Vertebral artery laceration mimicking elder abuse

Elder abuse was first described almost 30 years ago. Today, approximately 1 in 25 elders is abused each year in the United States. A newly described form of domestic violence, the incidence of elder abuse will surely increase as the elderly population grows. Physical abuse/inflicted trauma is generally considered the most extreme form of elder mistreatment and includes blunt trauma, sexual assault, traumatic alopecia, and burns. Elder homicide is usually due to gunshot wounds, blunt trauma, stab wounds, or asphyxia. However, the difficult aspect of assessing the possible elder abuse homicide victim is delineating such inflicted trauma from accidental trauma. We report the case of a 94-year-old "demented" male, who reportedly fell out of his wheelchair. He was transported to a local emergency room, where he became unresponsive during examination. He experienced respiratory distress and was pronounced dead shortly thereafter. At autopsy, he had periorbital contusions and a midline abrasion between the eyes, with underlying supraorbital contusion. The skull, brain, and spinal cord were unremarkable for signs of trauma. The major traumatic finding was in the neck region. Neck dissection revealed hemorrhage extending from the base of the skull to the level of T-1 and anteriorly about the soft tissues, strap muscles, and vasculature. The strap muscles were individually examined and were free of hemorrhage. The carotid arteries and jugular veins were unremarkable. The larynx, hyoid, and thyroid were intact, with only surrounding hemorrhage. Further examination revealed a horizontal fracture of the C5 vertebral body and a medial laceration of the left vertebral artery at the C5 level; subarachnoid hemorrhage was absent. What initially appeared to be trauma to the neck, worrisome for strangulation or blunt force trauma, was a large retropharyngeal hematoma from the left vertebral artery laceration. Traumatic rupture of the vertebral artery usually occurs at the C1 and C2 levels, with resultant subarachnoid hemorrhage. This is an especially vulnerable location since it is where the artery turns and then enters the skull. Associated injuries include spinal cord transection or contusion, brachial plexus injury, pharyngoesophageal injury, and vertebral fractures. Retropharyngeal hemorrhage may result from deep neck infection, tumor, and trauma. Hemorrhage associated with trauma often involves flexion of the cervical spine, followed by hyperextension. The accumulation of blood slowly impinges on the pharynx/larynx and vasculature structures. The exact injuries and etiology of the hemorrhage must be determined to distinguish strangulation from blunt force trauma. The presentation of signs and symptoms can be helpful in assessing the decedent; however, in the practice of forensic pathology such a history is more often lacking.     

An integrated understanding of elder abuse and neglect

In the past three decades, society has developed interest in what has come to be called elder abuse. Since interest initially appeared, concern about elder abuse has gone through different cycles regarding the conceptualization of the problem, appropriate responses, and explanations. A recent trend has witnessed a call for an interdisciplinary and integrated understanding of, and response to, elder abuse. This article describes what is meant by an integrated response to elder abuse. Ways to promote a broader response to the problem are suggested.     

Thymus alterations related to intravenous drug abuse.

It has been noticed on forensic material that Hassall's corpuscles of the thymus are more often calcified in intravenous drug abusers than in healthy persons. Thymuses of 15 intravenous heroin addicts were histologically examined and compared with thymuses of 15 healthy persons. Acute bleeding and dystrophic calcification in the thymocyte's parenchyma were more common among intravenous drug abusers (p = .005 and p = .001, respectively). The degree of physiologic involution measured by fatty replacement and the clarity of border between cortex and medulla was equal. No significant diversity was found in the features of Hassall's bodies. Our study emphasizes the necessity for a defined criteria of morphologic changes in the thymus that could be expected in intravenous drug abusers. In that way it would be possible to complete the forensic findings as well as to examine immunologic system alterations of that risk population.     

The portrayal of elder abuse in the national media

Over the last two decades, researchers and policy makers have begun to devote more attention to the problem of elder abuse. Still, compared to studies on other types of family violence, research on elder abuse is scarce. To better understand how elder abuse is portrayed in the media and using “newsmaking criminology” as a theoretical framework, this study considers how 11 newspapers describe the phenomenon. In all, 530 articles about elder abuse were content analyzed using standard rules of content analysis. Results suggest that certain types of elder abuse are excluded from the press. In addition, the press tends to define elder abuse as a crime, but not as a domestic violence offense. Implications are provided.     

Public definitions and endorsement of the criminalization of elder abuse

A longitudinal cross sectional ten-year study was conducted measuring public attitudes toward the definition and criminalization of elder abuse. The study found that the public endorsed a fairly broad definition of elder abuse and that this definition of elder abuse was fairly stable over time. Subjects also strongly endorsed the creation of misdemeanor and felony statutes and strongly endorsed the use of prison to punish elder abusers. The subjects also believed that the criminalization of elder abuse would be effective in reducing elder abuse.     

Reconceptualizing elder abuse: treating the disease of senior community exclusion

This article focuses on the phenomenon of elder abuse, which is one of the paramount symptoms of the larger community's failure to address the social, medical, and legal needs of the senior populace. Although there have been multidisciplinary efforts to address this problem, they are not responsive to the needs of the senior population itself In response, the authors propose a model that takes into account the specific concerns of local senior communities and provides seniors and their stakeholder providers a stable infrastructure to ensure open, consistent, and effective participation and delivery of services.     

Ethanol-oxidizing enzymes of the adrenal glands in acute alcoholic intoxication

Complex morphological-and-histological examinations of the adrenal glands were performed on actual forensic-medical samples in acute alcoholic intoxication (AAI), i.e. 107 death cases of men and women, aged 17 to 60, due to mechanical trauma, lethal ethanol intoxication and somatic complications of chronic alcoholism. A differentiated distribution of ethanol-oxidizing enzymes was defined, i.e. of alcohol-dehydrogenase and acetyl-dehydrogenase in the structural-and-functional zones of the adrenal cortex and medullary substance. A differential activity of enzymes was established that correlated with the level of exogenous alcoholemia. Sets of morphological signs related with examinations of the adrenal glands, which enabled a differential diagnosis of death causes in AAI, were specified.     

The impact of juror characteristics and victim health status on the perception of elder physical abuse

An experiment investigated mock juror perceptions of elder abuse using a community sample from Lexington, Kentucky. Two-hundred six men and women ranging in age from 18 to 88 read a fictional criminal trial summary of a case of elder physical abuse (EPA) in which the accuser was described as healthy, frail, or confused. In addition, the influence of participant age, participant gender, and attitude toward the elderly on juror perceptions of EPA was also investigated. Results showed that women had higher conviction rates than did men. Accuser health status, participant age, participant gender, and attitude toward the elderly affected other rating variables including accuser believability, accuser inaccuracy, defendant believability, and verdict confidence. Results suggest implications for how EPA cases are perceived in court.     

Analysis of legal cases for prevention of elder abuse: decisions from New Zealand

Elder abuse is a universal concern and is gaining greater public and professional attention. This increased concern to protect elders is internationally evident in policy reform, multidisciplinary research and education. Yet neglect in care settings continues. This research responds by contributing to the international effort to promote humane care for elders who are in a position of dependence, particularly in residential facilities. The legal cases that result from some complaints by aggrieved elders and their advocates may offer insights that are relevant for prevention. While the law is often viewed merely as a system of control, it may also be a resource for learning, particularly in the context of abuse prevention. Although the analysis references New Zealand law, the discussion may have broader application by indicating factors that precede, or trigger, unacceptable conduct. By understanding what went wrong and why, we may decrease the likelihood of future incidents. Also, understanding the legal ramifications may have a deterrent effect. Many advocates and activists have asked how we can ensure that abuses do not recur; some answers may lie within the legal cases themselves. How may recent legal cases be used to prevent mistreatment of elders in residential facilities? This question is applied to select decisions of New Zealand's Health and Disability Commissioner, Human Rights Review Tribunal and Health Practitioners Disciplinary Tribunal. While each body has distinct functions, relevant factors identified within the cases may reveal information that is of interest to elderly people and their advocates, caregivers, health educators and professional registration bodies. The research is timely in light of New Zealand's Review of Elder Abuse and Neglect Prevention Services in New Zealand (Department of Child Youth and Family Services, 2004) and New Zealand's Positive Ageing Strategy (Office of Senior Citizens, 2001). This article incorporates current debates regarding the use and analysis of legal cases and suggests that such analyses offer learning opportunities.     

Histochemical changes in the hypothalamus, hypophysis, and adrenal glands observed in ethanol poisoning

A comprehensive morphological-and-histochemical study of neuroendocrinal internals in cases of ethanol poisonings was undertaken. Actual forensic medical materials were used (62 cadavers) to make morphometry examinations of the hypothesis and adrenal glands. Besides, the distribution of alcohol dehydrogenase and acetaldehyde dehydrogenase was investigated in the mediatory differential brain sections, i.e. cerebellum, locus coeruleus, dorsal raphe nucleus, hypothalamus and adrenal glands. A differential distribution of ethanol-oxidizing enzymes as well as their changes in ethanol lethal poisoning were established; additionally, a variety of morphological signs were defined, which enable the differential diagnosis of a death reason in acute alcoholic intoxication.     

Clinical case management: a strategy to coordinate detection, reporting, and prosecution of elder abuse

Despite civil and criminal sanctions, elder abuse is a prevalent, underreported, and underprosecuted event in the United States. Traditional reporting legislation and common law remedies have had minimal effect on the incidence and prevalence of elder abuse. The epidemic nature of elder abuse is projected to increase exponentially as the elderly population grows disproportionately over the next several decades. The fragmented system of detecting, reporting, and prosecuting this abuse across a wide range of medical and legal settings creates a poor structure to effectively allow a potentially abused patient to have his/her abuse circumstance communicated to the relevant parties to protect the patient, have his/her situation reported and investigated, and, if necessary, have the perpetrator brought to justice. Emergency rooms and other facilities where elders present for care should be staffed by clinically trained persons who have familiarity interacting with patients and providers across settings of care, and who are trained to detect and report abuse. Nursing case managers fill this role well because they are able to coordinate efforts among acute and long-term care facilities while also being able to supply patients with legal and clinical information about elder abuse. In addition they may support prosecution efforts through their clinical observations and expertise. Hence, clinical case managers are able to coordinate efforts lacking in the current system to effectively evaluate, report, protect, and arrange for relevant services for the patient. Through clinical and special training in elder abuse, nursing case managers can provide support to prosecution efforts against the perpetrators of this most egregious crime.     

肾上腺结核猝死的法医学鉴定

通过两例肾上腺结核猝死的案例观察发现：肾上腺和肾上腺以外器官的结核病变均表现为不典型的慢性陈旧性的病理学特征。提示在法医学鉴定中,对患过结核病和“不明死因”猝死尸体剖验时肾上腺的组织病理学检验尤为重要     

Prevalence and correlates of elder mistreatment in South Carolina: the South Carolina elder mistreatment study

The purposes of this study were to (a) derive prevalence estimates for elder mistreatment (emotional, physical, sexual, neglectful, and financial mistreatment of older adults [age 60 +]) in a randomly selected sample of South Carolinians; (b) examine correlates (i.e., potential risk factors) of mistreatment; and (c) examine incident characteristics of mistreatment events. Random Digit Dialing (RDD) was used to derive a representative sample in terms of age and gender; computer-assisted telephone interviewing was used to standardize collection of demographic, correlate, and mistreatment data. Prevalence estimates and mistreatment correlates were obtained and subjected to logistic regression. A total of 902 participants provided data. Prevalence for mistreatment types (since age 60) were 12.9% emotional, 2.1% physical, 0.3% sexual, 5.4% potential neglect, and 6.6% financial exploitation by family member. The most consistent correlates of mistreatment across abuse types were low social support and needing assistance with daily living activities. One in 10 participants reported either emotional, physical, sexual, or neglectful mistreatment within the past year, and 2 in 10 reported mistreatment since age 60. Across categories, the most consistent correlate of mistreatment was low social support, representing an area toward which preventive intervention may be directed with significant public health implications.     

Childhood history of abuse and adult child abuse potential

The experience of aversive interactions within the family of origin is believed to increase the probability of parental physical child abuse. To test this hypothesis, 375 subjects were given a Childhood History Questionnaire (CHQ) and the Child Abuse Potential (CAP) Inventory. The CHQ contained a series of questions about the presence and frequency of various abusive behaviors and associated sequelae that were received and/or observed before and/or after puberty. The CAP Inventory was used to measure adult physical child abuse potential. As expected, a childhood history of physical abuse was significantly related to adult physical child abuse potential; and, as chronicity increased, so did abuse potential. The experience of physical abuse prior to puberty produced higher abuse scores than the experience of physical abuse after puberty. The study provides preliminary data indicating the childhood experience of a caring adult and / or caring friend moderates adult child abuse potential.     

Decision-making in child abuse and neglect

Social attachment theory can be of value in examining the wide variety of abuse and neglect situations that come to the attention of authorities. We consider evaluation of the parent-child relationship as a crucial part of the judicial process. We have suggested parameters that can be used to evaluate the relationship. We have outlined some of the more common distortions in this relationship that have, in our experience, been associated with the mistreatment of children. The use of social attachment theory has been of great help in understanding the emotional reactions of the many children we have seen for evaluation and treatment. The theory also serves as a potential guide for improvements in social policy. If we are more sensitive to the psychological world of these children, we will be better able to truly protect them.     

挥发性有机溶剂的危害及滥用

本文简要介绍了挥发性有机溶剂对人体的危害及其存在的可能性，分析了几类人群对此类物质形成滥用、依赖的因素及与此相关的部分规定，提醒注意此类具有隐匿性的滥用物质。     

Amitriptyline abuse and misuse

Deaths related to amitriptyline toxicity are relatively common and are typically related to suicidal overdose. A less well-recognized situation of amitriptyline intoxication occurs when the drug is abused for its euphorigenic effects. An amitriptyline-related death due to a mixed drug intoxication is presented. Death investigation revealed that the death was accidental rather than suicidal. The case serves to remind forensic investigators that not all amitriptyline overdose deaths represent suicides. A segment of the population is known to abuse amitriptyline.     

Drugs and chronic alcohol abuse in drivers

Blood specimens from 210 drivers (179 male and 31 female) apprehended in Luxembourg from autumn 2001 to spring 2002 and requested for the determination of their blood alcohol concentration (BAC) were tested for medicinal drugs, illicit drugs, and chronic alcohol abuse (by quantification of the carbohydrate-deficient transferrin: CDT). These additional analyses were performed anonymously and with permission of state prosecutor. The 22.8% had consumed medicinal drugs, with benzodiazepines and antidepressants (10.9 and 7.6%, respectively) as main psychoactive classes. Cannabis was the most detected illicit drug (9.5%) but only one in three had THC detectable in their blood. Association of two or more psychoactive substances (poly-drug use) was observed in 27.6% of drivers (90.6% of drug consumers). On the basis of CDT values, 29.5% of drivers investigated were assumed to be chronic alcohol abusers. Statistical analysis revealed that chronic alcohol abuse and medicinal psychoactive drugs were associated with significantly higher BAC. Medicinal psychoactive drugs were clearly associated with poly-drug use, and were furthermore detected at supra-therapeutic levels in 34.9%.     

Cognitive and interpersonal factors in woman abuse

As part of a larger ecological analysis of woman battering in Israel, this study examined the combined ability of selected cognitive and interpersonal measures to differentiate among couples in which women were battered and those in which they were not. The ability of these variables to predict men's physical violence and verbal abuse and women's verbal abuse was also executed. Results indicate that a combination of low marital adjustment, high levels of conflict over children, and more perceived self-control over one's life characterized violent men; low marital adjustment and high conflict over child rearing characterized battered women. Both men's and women's verbal abuse was moderately predicted by lower marital adjustment while men's physical violence was predicted by increased levels of conflicts with his partner over child rearing. These findings suggest the importance of marital relationship factors in domestic violence and highlight the need for further study of the interaction between perceived control and marital relationship problems in relationships where men physically abuse women.