{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:47:29Z","timestamp":1792003649697,"version":"4.4.0"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Legal Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Forensic medicine represents a critical socio-health observatory for socially marginalized populations. This study provides the first systematic retrospective forensic analysis of mortality among people experiencing homelessness in Italy. We examined 104 decedents undergoing autopsy in Milan between 2014 and 2024. The annual number of autopsied homeless decedents increased over the study period, peaking in 2023\u20132024. The majority of deaths occurred in indoor public spaces (45\/104, 43.3%), with the remainder in hospitals or green areas, reflecting extreme social marginalization and environmental exposure. Anamnestic data were available for 56\/104 cases (53.8%), of whom 42 (75%) had chronic medical conditions, while psychiatric or psychosocial histories were known for 43\/104 cases (41.3%). These figures likely underestimate the true burden due to fragmented healthcare access and incomplete documentation. Causes of death were classified as natural (25\/104, 24.0%), non-natural (17\/104, 16.4%), or undetermined (62\/104, 59.6%). Natural deaths, predominantly in middle-aged adults, illustrate accelerated health deterioration associated with homelessness, while non-natural deaths reflect heightened exposure to hazardous urban environments. Undetermined deaths \u2013 mainly acute circulatory insufficiency without macroscopic findings \u2013 highlight substantial gaps in post-mortem evaluation. Toxicological and histological analyses were rarely performed, revealing procedural and structural constraints that impede accurate cause-of-death determination in socially vulnerable and clinically complex populations. These findings uncover preventable and identifiable patterns of mortality, emphasize the forensic and public health value of comprehensive post-mortem investigation, and call for integrated strategies combining proactive healthcare delivery, harm reduction, and standardized forensic protocols to improve diagnostic accuracy and strengthen mortality surveillance in homeless populations.<\/jats:p>","DOI":"10.1007\/s00414-026-04037-z","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:47:40Z","timestamp":1791856060000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Forensic insights into mortality and challenges in post-mortem investigations of homeless individuals: a 10-year study (2014\u20132024) in Milan, Italy"],"prefix":"10.1007","author":[{"given":"Stefano","family":"Tambuzzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devis","family":"Valleriani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Carsana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Arzenati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Mazzarelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Cattaneo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"4037_CR1","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1186\/s12889-022-13499-w","volume":"22","author":"AL Thorndike","year":"2022","unstructured":"Thorndike AL, Yetman HE, Thorndike AN et al (2022) Unmet health needs and barriers to health care among people experiencing homelessness in San Francisco\u2019s Mission District: a qualitative study. BMC Public Health 22:1071. https:\/\/doi.org\/10.1186\/s12889-022-13499-w","journal-title":"BMC Public Health"},{"key":"4037_CR2","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s12875-015-0361-3","volume":"16","author":"DJT Campbell","year":"2015","unstructured":"Campbell DJT, O\u2019Neill BG, Gibson K, Thurston WE (2015) Primary healthcare needs and barriers to care among Calgary\u2019s homeless populations. BMC Fam Pract 16:139. https:\/\/doi.org\/10.1186\/s12875-015-0361-3","journal-title":"BMC Fam Pract"},{"key":"4037_CR3","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1186\/1472-6963-14-376","volume":"14","author":"A Skosireva","year":"2014","unstructured":"Skosireva A, O\u2019Campo P, Zerger S et al (2014) Different faces of discrimination: Perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Serv Res 14:376. https:\/\/doi.org\/10.1186\/1472-6963-14-376","journal-title":"BMC Health Serv Res"},{"key":"4037_CR4","doi-asserted-by":"publisher","first-page":"49","DOI":"10.12688\/wellcomeopenres.15151.1","volume":"4","author":"RW Aldridge","year":"2019","unstructured":"Aldridge RW, Menezes D, Lewer D et al (2019) Causes of death among homeless people: A population-based cross-sectional study of linked hospitalisation and mortality data in England. Wellcome Open Res 4:49. https:\/\/doi.org\/10.12688\/wellcomeopenres.15151.1","journal-title":"Wellcome Open Res"},{"key":"4037_CR5","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1016\/S0140-6736(11)60747-2","volume":"377","author":"SF Nielsen","year":"2011","unstructured":"Nielsen SF, Hjorth\u00f8j CR, Erlangsen A, Nordentoft M (2011) Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. Lancet 377:2205\u20132219. https:\/\/doi.org\/10.1016\/S0140-6736(11)60747-2","journal-title":"Lancet"},{"key":"4037_CR6","doi-asserted-by":"publisher","first-page":"e762","DOI":"10.1016\/S2468-2667(25)00171-9","volume":"10","author":"SF Nilsson","year":"2025","unstructured":"Nilsson SF, Erlangsen A, Munch Nielsen C et al (2025) Life-years lost in people experiencing homelessness and other high-risk groups in Denmark: a population-based, register-based, cohort study. Lancet Public Health 10:e762\u2013e773. https:\/\/doi.org\/10.1016\/S2468-2667(25)00171-9","journal-title":"Lancet Public Health"},{"key":"4037_CR7","doi-asserted-by":"publisher","first-page":"E725","DOI":"10.17269\/s41997-025-01045-1","volume":"10","author":"R Lucie","year":"2025","unstructured":"Lucie R (2025) Mortality among individuals living in permanent supportive housing: A retrospective cohort study. Lancet Public Health 10:E725\u2013E726. https:\/\/doi.org\/10.17269\/s41997-025-01045-1","journal-title":"Lancet Public Health"},{"key":"4037_CR8","unstructured":"Fondation Abb\u00e9 Pierre - FEANTSA (2023) Eighth overview of housing exclusion in europe 2023. Sofiaplan"},{"key":"4037_CR9","unstructured":"ISTAT (2026) ISTAT - senza tetto e senza fissa dimora. http:\/\/dati-censimentipermanenti.istat.it\/Index.aspx?DataSetCode=DCSS_SENZA_TETTO. Accessed 7 Jul 2026"},{"key":"4037_CR10","doi-asserted-by":"crossref","unstructured":"fioPSD -Federazione Italiana Organismi per le Persone Senza Dimora (2023) Principali statistiche sul fenomeno homelessness in Italia [Main statistics of homelessness in Italy]. https:\/\/www.fiopsd.org\/wp-content\/uploads\/2023\/03\/IT_Country_Profile_IT.pdf. Accessed 7 Jun 2026","DOI":"10.70818\/ijbass.2026.v07i01.2604"},{"key":"4037_CR11","unstructured":"Fondazione Ing, Rodolfo, Debenedetti (2024) racCONTAMI 2024. Indagine sulle persone senza dimora nella citt\u00e0 di Milano [Survey on homeless people in the city of Milan]. https:\/\/www.frdb.org\/progetti\/raccontami2024\/. Accessed 7 Jun 2026"},{"key":"4037_CR12","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1056\/NEJMp0707996","volume":"358","author":"GBEC Shojania Kaveh","year":"2008","unstructured":"Shojania Kaveh GBEC (2008) The Vanishing Nonforensic Autopsy. N Engl J Med 358:873\u2013875. https:\/\/doi.org\/10.1056\/NEJMp0707996","journal-title":"N Engl J Med"},{"key":"4037_CR13","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1093\/ije\/dyac088","volume":"51","author":"C Cattaneo","year":"2022","unstructured":"Cattaneo C, Tambuzzi S, Maggioni L, Zoja R (2022) Has violent death lost the interest of epidemiology? Int J Epidemiol 51:2020\u20132021. https:\/\/doi.org\/10.1093\/ije\/dyac088","journal-title":"Int J Epidemiol"},{"key":"4037_CR14","doi-asserted-by":"publisher","first-page":"e0178200","DOI":"10.1371\/journal.pone.0178200","volume":"12","author":"BM Blokker","year":"2017","unstructured":"Blokker BM, Weustink AC, Hunink MGM, Oosterhuis JW (2017) Autopsy rates in the Netherlands: 35 years of decline. PLoS ONE 12:e0178200. https:\/\/doi.org\/10.1371\/journal.pone.0178200","journal-title":"PLoS ONE"},{"key":"4037_CR15","unstructured":"CDC - National Center for Health Statistics (2024) ICD-10-CM tabular list of diseases and injuries. https:\/\/ftp.cdc.gov\/pub\/health_statistics\/nchs\/publications\/ICD10CM\/2022\/icd10cm-tabular-2022-April-1.pdf. Accessed 7 Jun 2026"},{"key":"4037_CR16","unstructured":"Collectif Les Morts de la Rue (2024) Mortalit\u00e9 des personnes sans chez-soi en 2023 [Mortality of people experiencing homelessness in 2023]. https:\/\/mortsdelarue.org\/publication-du-rapport-2024\/. Accessed 7 Jun 2026"},{"key":"4037_CR17","unstructured":"Taylor G, VJTJ (2023) and TM Dying Homeless Project. https:\/\/museumofhomelessness.org\/dhp. Accessed 7 Jun 2026"},{"key":"4037_CR18","unstructured":"Los Angeles County Department of Public Health (2023) New Public Health Report Shows Sharp Rise in Mortality Among People Experiencing Homelessness. https:\/\/lacounty.gov\/2023\/05\/12\/new-public-health-report-shows-sharp-rise-in-mortality-among-people-experiencing-homelessness\/. Accessed 7 Jun 2026"},{"key":"4037_CR19","unstructured":"NYC Department of Homeless Services (2024) Stats & Reports. https:\/\/www.nyc.gov\/site\/dhs\/about\/stats-and-reports.page?utm. Accessed 7 Jun 2026"},{"key":"4037_CR20","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/S0140-6736(17)31869-X","volume":"391","author":"RW Aldridge","year":"2018","unstructured":"Aldridge RW, Story A, Hwang SW et al (2018) Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet 391:241\u2013250. https:\/\/doi.org\/10.1016\/S0140-6736(17)31869-X","journal-title":"Lancet"},{"key":"4037_CR21","doi-asserted-by":"publisher","unstructured":"White J, Moriarty Y, Lau M et al (2025) Homelessness, type of homelessness, and risk of cause-specific mortality: a systematic review and meta-analysis of 116 studies comprising 2,563,633 homeless people and 129,292,553 population controls. https:\/\/doi.org\/10.1101\/2025.04.22.25326193. medRxiv","DOI":"10.1101\/2025.04.22.25326193"},{"key":"4037_CR22","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1053\/cmaj.1031167","volume":"170","author":"AM Cheung","year":"2004","unstructured":"Cheung AM, Hwang SW (2004) Risk of death among homeless women: a cohort study and review of the literature. CMAJ 170:1243\u20131247. https:\/\/doi.org\/10.1053\/cmaj.1031167","journal-title":"CMAJ"},{"key":"4037_CR23","doi-asserted-by":"publisher","first-page":"46","DOI":"10.2105\/AJPH.2014.302330","volume":"105","author":"RS Bernstein","year":"2015","unstructured":"Bernstein RS, Meurer LN, Plumb EJ, Jackson JL (2015) Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis. Am J Public Health 105:46\u201360. https:\/\/doi.org\/10.2105\/AJPH.2014.302330","journal-title":"Am J Public Health"},{"key":"4037_CR24","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.1016\/j.jacc.2018.02.077","volume":"71","author":"TP Baggett","year":"2018","unstructured":"Baggett TP, Liauw SS, Hwang SW (2018) Cardiovascular Disease and Homelessness. J Am Coll Cardiol 71:2585\u20132597. https:\/\/doi.org\/10.1016\/j.jacc.2018.02.077","journal-title":"J Am Coll Cardiol"},{"key":"4037_CR25","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1001\/jamapsychiatry.2024.0426","volume":"81","author":"R Barry","year":"2024","unstructured":"Barry R, Anderson J, Tran L et al (2024) Prevalence of Mental Health Disorders among Individuals Experiencing Homelessness: A Systematic Review and Meta-Analysis. JAMA Psychiatry 81:691\u2013699. https:\/\/doi.org\/10.1001\/jamapsychiatry.2024.0426","journal-title":"JAMA Psychiatry"},{"key":"4037_CR26","doi-asserted-by":"publisher","first-page":"395","DOI":"10.7861\/clinmed.2023-0074","volume":"23","author":"JJ Nadicksbernd","year":"2023","unstructured":"Nadicksbernd JJ, Nguyen T, Jackson T, Shulman C (2023) Health and care needs of hospitalised people experiencing homelessness: an inpatient audit. Clinical Medicine. J R Coll Physicians Lond 23:395\u2013402. https:\/\/doi.org\/10.7861\/clinmed.2023-0074","journal-title":"J R Coll Physicians Lond"},{"key":"4037_CR27","doi-asserted-by":"publisher","first-page":"1865","DOI":"10.1056\/nejmp2411265","volume":"391","author":"A Katherine","year":"2024","unstructured":"Katherine A, Koh (2024) Invisible Deaths \u2014 Mortality among People Experiencing Homelessness. New Engl J Med 391:1865\u20131868. https:\/\/doi.org\/10.1056\/nejmp2411265","journal-title":"New Engl J Med"},{"key":"4037_CR28","unstructured":"Camera dei Deputati (2023) Modifica all\u2019articolo 19 della legge 23 dicembre 1978, n. 833, e altre disposizioni in materia di assistenza sanitaria per le persone senza dimora [Amendment to Article 19 of Law No.833 of 23 December 1978 and other provisions on healthcare for homeless people]. https:\/\/documenti.camera.it\/leg19\/dossier\/Pdf\/AS0030.pdf. Accessed 7 Jun 2026"},{"key":"4037_CR29","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1111\/inm.13034","volume":"31","author":"A Hallyburton","year":"2022","unstructured":"Hallyburton A (2022) Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses. Int J Ment Health Nurs 31:1360\u20131372. https:\/\/doi.org\/10.1111\/inm.13034","journal-title":"Int J Ment Health Nurs"},{"key":"4037_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2150132720910289","volume":"11","author":"C Gilmer","year":"2020","unstructured":"Gilmer C, Buccieri K (2020) Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain. J Prim Care Community Health 11:1\u20137. https:\/\/doi.org\/10.1177\/2150132720910289","journal-title":"J Prim Care Community Health"},{"key":"4037_CR31","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1001\/jamainternmed.2023.5475","volume":"183","author":"L Haghighat","year":"2023","unstructured":"Haghighat L, Ramakrishna S, Salazar JW et al (2023) Homelessness and Incidence and Causes of Sudden Death Data From the POST SCD Study. JAMA Intern Med 183:1306\u20131314. https:\/\/doi.org\/10.1001\/jamainternmed.2023.5475","journal-title":"JAMA Intern Med"},{"key":"4037_CR32","doi-asserted-by":"publisher","first-page":"2689","DOI":"10.1161\/CIRCULATIONAHA.117.033427","volume":"137","author":"ZH Tseng","year":"2018","unstructured":"Tseng ZH, Olgin JE, Vittinghoff E et al (2018) Prospective Countywide Surveillance and Autopsy Characterization of Sudden Cardiac Death: POST SCD Study. Circulation 137:2689\u20132700. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.117.033427","journal-title":"Circulation"},{"key":"4037_CR33","doi-asserted-by":"publisher","DOI":"10.7326\/m20-0977","author":"RM Rodriguez","year":"2020","unstructured":"Rodriguez RM (2020) Occult overdose masquerading as sudden cardiac death: from the postmortem systematic investigation of sudden cardiac death study. Ann Intern Med. https:\/\/doi.org\/10.7326\/m20-0977","journal-title":"Ann Intern Med"},{"key":"4037_CR34","volume-title":"Medicina legale per giuristi [Legal medicine for lawyers]","author":"CMGA Barbieri","year":"2021","unstructured":"Barbieri CMGA (2021) Medicina legale per giuristi [Legal medicine for lawyers]. Giuffr\u00e8 Francis Lefebvre, Milano"},{"key":"4037_CR35","unstructured":"Governo I (1990) Regolamento di polizia mortuaria. D.P.R. 10 settembre 1990, n. 285 [Presidential Decree 10 September 1990, No. 285 - Mortuary police regulation]. In: Gazzetta Ufficiale. https:\/\/presidenza.governo.it\/USRI\/ufficio_studi\/normativa\/D.P.R.%2010%20settembre%201990,%20n.%20285.pdf. Accessed 7 Jun 2026"},{"key":"4037_CR36","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1056\/nejmp1909017","volume":"381","author":"KM De Cock","year":"2019","unstructured":"De Cock KM, Zielinski-Guti\u00e9rrez E, Lucas SB (2019) Learning from the Dead. N Engl J Med 381:1889\u20131891. https:\/\/doi.org\/10.1056\/nejmp1909017","journal-title":"N Engl J Med"},{"key":"4037_CR37","doi-asserted-by":"publisher","first-page":"112395","DOI":"10.1016\/j.forsciint.2025.112395","volume":"368","author":"C Karydi","year":"2025","unstructured":"Karydi C, Leventaki C, Katsos K et al (2025) Late discovery of bodies in indoor settings: A forensic practitioner\u2019s view on recognizing cases of social isolation in eastern Attica, Greece. Forensic Sci Int 368:112395. https:\/\/doi.org\/10.1016\/j.forsciint.2025.112395","journal-title":"Forensic Sci Int"},{"key":"4037_CR38","unstructured":"Federman SCA (2024) Street medicine can address the health needs of people who are homeless. The Commonwealth Fund. https:\/\/www.commonwealthfund.org\/blog\/2024\/street-medicine-can-address-health-needs-people-who-are-homeless.Federman"},{"key":"4037_CR39","doi-asserted-by":"publisher","unstructured":"Casavola V, Giampieri E, Paggi E et al (2023) Treating homeless people with psychiatric disorders: evidence from the Italian \u201cDiogene\u201d project. J Nerv Ment Dis 211:870\u2013875. https:\/\/doi.org\/10.1097\/NMD.0000000000001709","DOI":"10.1097\/NMD.0000000000001709"},{"key":"4037_CR40","doi-asserted-by":"publisher","unstructured":"Frankeberger J, Gagnon K, Withers J, Hawk M (2023) Harm reduction principles in a street medicine program: a qualitative study. Cult Med Psychiatry 47:1005\u20131021. https:\/\/doi.org\/10.1007\/s11013-022-09807-z","DOI":"10.1007\/s11013-022-09807-z"},{"key":"4037_CR41","doi-asserted-by":"publisher","unstructured":"Robet T, Santos-Cruz J, Zullino D et al (2025) Clinical and public health challenges of crack consumption. Rev Med Suisse 21:226\u2013230. https:\/\/doi.org\/10.53738\/REVMED.2025.21.904.226","DOI":"10.53738\/REVMED.2025.21.904.226"},{"key":"4037_CR42","doi-asserted-by":"publisher","unstructured":"Burton JL, Underwood J (2007) Clinical, educational, and epidemiological value of autopsy. Lancet 369:1471\u20131480. https:\/\/doi.org\/10.1016\/S0140-6736(07)60376-6","DOI":"10.1016\/S0140-6736(07)60376-6"},{"key":"4037_CR43","doi-asserted-by":"publisher","unstructured":"Bassat Q, Castillo P, Alonso PL et al (2016) Resuscitating the dying autopsy. PLoS Med 13:1001927. https:\/\/doi.org\/10.1371\/journal.pmed.1001927","DOI":"10.1371\/journal.pmed.1001927"}],"container-title":["International Journal of Legal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00414-026-04037-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00414-026-04037-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00414-026-04037-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:02:08Z","timestamp":1792000928000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00414-026-04037-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":43,"alternative-id":["4037"],"URL":"https:\/\/doi.org\/10.1007\/s00414-026-04037-z","relation":{},"ISSN":["0937-9827","1437-1596"],"issn-type":[{"value":"0937-9827","type":"print"},{"value":"1437-1596","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"11 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All subjects included in this study underwent judicial or clinical autopsy at the Institute of Legal Medicine in Milan for the determination of the cause of death. Data collection, sampling procedures, and subsequent forensic analyses were authorized by the Public Prosecutor or the Health Authority and carried out within the framework of a judicial or health investigation, in accordance with the Italian Police Mortuary Regulations. The report does not contain personal data. In any case, all data are covered by the Italian Law \u2013 Data Protection Authority (Official Gazette no. 72 of March 26, 2012) for scientific research purposes as well as GDPR no 679\/2016 and 9\/2016, and law addition number 424\/19 July 2018. Therefore, in accordance with national data protection regulations, informed consent and formal ethical approval was not required. The study was conducted in accordance with the principles outlined by the Italian National Bioethics Committee and the Declaration of Helsinki.","order":1,"name":"Ethics","label":"<b>Ethics approval<\/b>","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not Applicable.","order":2,"name":"Ethics","label":"Human Ethics and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. The manuscript does not contain any identifiable personal data, images, or videos requiring consent for publication.","order":3,"name":"Ethics","label":"<b>Consent to publish<\/b>","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not Applicable.","order":4,"name":"Ethics","label":"Clinical trial number","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"<b>Competing interests<\/b>","group":{"name":"EthicsHeading","label":"Declarations"}}]}}