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2. Materials and Methods

2.1. Study design and setting
This was a retrospective, descriptive study based on analysis of autopsy and external corpse examination report files of all cases involving dark-skinned persons whose deaths were investigated at the Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf between January 1994 and December 2017.

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2.2. Case selection and statistical analysis

All records of external corpse examinations as well as medico-legal, clinical and anatomical autopsies that were done in the Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf during the period from January 1994 to December 2017 were retrieved and analyzed using the keywords and search terms “Schwarze Hautfarbe” (Black skin color), “Afrikaner”(African), “Afrikanerin” (African), “Afro-Amerikanisch” (Afro-American), “dunkler Hautfarbe”(dark skin color),”dunkle Hautfarbe”(dark skin color), “Schwarzafrikaner” (black African) and “Schwarzafrikanerin” (black African).

With the help of a pre-established data collection form, the files retrieved were then reviewed for demographic and clinical data concerning the deceased person such as age; sex; country of origin/place of birth; social status/occupation; type of autopsy done; place where body was found/place where death occurred; authority who requested the autopsy; manner of death as well as cause of death. Furthermore, the information regarding social status/occupation of the deceased was further analyzed into residence status of the individual such as whether the deceased was homeless; a refugee/asylum seeker; had own accommodation or not, employed or not; or whether the deceased was a student or not. For the cases in which an autopsy was done, the type of autopsy was further classified into medico-legal, clinical or others (those that were done to determine whether the disease condition leading to death was occupational-related or not). The manner of death was further classified into natural, unnatural and in cases where the definitive cause of death was not known, as unascertained. Furthermore, to determine the commonest causes of death in dark-skinned individuals examined during this period, we recorded the causes of death as indicated on the death certificate for all cases in which an autopsy was not requested or done. For the cases in which an autopsy was done, the cause of death recorded was that indicated in the autopsy report following completion of the autopsy and the respective necessary complementary investigations such as histology, toxicological analysis etc.

The deaths certified as natural were further classified according to the diseased body system or organ i.e. respiratory, cardiovascular, gastrointestinal tract, nervous system or systemic infections. All disease conditions not fitting in the above categories were then classified as others. On the other hand, all deaths certified as unnatural were further classified according to the primary event leading to death i.e. whether it was suicide, homicide, accident, post-op complications, drowning or intoxication. The rest were then classified as others. To further determine the frequency, precipitating factors as well as events leading to homicides and suicides, data on social status/occupation of the individual, deceased and perpetrator’s countries of origin/birth and the crime trigger were collected. Furthermore, data on previous history of psychotic or psychiatric conditions, mode of crime execution, history of prior suicide attempts or criminal record, crime scene, the perpetrator-victim relationship as well as the possible influence of drugs/alcohol were collected.

In a separate chapter of this dissertation, we also present cases in which the deaths were investigated by a team of forensic pathologists from the Hamburg Institute of Legal Medicine in collaboration with Rwandan doctors through yearly interdisciplinary forensic summer schools held in Kigali-Rwanda every year since 2012. The annual forensic summer schools are conducted within the framework of a cooperation project between the Institute of Legal Medicine/University Medical Center Hamburg-Eppendorf and various academic and administrative institutions in Rwanda aimed at the transfer of knowledge in the field of legal medicine.

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