How much does a forensic autopsy cost in Spain?

INTRODUCTION AND OBJECTIVES: The autopsy is considered the gold standard in death investigation. Performing an autopsy requires human and material resources that must be programmed in order to meet the demands of the judicial system. However, as far as we know, the cost of forensic autopsy in Spain has not been determined. Thus, the aim of this study was to estimate the cost of a standard autopsy in order to organise Forensic Pathology Services more efficiently. MATERIAL AND METHODS: A micro-cost analysis was carried out. The nominal group technique was applied using a panel of 10 forensic experts in order to identify and quantify the resources associated with a forensic autopsy. RESULTS: The results showed that analysis and studies are the most important item in the total cost (54.7%), followed by staff (20.5%), preservation of body (14%), single-use products (7%), equipment and stock (1.6%), cleaning and disinfection (1.5%), facilities maintenance (0.5%) and IT (0.2%). CONCLUSIONS: The total cost of a standard autopsy was €1501.45, which is lower than the European average. This study is the first in Spain to calculate the unit price of a forensic autopsy by means of micro-cost analysis. This may help to address the way forensic pathology centres are organised at different levels of complexity.

Structural abnormalities in the human diaphragm in drowning and hanging deaths: preliminary results.

PURPOSE: Previous experiments in rats have indicated that there are histological changes in skeletal muscle in drowning deaths; these changes include muscle fibers that contain ragged red fibers (RRF). The purpose of this study was to examine whether these changes also occur in humans. METHODS: Histologic and histochemical examinations of three muscles (diaphragm, pectoralis, and psoas) were performed on 24 cadavers with three different causes of death: 8 drowning, 8 hanging, and 8 sudden cardiac disease. Muscle samples were stained with hematoxylin-eosin, MGT, nicotinamide adenine dinucleotide-tetrazolium reductase, succinate dehydrogenase, ATPase, and acid phosphatase via standard staining procedures. RESULTS: There were statistically significant differences in the detection of RRFs in these cohorts. Additionally, several other cytoarchitectural changes (whorled and core-like fibers) were observed in the diaphragm in the drowning cohort and to a lesser extent in the hangings. These structural abnormalities were not observed in the sudden cardiac disease deaths, thus suggesting a common mechanism for the production of these muscular changes that is not shared in the cardiac death group. The mechanism is most likely intense hypoxia and mechanical trauma of the respiratory muscles in the setting of active blood circulation with intense muscle contraction. CONCLUSIONS: Our results confirmed that there are histological changes in the diaphragm in drownings and, to a lesser extent, in hangings.

Clusters de casos de suicidio espacio-temporal en la comunidad de Antequera (España) / Space-time suicide clustering in the community of Antequera (Spain)

Introducción. En España, cada año consuman suicidio alrededor de 3.500 personas. El principal objetivo del presente estudio fue examinar si eran evidentes agrupaciones (clusters) espacio-temporales de suicidio en la región de Antequera (Málaga, España). Métodos. Muestra y procedimiento. Entre el 1 de enero de 2004 y el 31 de diciembre de 2008, se identificaron todos los casos de suicidio consumado (fuente: Servicio de Patología Forense del Instituto de Medicina Legal, Málaga, España). Geolocalización. Usamos Google Earth para calcular las coordenadas del domicilio de todos los casos de suicidio. Análisis estadístico. Usamos el programa SaTScan® espacio-temporal y la función K de Ripley para examinar la presencia de agrupaciones (clusters) espacio-temporales de los casos de suicidio. Acto seguido, utilizamos la prueba de la X2 de Pearson para determinar la presencia de diferencias estadísticamente significativas entre los casos de suicidio identificados dentro y fuera de las agrupaciones de suicidio. Resultados. En los análisis del presente estudio efectuado en el municipio de Antequera, de un total de 120 individuos que cometieron suicidio se incluyeron 96 (80%). Se identificaron pruebas estadísticamente significativas para 7 agrupaciones espacio-temporales de suicidio dentro de los límites críticos de 0-2,5 km de distancia y durante la primera y segunda semana después del caso de suicidio (p < 0,05 en ambos casos). Entre los casos de suicidio dentro de agrupaciones (n = 17), no hubo ningún individuo en el que se hubiera establecido un diagnóstico de trastorno psicótico actual, mientras que, entre los casos de suicidio fuera de las agrupaciones espacio-temporales, en el 20%, se había establecido dicho diagnóstico (X2 = 4,13; gl = 1; p < 0,05). Conclusiones. En la región circundante de Antequera están presentes agrupaciones (clusters) espacio-temporales de los casos de suicidio. Entre pacientes con un diagnóstico de trastorno psicótico actual hubo menos probabilidades de una influencia por los factores que determinan las agrupaciones espacio-temporales de los casos de suicidio consumado (AU)

Introduction. Approximately 3,500 people commit suicide every year in Spain. The main aim of this study is to explore if a spatial and temporal clustering of suicide exists in the region of Antequera (Málaga, España). Methods. Sample and procedure: All suicides from January 1, 2004 to December 31, 2008 were identified using data from the Forensic Pathology Department of the Institute of Legal Medicine, Málaga (España). Geolocalisation. Google Earth was used to calculate the coordinates for each suicide decedent's address. Statistical analysis. A spatiotemporal permutation scan statistic and the Ripley's K function were used to explore spatiotemporal clustering. Pearson's chi-squared was used to determine whether there were differences between suicides inside and outside the spatiotemporal clusters. Results. A total of 120 individuals committed suicide within the region of Antequera, of which 96 (80%) were included in our analyses. Statistically significant evidence for 7 spatiotemporal suicide clusters emerged within critical limits for the 0-2.5 km distance and for the first and second semanas (P < .05 in both cases) after suicide. There was not a single subject diagnosed with a current psychotic disorder, among suicides within clusters, whereas outside clusters, 20% had this diagnosis (X2 = 4.13; df = 1; P < .05). Conclusions. There are spatiotemporal suicide clusters in the area surrounding Antequera. Patients diagnosed with current psychotic disorder are less likely to be influenced by the factors explaining suicide clustering (AU)

[Space-time suicide clustering in the community of Antequera (Spain)]. / Clusters de casos de suicidio espacio-temporal en la comunidad de Antequera (España).

INTRODUCTION: Approximately 3,500 people commit suicide every year in Spain. The main aim of this study is to explore if a spatial and temporal clustering of suicide exists in the region of Antequera (Málaga, España). METHODS: Sample and procedure: All suicides from January 1, 2004 to December 31, 2008 were identified using data from the Forensic Pathology Department of the Institute of Legal Medicine, Málaga (España). Geolocalisation. Google Earth was used to calculate the coordinates for each suicide decedent's address. Statistical analysis. A spatiotemporal permutation scan statistic and the Ripley's K function were used to explore spatiotemporal clustering. Pearson's chi-squared was used to determine whether there were differences between suicides inside and outside the spatiotemporal clusters. RESULTS: A total of 120 individuals committed suicide within the region of Antequera, of which 96 (80%) were included in our analyses. Statistically significant evidence for 7 spatiotemporal suicide clusters emerged within critical limits for the 0-2.5 km distance and for the first and second semanas (P<.05 in both cases) after suicide. There was not a single subject diagnosed with a current psychotic disorder, among suicides within clusters, whereas outside clusters, 20% had this diagnosis (X2=4.13; df=1; P<.05). CONCLUSIONS: There are spatiotemporal suicide clusters in the area surrounding Antequera. Patients diagnosed with current psychotic disorder are less likely to be influenced by the factors explaining suicide clustering.

Factores de riesgo y protectores en el suicidio. Un estudio de casos y controles mediante la autopsia psicológica / Risk and protective factors in suicide. A case-control study using the psychological autopsy

Las tasas, los métodos y algunos de los factores de riesgo en el suicidio parecen depender de las diferencias geográficas y culturales, lo que implica la elaboración de estudios en zonas específicas de alto riesgo cara a la implementación de estrategias preventivas. Este estudio busca determinar los factores de riesgo y protectores en el suicidio en la Comarca de Antequera-Málaga (España). Se realiza en un estudio de caso y controles mediante la autopsia psicológica con 40 casos de suicidio y 80 controles poblacionales emparejados en género, edad y zona de residencia. El modelo multivariante hallado está compuesto por los siguientes factores: el presentar antecedentes familiares de suicidio y agregación de desordenes mentales en la familia, un diagnóstico de trastorno de la personalidad y conflictos familiares en el mes previo al suicidio. Estos factores permiten discriminar poblaciones de riesgo cara a la implementación de programas preventivos (AU)

Rates, methods and some of the risk factors of suicide seem to depend on geographical and cultural differences, which involve conducting research in specific high-risk areas facing the implementation of preventive strategies. This study seeks to determine the risk and protective factors of suicide in the region of Antequera-Málaga (Spain). Is performed on a case-control study using the psychological autopsy of 40 cases of suicide and 80 population controls matched on gender, age and area of residence. The multivariate model found is composed of the following factors: the antecedents of suicide and mental disorders aggregate in families, a diagnosis of personality disorder and family conflict in the month prior to suicide. These factors discriminate risk populations facing the implementation of preventive programs (AU)

El médico en el estrado. Recomendaciones para comparecer como perito ante los tribunales / Doctor in the podium. Recommendations to appear as an expert in the court

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