo desconocido en diez (5.9 por ciento), todos ellos recién nacidos; las heridas por arma de fuego fueron encontradas en niños mayores (9.6ñ4.2 años), mientras que la inmersión en menores (4.9ñ3.5 años) del promedio. La causa de muerte más frecuente fue la lesión encefálica en 68 casos (40 por ciento), anoxia en 27 (15.9 por ciento), ruptura de visceras abdominales en 16 (9.4 por ciento), lesión múltiple en 14 (8.2 por ciento) y sepsis en 9 (5.3 por ciento); excluyendo los neonatos, no hay diferencia significativa en la edad según causa de muerte (p<0.26578). No hay diferencia significativa en el sexo según mecanismo de lesión y causa de muerte. Se concluye que las causas de muerte y mecanismos de lesión de origen externo en menores de 15 años son similares a los registrados en la literatura, excepto a los informes de las zonas en conflicto donde predominan las lesiones por arma de fuego

Causas de muerte en pacientes a quienes se practicó autopsia entre 1977 y 1988 en el Hospital Universitario Ramón González Valencia

El presente estudio permite conocer las causas de muerte encontradas en autopsias realizadas por el Departamento de Morfopatología de la Facultad de Salud de la Universidad Industrial de Santander (UIS) entre el 1 de enero de 1977 y el 31 de diciembre de 1988, practicadas a pacientes fallecidos en el Hospital Universitario Ramón González Valencia (HURGV) de la ciudad de Bucaramanga. Además de los datos obtenidos se presentan, como punto de comparación, los publicados a nivel nacional por el Departamento Administrativo Nacional de Estadística (DANE), regional con el Boletín Epidemiológico del servicio de Salud de Santander y local con los archivos de estadística del HURGV. Se muestran los resultados para el total de la población estudiada (1004 casos) por causa general de muerte, grupo etiológico, grupo de edad y sexo

Medicina legal / Legal mediine

Contiene: La medicina legal; deontologia medica; etica medica; responsabilidad profesional, ejercicio de la medicina; traumatologia medicolegal; homicidio -suicidio; lesiones; formas de lelsiones; medicina legal del trabajo; riesgos y accidentes de trabajo; peritaje medico en materia laboral; tanatologia medicolegal; la muerte; autopsia medico legal; criminalistica; identificacion policial, dactiloscopia;identificacion medico legal; sexologia forence; desviaciones del institnto sexual; delitos de caracter sexual; medicina legal del matrimonio embarazo y nacimiento; aborto, infanticidio; asfixiologia; psicopatologia forence; los disturbios transitorios de la conciencia; capacidad vital