Can Birth Trauma Be Confused for Abuse?

Abstract: An unexpected infant death is usually investigated with a complete autopsy. If evidence of prior trauma is found at autopsy in these cases, suspicion is raised for nonaccidental trauma. In a young infant, the residua of trauma received during birth has the potential to be incorrectly interpreted as nonaccidental trauma. We report a the findings of a 4 1/2‐month‐old‐infant that died unexpectedly with a healing linear skull fracture and a circular lesion over the calvarium found at autopsy. Though this lesion was concerning, the remainder of the autopsy and the histological findings did not support a diagnosis of recent trauma. Review of the literature describing birth injuries made the diagnosis of healing, residual birth trauma more convincing in this case.     

The Effect of Decalcifying Solutions on Hemosiderin Staining

Abstract: To determine whether routine decalcification may reduce the amount of stainable iron that is visible on tissue sections, samples of liver and lung tissue with excessive iron stores were placed in three standard decalcifying solutions (i) formic acid [33%], formaldehyde [4%], and NaCl [0.85%]; (ii) formic acid [30%], formaldehyde [4%], and water; and (iii) nitric acid [5%] for 24, 48, 72, and 96 h. After exposure to the decalcifying solutions, the tissues were stained with Perls stain. The slides were examined blind and the intensity of iron staining was scored semiquantitatively from 0 to 3+. The trend in all samples over the course of the experiment (96 h) was for reduction in the intensity of hemosiderin staining. As the amount of stainable hemosiderin in tissues may be significantly altered by decalcification, the absence of hemosiderin in tissues adjacent to a fracture site does not necessarily indicate that the injury was acute.     

WHY A LAWYER?—THE IMPORTANCE OF CLIENT‐DIRECTED LEGAL REPRESENTATION FOR YOUTH

This article begins with a discussion about the importance of ensuring that all children have lawyers in abuse and neglect cases. Lawyers provide a vital role in giving youth a voice in proceedings that sound profoundly affect their lives. The article then discusses why the client‐directed lawyer's role is consistent with federal law and legal ethics. Finally, the article discusses the growing support for client‐directed representation and what the American Bar Association has done to support this type of child representation.     

Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science

Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6‐year‐old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo–ecto‐mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse.     

Case of Fatal Starvation: Can Stable Isotope Analysis Serve to Support Morphological Diagnosis and Approximate the Length of Starvation?

The diagnosis of death as a result of starvation is established on anthropological measurements, visual appearance of the deceased on external and internal examination, microscopic analysis, laboratory testing, and exclusion of other causes of death. Herein, we present our findings on a case of 95‐year‐old man who died of starvation. After the diagnosis of starvation was established by traditional forensic medicine methods, we have conducted retrospective segmental analysis of stable carbon (δ¹³C) and nitrogen (δ¹⁵N) isotope ratios in hair sample. This method reveals periods of starvation through decrease in δ¹³C and increase in δ¹⁵N along the strand of hair. Our analysis revealed the decrease of 0.6 ‰ in δ¹³C during the last 10–12 weeks prior to death, similar as reported in other investigations. Also, a decrease of 0.7 ‰ in δ¹⁵N during the last 8–10 weeks prior to death was determined that was different than observed in previous studies.     

Deaths Due to Child Abuse: A 6‐Year Review of Cases in The Cook County Medical Examiner's Office

Case files from the Cook County Medical Examiner's Office from 2007 to 2012 were reviewed to analyze homicides due to physical child abuse in children <3 years old. Fatal cases mostly involved younger subjects. Intracranial injuries were the leading cause of death, while death due to extracranial injuries was uncommon. Eyes were involved in most of the cases. Spinal cord was involved in about 1/3 of the cases, mostly in the thoracic area. In some cases, previous injuries were present. There were significant differences in the pattern of injuries between age groups. Subjects showing signs of impact to the head and subjects with no evidence of an impact showed no significant difference in internal injuries. The association of multiple injuries is highly suggestive of child abuse. In suspected child abuse, a postmortem examination including neuropathological, ophthalmological, and radiological information should be always evaluated, together with investigative reports and the medical history.     

Chronic Alcohol Abuse Leads to Low Bone Mass with No General Loss of Bone Structure or Bone Mechanical Strength,

Chronic alcohol abuse (CAA) has deleterious effects on skeletal health. This study examined the impact of CAA on bone with regard to bone density, structure, and strength. Bone specimens from 42 individuals with CAA and 42 individuals without alcohol abuse were obtained at autopsy. Dual‐energy X‐ray absorptiometry (DEXA), compression testing, ashing, and bone histomorphometry were performed. Individuals with CAA had significantly lower bone mineral density (BMD) in the femoral neck and significantly lower bone volume demonstrated by thinner trabeculae, decreased extent of osteoid surfaces, and lower mean wall thickness of trabecular osteons compared to individuals without alcohol abuse. No significant difference was found for bone strength and structure. Conclusion: CAA leads to low bone mass due to a decrease in bone formation but with no destruction of bone architecture nor a decrease in bone strength. It is questionable whether this per se increases fracture risk.     

Memory Ability is Associated With Disagreement About the Most Recent Conflict in Polysubstance Abusing Couples

There is strong evidence that men and women do not agree about the occurrence of intimate partner violence (IPV). However, few studies to date have attempted to test explanatory models of violence concordance. One possible mechanism underlying disagreement is cognitive impairment, specifically, memory dysfunction. The principal goal of this study is to test whether memory ability and overall cognitive functioning is related to disagreement about the most recent occurrence of IPV within the dyad. Data were collected from both partners of cohabiting or married couples. The male partners were polysubstance abusers within their first year of abstinence. Results indicate that the men and womens memory ability, problem solving, disinhibition, and verbal ability are significantly related to disagreement about the most recent IPV episode. Thus, cognitive ability, particularly memory ability, of the participants should be considered when assessing the accuracy of measuring IPV among individuals diagnosed with polysubstance abuse. Other implications are discussed.1Portions of this paper were presented at the 128th annual meeting of the American Public Health Association (2000).     

Isolating Adult Psychological Correlates of Witnessing Parental Violence: Findings from a Predominantly Latina Sample

This study examined the relationship between childhood exposure to parental violence and adult psychological functioning in a sample of predominantly Mexican American participants. Questionnaires assessing childhood maltreatment, family environment, and current psychological symptomatology were completed by 142 female undergraduates. Findings revealed that witnessing parental violence in childhood was associated with depressive symptoms, low self-esteem, and trauma symptoms in adulthood, even after controlling for child physical and sexual abuse. However, in subsequent analyses, also controlling for levels of nonphysical family conflict, previous associations between exposure to parental violence and adult symptomatology were reduced, such that trauma-related symptoms remained the sole outcome still predicted by a history of witnessing parental violence. Implications of these findings, issues related to the use of statistical control procedures in abuse effects research, and directions for future investigation are discussed.     

An Integrated Theoretical Model of Sibling Violence and Abuse

Drawing on three theoretical perspectives (feminist, conflict, and social learning), an integrated analytical model of adolescence sibling violence and abuse is proposed. The model suggests that certain characteristics of the parents' relationship, various aspects of parent–child relations, and characteristics of the sibling relationship are major components in explaining sibling violence and abuse. These are mediated by individual sibling characteristics and sibling verbal conflict. The model should enable researchers to systematically examine, in a more holistic way, the factors related to violence and abuse, and to assess their relative importance in accounting for these phenomena.