Changing trends and characteristics of one punch deaths in Australia (2012-2018).

One-punch assaults also known as 'coward punches', are characterised by a single severe blow to the head causing the victim to lose consciousness, resulting in a secondary impact between the head and surrounding environment. Such impacts may result in brain injury leading to fatality or permanent neurological impairment. In a previous publication, there were 90 one punch deaths around Australia between 2000 and 2012, mostly involving young men drinking alcohol at a licensed venue at the weekend. This prompted a surge of public education and awareness campaigns around Australia, in addition to regulatory and legislative changes aimed at curbing social violence. This retrospective descriptive study aimed to examine one punch deaths since 2012 in Australia to determine if there has been a decrease in deaths, and whether the demographics and circumstances of these deaths have changed. A search of the National Coronial Information System was undertaken for all closed coronial cases between 1 January 2012 and 31 December 2018. Additional information was collected from medicolegal reports including toxicology, pathology and coronial findings. There were 80 one punch fatalities in Australia, almost exclusively involving males. The median age was 43.5 (range 18-71) years and there was a decreasing trend in the number of deaths annually. Most fatal assaults occurred in the state of New South Wales (28.8%) followed by Queensland (23.8%), and in metropolitan locations (64.6%) rather than regional areas (35.4%). Alcohol was the most commonly detected drug, found in 47 cases of the 71 cases where toxicology results were available (66%), with a median concentration of 0.14 and 0.19 g/100 mL in antemortem and postmortem samples, respectively (range 0.005-0.32 g/100 mL). Five deaths reported methylamphetamine, with THC detected in 21.1% of cases. Assaults more commonly occurred on a footpath or roadside (41.3%), followed by a home or dwelling (32.5%). 8.8% of assaults occurred inside hotels, bars or other licenced venues. Most transpired on a weekday, which differed from the pre-2012 period when these assaults occurred mainly on the weekend. While some trends are positive, there has been a shift in the victim demographic as well as the typical environment for fatal one punch assaults, highlighting the importance of public health surveillance in providing a current evidence base to inform policy and practice.

Family violence homicide rates: a state-wide comparison of three data sources in Victoria, Australia.

BACKGROUND: Family violence homicide (FVH) is a major public health and social problem in Australia. FVH trend rates are key outcomes that determine the effectiveness of current management practices and policy directions. Data source-related methodological problems affect FVH research and policy and the reliable measurement of homicide trends. OBJECTIVE: This study aimed to determine data reliability and temporal trends of Victorian FVH rates and sex and relationship patterns. METHOD: FVH rates per 100,000 persons in Victoria were compared between the National Coronial Information System (NCIS), Coroners Court of Victoria (CCoV) Homicide Register, and the National Homicide Monitoring Program (NHMP). Trends for 2001-2017 were analysed using Joinpoint regression. Crude rates were determined by sex and relationship categories using annual frequencies and Australian Bureau of Statistics population estimates. RESULTS: NCIS closed FVH cases totalled 360, and an apparent downward trend in the FVH rate was identified. However, CCoV and NHMP rates trended upwards. While NCIS and CCoV were case-based, NHMP was incident-based, contributing to rate variations. The NCIS-derived trend was particularly impacted by unavailable case data, potential coding errors and entry backlog. Neither CCoV nor NHMP provided victim-age in their public domain data to enable age-adjusted rate comparison. CONCLUSION: Current datasets have limitations for FVH trend determination; most notably lag times for NCIS data. IMPLICATIONS: This study identified an indicative upward trend in FVH rates in Victoria, suggesting insufficiency of current management and policy settings for its prevention and control.

Orofacial injuries in child family homicide: a population study.

Child family violence homicide (FVH) is a significant public health problem in Australia and globally. Population-wide studies of orofacial injuries in child FVH are uncommon despite their recognized importance. This whole population descriptive study of orofacial injuries in child FVH in Victoria, Australia aims to implement a novel methodological approach to provide an overview of child FVH and describe frequency and patterns of abusive orofacial injuries. Closed cases of child FVH aged 0-17 years, January 2000-December 2018, were identified from screening all Victorian assault deaths for eligible offender relationships. Significant associations of clinical/demographic characteristics were explored using two-step clustering and the Spearman correlation coefficient. Of 895 closed homicide cases, 358 were FV-related. Of the 53 child FVH, 40 were eligible for injury analysis with 36 of these cases (90%) having orofacial injuries. Among these 36 cases, 72% were aged 0-4 years, males predominated (64%) and the injury mechanism was blunt force for 56%. The discrete orofacial injury frequency was associated with the non-orofacial injury frequency (rho: 0.362, 2-tailed p < 0.03). A three-cluster statistical solution was identified, each represented by an injury mechanism. The largest cluster identified a pattern of blunt force trauma in 0-4 years with drug presence, high average non-orofacial injury numbers and parent-offenders. A novel methodological approach was implemented to comprehensively describe the frequency, nature, patterns and risk indicators of orofacial injuries in child FVH. It explored associations between a wide range of clinical and demographic characteristics, which might have otherwise been missed in summary description. These methods will potentially underpin future comparative studies of intentional-unintentional child injuries and fatal-nonfatal child abuse. The study narrows a significant research gap regarding patterns of inflicted injuries, and demographic and clinical indicators in child FVH potentially informing future systematic classification processes, risk assessment tools and pathways to FV intervention.

Systematic Review of the Patterns of Orofacial Injuries in Physically Abused Children and Adolescents.

OBJECTIVE: To examine the evidence base for patterns of oro-facial injuries in physical abuse cases of children and adolescents aged 0-17 years. DATA SOURCES: Systematic searches of Ovid Medline, Ovid Embase, Cochrane Central and grey literature, dating from the oldest entry to August 2017. REVIEW METHODS: Search criteria included English language peer reviewed articles and theses on physical abuse cases affecting the age group of 0-17 years. Exclusion criteria were: Case reports and <10 case series; studies involving bite mark injuries elsewhere on the body, sexual, ritualistic or emotional abuse and neglect, exposure to domestic violence; reviews; book chapters and conference proceedings. The following data was extracted: quality and design of study, oro-facial manifestations, new/old injuries, fatalities, coexistent injuries, co-morbidities and radiologic investigations. Each study was subjected to two independent reviews and a third, if reviewers disagreed. RESULTS: The authors identified 51 articles, 26 of which satisfied the inclusion criteria. The oro-facial signs were superficial injuries of face, ears, neck, lips and oral mucosa, burns, torn fraenii and fractured teeth and jaws. A minority of studies stood out due to their well-developed design; expert opinion inclusion; new/old/occult injury investigations and facial bruising/ intraoral injuries as sentinel markers. Overall, the review demonstrated weak study quality and representativeness as well as lacunae in uniform reporting. CONCLUSIONS: The available literature does not endorse any pathognomonic signature patterns of child physical abuse to the exposed oro-facial region.

Population study of orofacial injuries in adult family violence homicides in Victoria, Australia.

BACKGROUND: This study describes the prevalence and orofacial injury patterns associated with adult family violence (FV) homicides in Victoria, Australia. It follows a methods study for case selection of all FV homicides and injury measurement. Comprehensive analysis of orofacial injuries in FV homicides and their clinico-demographic context will inform future research on clinical FV indicators and sentinel injuries, and potentially lead to premorbid intervention in health services. METHODS: All closed cases of FV homicides aged ≥18 years, January 2006 to December 2018, were identified by screening Victorian fatal assaults, based on victim-offender relationship. Primary data such as post-mortem computed tomography scans and photographs were assessed. Socio-demographic, clinical, interpersonal and incident parameters were descriptively analysed and statistically compared across FV homicides with and without facial injuries using cluster analysis and nonparametric tests. RESULTS: Of 170 adult homicides screened for eligibility, 151 were included for final analysis. Over the 12-year period, 78.1% of all Victorian adult FV homicides had orofacial injuries. Significant cluster patterns of injury mechanism, victim-offender relationship and drug/alcohol impairment were identified in all homicides. Non-facial injuries were significantly higher in facial vs. non-facial injury homicides. Facial abrasion and incised wounds were the most common injury types. CONCLUSIONS: This is the first forensic-epidemiologic study evaluating the empirical evidence concerning orofacial injuries associated with population-wide adult Victorian FV homicides. The high level of orofacial injuries in this population during the study period may inform clinical practice and policy in FV intervention in Victoria and globally.

Methods in population study of orofacial injuries in Victorian family violence homicides.

This study standardized the methods used in the determination of orofacial injuries in Victorian family violence homicides and informed potential control selection for an analytic study. Dental service contacts with family violence victims may be intervention avenues due to the presence of abusive injuries in the orofacial region. All Victorian family homicides from January 2000-September 2018 were identified by determining the kinship/relationship and grouped by age. A 20% random sample of adult cases, aged 18-64 years was selected. The median number of orofacial injuries in categories of injury mechanisms/age/gender and the nature of abusive orofacial injuries was reported for the sample. Of 357 closed cases of family homicide, 261 were adults aged 18-64 years. Offender information and injury mechanism data was available for all closed cases, enabling case selection. Of a random sample of 50 adults, 8 cases were excluded. After 2006, CT scans and photos were present in 20 (91%) and 19 (86.4%) of 22 cases, respectively. The nature and median number of orofacial injuries showed correlation to the reported injury mechanism. Strengths and limitations of the used methods were assessed. Not all cases were compatible for assessment of orofacial injuries, thus serving as an additional criterion for exclusion in our methodology. Further detailed study of the whole population of adults should be limited to the period 2006-2018 where the data is more complete. The mechanism of injury may influence control selection for analytic studies. We present preliminary evidence of the frequent occurrence of orofacial injuries in family violence homicides.

Mandatory reporting of child physical abuse and dental neglect by Australian dentists.

Child protection measures are organized into three major themes: laws; service programs; and status of outcomes of these interventions. Contextually, mandatory reporting of child abuse and neglect is governed by a complex system of State legislation across Australia. The purpose of this review was to investigate the evidence base for the legislative obligations of Australian dentists as mandatory reporters; the functionality of dental practice in the determination of orofacial signs of abuse and neglect; and, relevant knowledge and practice demonstrated by the Australian dental work force. Our research question explores the role of Australian dentists in intervention of child physical abuse and dental neglect. Information was sourced from literature and web-based reviews. Peer reviewed articles included reviews and empirical studies. Official websites/databases were accessed for relevant legislation. The study found that child protection laws lack an evidence base for including/excluding dentists as reporters. Child abuse and neglect is associated with strong orofacial signs, thus imparting a key advantage to utilizing dentists as potential notifiers. An action response to child abuse is not seen in the Australian dental service. This review identifies gaps in the dental literature concerning mandatory reporting, calls for optimization of the related evidence base, and uniform Australian child abuse reporting requirements.

Osteoid producing primary lesion at morphologic and biologic interface.

Fibroosseous gnathic lesions comprise a wide spectrum of diseases. Many of the entities have overlapping features. A pediatric case is encountered with a complex clinicopathologic profile. Although radiographically the lesion appears benign but on histopathological examination it possesses features of osteoid producing aggressive neoplasm. This paper highlights the unusual histologic features existing within the spectrum of fibroosseous lesions and discusses relevant clinicopathologic correlations.

Clinicopathologic assessment of Candida colonization of oral leukoplakia.

BACKGROUND: Leukoplakia is the most common premalignant lesion of the oral mucosa. We studied the colonization of Candida in oral leukoplakia using direct microscopy, culture and histopathology to determine if there is a statistical correlation between Candida invasion and the clinical appearance and presence of epithelial dysplasia in leukoplakia. METHODS: Samples were collected from 40 patients with oral leukoplakia and 21 controls. The swabs collected were used to inoculate Sabouraud's dextrose agar slant and for direct microscopy with Gram's stain. Culture growths were subjected to germ tube and corn meal agar tests to differentiate between Candida albicans and non-albicans groups. Biopsies were also done in all patients for histopathological confirmation; Gomori's methanamine silver stain was used to identify fungal invasion of lesional epithelium. RESULTS AND CONCLUSIONS: Nineteen cases of leukoplakia showed Candida on direct smears, compared to 3 controls. Eighteen cases and one control showed growth of Candida on culture. Non-homogenous leukoplakia showed a higher positivity rate on microscopy and culture than homogenous lesions. All these correlations were statistically significant. Forty percent of leukoplakia cases were simultaneously positive for Candida on direct microscopy, culture and histopathologic evaluation. No significant difference was found between non-dysplastic and distinctly dysplastic lesions with respect to Candida detection on microscopy or culture.

Mural adenomatoid odontogenic tumour as anterior mandibular swelling: a diagnostic challenge.

Adenomatoid odontogenic tumour is an uncommon, benign, hamartomatous lesion that commonly affects the anterior maxilla and has two radiographic variants, follicular and extrafollicular where the former is more common than the latter. Here, we report a case of 15-year-old female with midline swelling of the mandible. Radiographically, impacted right permanent mandibular canine was associated with the radiolucent lesion. Dentigerous cyst was given as provisional diagnosis. However, histologically the lesion represented the features of cystic variant of Adenomatoid odontogenic tumour.

Pathological and clinical features of primary osseous tumours of the jaw.

Primary bone tumors of the jaw are rare. The neoplastic cells in these tumors are the osteoblasts and osteoclasts. The gnathic bone tumors have also been referred to as borderline. The clinicopathologic approach towards these bony lesions have been reviewed.

Oncologic profile of maxillary odontogenic myxoma: A rare case.

Odontogenic myxoma (OM) is an ectomesenchyme derived neoplasm, almost exclusively found in jaws. This article presents a maxillary OM with a brief review of the molecular and proteomic antecedents of OMs, capturing its histopathogenesis.