Anders Eriksson

Anders Eriksson
Umeå University | UMU · Department of Community Medicine and Rehabilitation

MD PhD, Professor, Senior Consultant

About

276
Publications
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6,893
Citations
Additional affiliations
April 1992 - present
Umeå University
Position
  • Professor (Full)

Publications

Publications (276)
Article
A major issue in current clinical research regarding shaken baby syndrome (SBS) and abusive head trauma (AHT) has been described as circular reasoning. Circular reasoning in this context means that a child protection team makes the SBS/AHT diagnosis, and that this diagnosis is also used as the reference test (gold standard) when researchers classif...
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We describe events arising from the case of Joby Rowe, convicted of the homicide of his three month old daughter, and explore what they illustrate about systemic problems in the forensic science community in Australia. A peer reviewed journal article that scrutinized the forensic evidence presented in the Rowe case was retracted by a forensic scien...
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In Reply Unfortunately, disapproval of our Viewpoint¹ seems to have resulted in fatal misinterpretations and blinded the authors from our constructive suggestion for improvements in future studies. We would like to reply to each of the authors’ points accordingly.
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Introduction Most findings of forensic pathology examinations are presented as written reports. There are currently no internationally accepted recommendations for writing forensic pathology reports. Existing recommendations are also varied and reflect the differences in the scope and role of forensic medical services and local settings in which th...
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Benign external hydrocephalus (BEH) is a subtype of hydrocephalus. It is common in boys and characterised by rapid increases in head circumference (HC), enlarged subarachnoid spaces and normal or moderately enlarged ventricles. Most infants with BEH are born with a normal HC that starts to grow too rapidly after birth. BEH predisposes infants for i...
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Fatal intoxications are common in a medico-legal autopsy setting and are associated with sparse findings during autopsy. It has been suggested that an increased lung weight may be associated with such fatalities. Previous literature is generally limited to a descriptive approach, including only opioid deaths, and lacking a definition of "heavy" lun...
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It is sometimes difficult to isolate the cause of a medical finding, especially when the origins and pathogenesis are unknown and there is only a statistical association between empirical phenomena. In 1965, the English epidemiologist Austin Bradford Hill presented 9 criteria to indicate possible causality.¹ The eighth criterion states that if a pr...
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The traditional theory of abusive head trauma requires scientific scrutiny. Those who question the validity of this theory have been accused of denialism for the purpose of obfuscating evidence in legal settings and supporting abusive caregivers. The tradi­tional theory holds that abusive head trauma results from “shaken baby syndrome”. In referenc...
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This study analyses suicides amongst reindeer herding Sámi in Sweden using information from the database of the National Board of Forensic Medicine. Suicides were identified using registers (39 suicides from 1961–2000) and key informants (11 suicides from 2001–2017). A great majority of cases were males (43 males, 7 females), and 50% occurred in th...
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We argue that there are similarities between the Vulcan-must-exist-theory, derived from the Original Unrestricted Newtonian Gravitational (OUNG) theory, on the one hand, and on the other hand the infant-must-have-been-shaken-theory, derived from the Original Unrestricted Abusive Head Trauma (OUAHT) theory. Although the Vulcan-must–exist-theory was...
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We present the hypothesis that subdural hemorrhages during childbirth might be associated with so-called three-month colic, whereby an infant cries intensively and repeatedly during its first three months. A traditional interpretation is that this infantile crying is associated with nutrition and is accordingly “a gut issue”, but this is probably n...
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Various algorithms have been developed for diagnosis of Abusive Head Trauma (AHT); however, there is no explicit algorithm for the 1/3 of alleged AHT cases which present with findings restricted to subdural and retinal hemorrhages, with or without encephalopathy—i.e., isolated triad cases. Moreover, such cases have been lumped together with AHT cas...
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We propose the medical hypothesis that a common denominator may be the precursor for Brief Resolved Unexplained Events (BRUE), cases of Sudden Infant Death Syndrome (SIDS) as well as to cases of alleged Shaken Baby Syndrome (SBS) without external signs of trauma. Although previous studies have emphasized differences, we have focused on the overarch...
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Finland has one of the highest homicide rates in Western Europe, and almost every tenth homicide is caused by asphyxiation. Reliable statistics, a strict legislation, and an exceptionally high medico‐legal autopsy rate formed a base for a nationwide analysis of asphyxia homicides (n = 383) during 30 years. The cases were identified through multiple...
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Background: We have previously evaluated muscle functions and morphology in power athletes of long term (5 to15 years) abuse of anabolic androgen steroids (AAS; Doped) and in clean power athletes (Clean), and observed significant improvements in both muscle morphology and muscle functions in Doped. To our knowledge, the effects of long term AAS ab...
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Since its publication in 2016, the Swedish systematic literature review of traumatic shaking (1) has attracted a number of critical comments (2-5). In one of the more comprehensive criticisms, parallels were drawn regarding the consequences, between the Swedish report and a study by Dr Andrew Wakefield published in The Lancet in 1998 (6,7). Wakefie...
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Epidemiological studies indicate that the incidence of shaken baby cases is overestimated and that this is due to biased classifications, based on ethical rather than scientific considerations. In the present paper, we analyze the nature of the ethical considerations and how they made their way into the classification procedures. We argue that the...
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The main conclusion of the SBU systematic review was that there is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low‐quality evidence) (1). Laurent‐Vannier et al are concerned that this conclusion is used by defence lawyers, but this concern can be understood and resp...
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A scientific paradigm typically embraces research norms and values, such as truth-seeking, critical thinking, disinterestedness, and good scientific practice. These values should prevent a paradigm from introducing defective assumptions. But sometimes, scientists who are also physicians develop clinical norms that are in conflict with the scientifi...
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The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language i...
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Background: Sweden's firearm legislation obligates physicians to report patients that are deemed unsuitable to possess a firearm. This study aimed to explore the involvement of firearm use in firearm fatalities and to evaluate physician reporting concerning cases of firearm deaths. Methods: Fatal firearm suicides and homicides in Sweden were stu...
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Since the publication of the Swedish systematic literature review on the diagnostic accuracy of the triad of signs and symptoms and shaken baby syndrome (1), several authors have commented on the arguments for classifying most previous studies as having a high risk of bias (2‐4). The main reason for this classification is that scientists have used...
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Since its publication in 2016, the report by the Swedish Agency for Health Technology Assessment and Assessment of Social Services on the diagnostic accuracy of the triad for determining traumatic shaking (1) has been criticised, mainly by paediatricians. One repeated criticism has been that the report focused on the triad of symptoms, namely subdu...
Article
In their editorial (1) on Andersson and Thiblin's study on abusive head trauma in Sweden (2), Fleming and Byard refer to a systematic literature study on shaken baby syndrome (3). They maintain that the review was strongly criticised and that major methodological flaws have been described. We would like respond to these comments. Firstly, we agree...
Article
A systematic review of shaken baby syndrome by the Swedish Agency for Health Technology Assessment and Assessment of Social Services generated numerous reactions from professional organisations, even before the review was published. There was also a lively debate after a paper summarising its findings were published in Acta Paediatrica The various...
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Fatalities caused by animal attacks are rare, but have the potential to mimic homicide. We present a case in which a moose attacked and killed a woman who was walking her dog in a forest. Autopsy showed widespread blunt trauma with a large laceration on one leg in which blades of grass were embedded. Flail chest was the cause of death. The case was...
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Many of the comments on our systematic literature review on shaken baby syndrome (1) have focused on our criticism of how child protection teams' classification of study cases and controls are used as gold standard and the faulty circular reasoning associated with that (2,3). Some commentators have also questioned how reasonable it is to focus on t...
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In their comments on the shaken baby syndrome report (1) and subsequent paper in Acta Paediatrica (2) Dr Bilo et al (3) assumed that the expert panel responsible for both publications used the "same meticulous approach to compile Table 1" in the Appendix to the report as they did in the main references to the report (1). This article is protected b...
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There have been a lot of views expressed about our paper on shaken baby syndrome, which was published in Acta Paediatrica (1). We acknowledge the concerns expressed by all of the authors who responded with regard to child welfare and the possibility that the diagnoses may be delayed in individual cases of child abuse. However, we are very troubled...
Article
In most studies on the diagnostic accuracy of the triad of subdural haematoma, retinal haemorrhages and encephalopathy, the classification of study cases and controls was performed by a child protection team. Since the triad is a very important criterion used by child protection teams, the extremely high diagnostic accuracy of the triad is obviousl...
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Narang et al (1) maintain that the research question in our systematic review in Acta Paediatrica (2) was based on the findings of Guthkelch in 1971 (3), and that we presumed that Guthkelch introduced the shaken baby syndrome triad. That is not correct. We used the Guthkelch example in the introduction in order to illustrate when the discussion on...
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In a recently published systematic review of the shaken baby literature in Acta Paediatrica (1), we and our fellow authors concluded that there was very little support for the claim that if the triad of subdural haematoma (SDH), retinal haemorrhages (RHs) and encephalopathy were present with absence of any impact, the infant must have been violentl...
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Lucas et al (1) maintain that there were substantial flaws in the way our review on shaken baby syndrome (2) was conducted and in our choice of research focus. They suggest that the reason for these major shortcomings was that the expert panel lacked clinicians and scientists with deep knowledge in the research area. This article is protected by co...
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We would like to thank to Dr Ludvigsson (1), who was the only critical commentary author to acknowledge the methodological problems inherent in the diagnosis of shaken baby syndrome, following the publication of our systematic review (2) in Acta Paediatrica. Dr Ludvigsson posed two questions regarding the two main conclusions, which deserve respons...
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Shaken baby syndrome has typically been associated with findings of subdural haematoma, retinal haemorrhages and encephalopathy, which are referred to as the triad. During the last decade, however, the certainty with which the triad can indicate that an infant has been violently shaken has been increasingly questioned. The aim of this study was to...
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Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed th...
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Heavy combined lung weight at autopsy is a non-specific autopsy finding associated with certain causes of death such as intoxication. There is however no clear definition of what constitutes “heavy” lung weight. Different reference values have been suggested but previous studies have been limited by small select populations and only univariate regr...
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We examined the association between unintentional nonhunting firearm deaths and changes in firearm legislation in Sweden. There were 43 fatalities during the study time frame 1983-2012, representing 46% of all unintentional firearm deaths during the same period. The victims were predominantly young males (mean age 25 years). Slightly more than half...
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Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation t...
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Fatal bear attacks on humans are uncommon with only one reported case in Sweden since 1902. The bear population is, however, growing and the frequency of confrontations is likely to increase. Case I-A 40-year-old hunter and his dog were found dead near a bear's den. Autopsy showed that a large portion of the face, facial skeleton, and anterior port...
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In 2008 only 55 % of all deaths not deemed to be natural in Sweden underwent a medicolegal autopsy. In the present study we describe and compare the characteristics of unnatural deaths in three counties through review of death certificates for unnatural deaths and, when applicable, corresponding police reports. The majority of unnatural deaths that...
Article
In 2008 only 55 % of all deaths not deemed to be natural in Sweden underwent a medicolegal autopsy. In the present study we describe and compare the characteristics of unnatural deaths in three counties through review of death certificates for unnatural deaths and, when applicable, corresponding police reports. The majority of unnatural deaths that...
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The effects of long-term (over several years) anabolic androgen steroids (AAS) administration on human skeletal muscle are still unclear. In this study, seventeen strength training athletes were recruited and individually interviewed regarding self-administration of banned substances. Ten subjects admitted having taken AAS or AAS derivatives for th...
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Prior authors have suggested that when occupant ejection occurs in association with a seat belt failure, entanglement of the outboard upper extremity (OUE) with the retracting shoulder belt will invariably occur, leaving injury pattern evidence of belt use. In the present investigation, the authors assessed this theory using data accessed from the...
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Fatal falls often involve a head impact, which are in turn associated with a fracture of the skull or cervical spine. Prior authors have noted that the degree of inversion of the victim at the time of impact is an important predictor of the distribution of skull fractures, with skull base fractures more common than skull vault fractures in falls wi...
Article
In 2008 only 55 % of all deaths not deemed to be natural in Sweden underwent a medicolegal autopsy. In the present study we describe and compare the characteristics of unnatural deaths in three counties through review of death certificates for unnatural deaths and, when applicable, corresponding police reports. The majority of unnatural deaths that...
Article
Aim: The aim was to investigate the possibility to evaluate the mortality pattern in a community intervention programme against cardiovascular disease by official death certificates. Methods: For all deceased in the intervention area (Norsjö), the accuracy of the official death certificates were compared with matched controls in the rest of Väst...
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Since any firearm injury is potentially lethal, it is of great interest to prevent firearm incidents. This study investigated such incidents during hunting and Swedish hunters' safety behaviour. A 48-item questionnaire was posted to a random sample of 1000 members of the Swedish Association for Hunting and Wildlife Management. The questions conside...
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This study investigates accident fatalities involving two types of off-road vehicles: snowmobiles and all-terrain vehicles (ATVs). All snowmobile fatalities in Sweden from the 2006/2007 season through the 2011/2012 season, and all ATV fatalities from 2007 through 2012, were retrospectively examined. A total of 107 fatalities—57 snowmobile-related a...
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We describe a fatality due to an intrathecally positioned epidural catheter and an infusion rate of bupivacaine set 10 times higher than planned. The undetected misplacement, despite safety routines, is discussed along with the toxicological findings and new information on the intrathecal distribution of bupivacaine. From a clinical point of view,...
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By studying the number and method of homicidal poisoning in Miami-Dade County, Florida; New York City, NY; Oakland County, Michigan; and Sweden, we have confirmed that this is an infrequently established crime.Several difficulties come with the detection of homicidal poisonings. Presenting symptoms and signs are often misdiagnosed as natural diseas...
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To identify the incidence of pelvic trauma, causes of death and factors predicting death with pelvic fractures. All pelvic fractures were retrospectively identified from a registry spanning from March 2007 to August 2009. Data was captured on a proforma. Data for survivors, non-survivors and a subgroup with pelvic injury as the underlying cause of...
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The purpose of this study was to investigate if teenagers visiting an emergency room because of injury have an increased risk of premature death ahead and, if so, identify possible risk factors and suggest preventive measures. In January 2010, the personal identity numbers of 12,812 teenagers who had visited the emergency room at the University Hos...
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Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the Natio...
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To determine the incidence as well as contributing factors to fatal hypothermia. Retrospective, registry-based analysis. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992-2008. Police reports, medical records and autopsy proto...
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This study evaluated the relationship between anabolic androgenic steroid (AAS) use and body constitution. Dual-energy x-ray absorptiometry was used to measure bone mineral density (BMD, g·cm(-2)) of the total body, arms, and legs. Total gynoid and android fat mass (grams) and total lean mass (grams) were measured in 10 strength trained athletes (4...
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This study examined all unintentional firearm fatalities while hunting that occurred in Sweden between 1983 through 2008. The circumstances as well as the impact of the hunter's exam on fatality frequency were analysed. During these 26 years, there were 48 such fatalities, representing 53% of all (n=90) unintentional firearm deaths during the same...
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Deaths by exsanguination among various underlying causes of death were analyzed in order to expand the knowledge on the relation of extravasated blood volume to other documented parameters. A consecutive series of 193 cases of ruptured thoracic aortic aneurysm (n=13), gunshot wounds (n=63), stab wounds (n=28), rib fractures (n=5), and blunt injury...
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The leaves of Kratom, a medicinal plant in Southeast Asia, have been used as an herbal drug for a long time. At least one of the alkaloids present in Kratom, mitragynine, is a mu-receptor agonist. Both Kratom and an additional preparation called Krypton are available via the internet. It seems to consist of powdered Kratom leaves with another mu-re...