Forensic Medicine

The research on the department of forensic medicine consists of four PhD projects and a few separate studies performed in collaboration with other universities. Currently running PhD projects:

  • Consequences of Abuse of anabolic-androgenic steroids (AAS)
  • Violence epidemiology and injury interpretation
  • Development of a model to assess the post-mortem interval (time between death and discovery)
  • Diagnosis of infant abuse

Collaboration projects: In collaboration with KI studies of drug-related death are performed;

  • Development and risk factors
  • A study that examines the hypothesis that intake of AAS may lead to an increased number of heart cell

In collaboration with the Department of Forensic Medicine in Budapest and Semmelweis University testicular changes among heroin addicts are studied.

AAS

This Ph.D. project aims to identify cardiac changes and testicular changes in deceased AAS users. Earlier studies suggest that the heart and the reproductive organs are strongly affected by AAS. Today there are quite a few clinical studies on AAS users suggesting adverse effects of AAS. However, large-scale pathological studies of the type we do have not been done before.


Violence epidemiology/injury interpretation

Epidemiological violence research is an important part of criminology. The community is interested in violent crime trends and what preventive measures are effective. Lethal violence is a parameter often in focus when the violence in society is discussed. One aspect that is often lacking in criminological studies is the intensity of the violence (brutality). A Ph.D. project at our unit is designed to validate existing tools and develop new tools for the estimation of violence intensity in homicides. The project idea was borne from a study that indicates that there has been a brutalization of deadly violence in Sweden during the 1990's compared with the previous two decades.

The model will be used in studies of risk factors for violence based on a nationwide perpetrator data base created at the department of Forensic Psychiatric in Huddinge (Joakim Sturup).

In collaboration with associate professor Svein Kleiven at KTH a method for advanced injury analysis is developed. In short, this method is to simulate injuries by means of so-called Finite element analysis made on the basis of data on the injured body part (i.e. skull bone thickness) and observations at the accident scene (documentation of vertical drop, the form of hard objects in the environment, etc.). The Finite element method is well established, but needs to be further developed and validated for forensic purposes. For this purpose a special devise for measuring pressure loads on skeletal structures has been built.

Determination of post mortem interval

A forensic death investigation must answer three questions: When did the person die? What was the cause of death? What was the manner of death (disease, accident, suicide or homicide)?

Of these three questions, it is the first that generally is the most difficult. It is particularly difficult when the body remained undetected for a long time after death. The project aims to develop a new model for estimating the interval between death and the discovery by combining the established models to assess the degree of decomposition with entomology (insect research) models. In order to be able to test the influence of various possible conditions (conditional answers) analysis with Bayesian networks is applied. The project is done in collaboration with Anders Lindström, at the SVA.

Infant abuse

In recent years, the scientific evidence for previously established views regarding certain findings diagnostic value for infant abuse has been questioned. One important aspect is that most studies confirming that  certain findings are highly specific for infant abuse are based on an assumption that care takers who do not provide a history of trauma lacks credibility, an assumption which is not a medical assessment. We have identified a number of hypotheses which lacks empirical verification (goes for hypotheses both for and against abuse as explanatory factor) and have further found that several of these hypotheses possibly can be tested from data in the case registries run by the Swedish Board of Forensic Medicine if combined with data from medical care registries. The project thus aims to unconditionally (without starting from a basic assumption regarding the credibility of the care takers) test hypotheses regarding certain findings diagnostic value for infant abuse. The project is done in collaboration with Professor Ulf Högberg, Department of Women and Children's Health, Uppsala University.

Drug-related death

More than 95% of all deaths recorded as drug-related in official death statistics are undergoing forensic autopsy. In collaboration with MD Anna Fugelstad at KI, regular updates of the drugs involved, age, sex etc. are done. In addition, we look closely at the methadone-related mortality including comparative time series on mortality and pharmacy prescriptions. A separate project is mapping (geoepidemiology) of drug-related deaths, giving a picture of how different substances of abuse spread over time in the country.

Finally, an on-going study examines the role of alcohol for drug-related mortality.

Cardiac cell turn over in users of AAS

There is strong evidence of an increased risk for cardiac hypertrophy in users of AAS. There is also evidence that, at the micro-level, cardiac muscle cells size increase. In contrast to previous belief, it has been found that there is a continuous slow formation of new cardiomyocytes in humans. This has led to the question if AAS can accelerate this process. Jonas Frisén’s research group at Karolinska Institutet has developed an elegant method to detect the formation of new cells. The method is based essentially on the measurement of radioactive carbon-14 in nuclear DNA. The cell carbon-14 activity is compared with the so-called bomb pulse curve, which shows the atmospheric concentration of carbon-14. Atmosphere carbon-14 is derived from nuclear tests during the Cold War and falls with constant speed. Therefore carbon-14 activity is lower in newly formed cells compared to older cells, e.g. those that are included from birth. The hypothesis is that AAS stimulates the formation of cardiomyocytes. MD Kanar Alkass linked to the Frisén research is the principal researcher of the study.

Testicular changes in heroin addicts

While working with testicular changes in users of AAS, a suspicion that opioid abuse may lead to similar changes has risen. To investigate this possibility, collaboration with the Institute of Forensic Medicine in Budapest started. Unlike the situation in Sweden, where the majority of drug addicts are polydrug users, there is a large group of addicts in the Budapest region that only use heroin. This provides an opportunity to study changes in relation to only one exposure factor. The study is performed in collaboration with Professor Eva Keller, Semmelweis University.

Members of the group

Ingemar Thiblin, Professor, Head of Unit
Greta Agren, Associate Professor
Håkan Sandler, MD
Monika Horwat, MD
Hamid-Mobini-Far, PhD student
Frederick Tamsen, PhD student
Jacob Andersson, PhD student
Ann-Sofie Pålsson, PhD student

Collaboration partners
Ulf Högberg, Professor, KBH, UU
Kanar Alkass, MD, KI
Jonas Frisén, Professor, KI
Anna Fugelstad, MD, KI
Joakim Sturup, PhD, Stockholm University and KI
Eva Keller, Professor, Semmelweis University, Budapest 

Publications in DiVA 2018-2016, Forensic Medicine

  • Li, Xiaogai; Sandler, Håkan; Kleiven, Svein

    Infant skull fractures: Accident or abuse? Evidences from biomechanical analysis using finite element head models

    Part of Forensic Science International, p. 173-182, 2019.

  • Gravensteen, Ida Kathrine; Ekeberg, Öivind; Thiblin, Ingemar; Helweg-Larsen, Karin et al.

    Psychoactive substances in natural and unnatural deaths in Norway and Sweden: a study on victims of suicide and accidents compared with natural deaths in psychiatric patients

    Part of BMC Psychiatry, 2019.

    Open access
  • Mostad, Petter; Tamsen, Fredrik

    Error rates for unvalidated medical age assessment procedures

    Part of International journal of legal medicine (Print), p. 613-623, 2019.

  • Tamsen, Fredrik; Sturup, Joakim; Thiblin, Ingemar

    Homicide injury severity in association with the victim-offender relationship

    Part of Forensic Science International, p. 151-156, 2019.

  • Andersson, M. Gunnar; Pålsson, Ann-Sofie; Sandler, Håkan; Mostad, Petter

    Application of the Bayesian framework for forensic interpretation to casework involving postmortem interval estimates of decomposed human remains

    Part of Forensic Science International, p. 402-414, 2019.

  • Fugelstad, Anna; Thiblin, Ingemar; Johansson, Lars Age; Ågren, Gunnar et al.

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

    Part of Drug And Alcohol Dependence, p. 253-259, 2019.

    Open access
  • Tamsen, Fredrik

    Homicide Injury Quantification: Measures of injury severity in homicide victims and associations with homicide characteristics

    Open access
  • Högberg, Ulf; Andersson, Jacob; Högberg, Göran; Thiblin, Ingemar

    Why is there a multi-fold difference in diagnosis of abuse among infants with long bone fracture in East Anglia compared with Sweden?

    Part of Archives of Disease in Childhood, 2019.

  • Andersson, Jacob; Thiblin, Ingemar

    National study shows that abusive head trauma mortality in Sweden was at least 10 times lower than in other Western countries.

    Part of Acta Paediatrica, p. 477-483, 2018.

  • Högberg, Ulf; Lampa, Erik; Högberg, Göran; Aspelin, Peter et al.

    Infant abuse diagnosis associated with abusive head trauma criteria: incidence increase due to overdiagnosis?

    Part of European Journal of Public Health, p. 641-646, 2018.

  • Andersson, Jacob; Thiblin, Ingemar

    It is important not to assume an aetiology for the triad before the outcomes of diagnostic investigations

    Part of Acta Paediatrica, p. 1308-1309, 2018.

  • Högberg, Ulf; Andersson, Jacob; Squier, Waney; Hogberg, Goren et al.

    Epidemiology of subdural haemorrhage during infancy: A population-based register study

    Part of PLoS ONE, 2018.

  • Högberg, Ulf; Andersson, Jacob; Högberg, Göran; Thiblin, Ingemar

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

    Part of PLoS ONE, 2018.

    Open access
  • Ceciliason, Ann-Sofie; Andersson, M Gunnar; Lindström, Anders; Sandler, Håkan

    Quantifying human decomposition in an indoor setting and implications for postmortem interval estimation

    Part of Forensic Science International, p. 180-189, 2018.