Population Of Victims Research Articles

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Unexpected sudden death related to medullary brain lesions

Lesions of the tractus solitarii nucleus, generally of a congenital nature, may be the pathophysiological substrate of the sudden infant death syndrome (SIDS). The neuropathological studies we have conducted on a large population of victims of SIDS, of unexpected neonatal deaths and fetal deaths at term, revealed analogous congenital lesions of the structures of the brainstem that modulate respiratory activity, as well as cardiovascular functions, arousal and upper digestive activities [1, 2, 3]. The common denominator of all these deaths was the absence of neurological symptoms, generally associated with the presence of congenital lesions and in some cases of acquired lesions. In our studies, we have observed a wide variability of degree and localization of congenital lesions, such as hypoplasia/agenesis of the arcuate nucleus (present in about 50% of the cases we examined), associated with hypoplasia of the reticular formation in

Psychological distress, perceived social support, and television viewing for reasons of companionship: A test of the compensation hypothesis in a population of crime victims

Becoming a crime victim is often associated with the development of psychological distress symptoms. In turn, these symptoms have been found to be related to a decrease in perceived social support by the victim. From a uses and gratifications point of view, the increase in distress and the decrease in perceived social support could well affect a victim's television use. Furthermore, the compensation hypothesis (Davis and Kraus, 1989) proposes that people with little social contact use mass media to compensate for social isolation. It could therefore be hypothesized that increased use of television for reasons of companionship is related to higher levels of psychological distress and lower levels of perceived social support. The present study used a structural equation model to test this hypothesis. The sample consisted of 212 Flemish victims of crime. The results confirm the proposed relationships and hypotheses. Directions for future research are discussed.

The emergency department as an effective environment for addressing interpersonal/domestic violence

Study objectives: Domestic violence is a significant pathology. Domestic violence is the leading cause of injury to women aged 15 to 44 years, more common than automobile accidents, muggings, and rapes combined (Office of the US Surgeon General; January 1994). Despite this pathology, literature reports that as few as 1.5% of women victims of domestic violence are screened in the primary care setting. We survey a population of domestic abuse victims in transitional housing about their experiences in emergency department (ED) that either helped or hindered their success. Methods: This was an observational study conducted though the 19 domestic violence agencies that provide transitional housing services in Pennsylvania. The study population was individuals successfully leaving the abusive environment, as evidenced by completing a shelter stay and subsequent participation in transitional housing. A survey was developed in conjunction with the domestic violence agencies. The survey was administered by a single agent within each organization. Those in shelter housing were not surveyed, and those who intended to return to the original environment were excluded. Results: One hundred forty-one surveys were returned. Of individuals successfully leaving the domestic violence environment who needed medical care and sought that care in the ED (N=48), 79.1% (N=38) were asked about abuse by some member of the ED staff. Twenty-one (55%) of 38 were asked about their abuse by more than 1 individual. Of those specifying the results of ED screening (n=39), 89% (n=35) received assistance; 65% (n=25) received more than 1 kind of assistance. Seventy-nine percent of those who received help in the ED thought that the help was adequate. Conclusion: In a population selected for success in leaving the domestic violence environment who sought care in EDs, high numbers of individuals were queried about their abuse, a majority were offered more than 1 type of assistance, and most believed that the help they received was adequate. The ED can be an effective environment for uncovering and addressing domestic violence.

Review of: Practical Aspects of Rape Investigation: A Multidisciplinary Approach, 3rd Ed.

Abstract This text is divided into four sections. The first four chapters deal with the victim—describing the victim's perspective, rape trauma syndrome, crisis care for the victim, and include a review of contemporary issues and a new chapter on victims in nursing homes. The next ten chapters discuss the investigation of rape and sexual assault, focusing on classifying the rape and profiling the behavior of the offender, including a discussion of false confessions. The third section consists of three chapters describing the recognition and collection of forensic evidence, the forensic medical examination of the victim, and the prosecutor's presentation of the case in court. The fourth section consists of six chapters on special populations, including juvenile and female offenders and sexual predators in nursing homes. The stated aim of this 3rd edition is to present current research findings, new forensic techniques, and recent data about special populations of victims and offenders.

Appraisal and coping strategy use in victims of school bullying.

Transactional models of coping (Lazarus & Folkman, 1984) can contribute to our understanding of why some children cope effectively with bullying while others suffer negative outcomes. However, previous research has relied on coping measures that are not comparable with adult measures, restricting investigation of developmental trends. Additionally, previous research has not included appraisals when measuring coping using an established coping measure. To examine the factor structure of a coping measure that is directly comparable with the adult literature; to examine the content of pupils' threat and challenge appraisals concerning bullying; and to examine the relationships between appraisals and coping strategy use within the victims of school bullying. Participants were 459 children aged 9 - 14 years. A self-report bullying questionnaire, incorporating Halstead et al.'s (1993) adolescent version of the Ways of Coping Checklist, was completed by participants. Also included were control, threat and challenge appraisal items. Confirmatory factor analysis confirmed that Halstead et al.'s four-factor model of coping is valid for a population of school bullying victims. Content validity of items used to measure threat and challenge appraisal was demonstrated. Ambiguity of challenge appraisal influenced the use of Wishful Thinking, Seeks Social Support and Problem Focused coping. Wishful Thinking was also influenced by control appraisal. Avoidance coping was not influenced by the appraisals measured. Halstead et al.'s Revised Ways of Coping Checklist can be used to measure coping amongst child and adolescent victims of bullying. Furthermore, including appraisal variables improves our understanding of individual differences between victims' coping strategy choices.

Delayed neuronal maturation of the medullary arcuate nucleus in sudden infant death syndrome

Recently, quantitative abnormalities in neuronal populations derived from the rhombic lip (inferior olive nucleus of the brain stem and external granular layer of the cerebellum) have been reported in victims of the sudden infant death syndrome (SIDS). In this study we examined the arcuate nucleus (ARCn) of 35 SIDS victims and 25 controls, to determine neuronal abnormalities involving this nucleus in SIDS. Computer-assisted cell evaluation was made on sections stained with hematoxylin and eosin to study the neuronal dimensions (nuclear and cytoplasmic area, nuclear/cytoplasmic ratio), the form factor and the density of reactive astrocytes. There was a significant reduction of the neuronal area (nuclear and cytoplasmic) in SIDS victims compared with controls. The neuronal populations of SIDS victims had a significantly higher form factor, index of immaturity. The SIDS victims were divided into two groups on the basis of ARCn development: 18 SIDS-A cases with a well-developed ARCn and 17 SIDS-B cases with severe bilateral hypoplasia. The results of our research indicate that the developmental defect is characterized by a reduction in size of the ARC neurons and by neuronal depletion. In SIDS the ARCn has the histomorphological features of neuronal immaturity, and there is a marked reduction of all quantitative cell parameters and lower astrocytes density with respect to controls. On the basis of the morphometric results of the arcuate neuronal populations, we hypothesize that infants whose neurons have failed to reach full maturity are at risk for SIDS because they are unable to develop appropriate cardioventilatory control.

Analysis of 418 cases of sexual assault

The aim of the study was to describe victim, assailant, assault characteristics for sexual assault victims according to the time between the last sexual assault and the examination, and to provide descriptive data on medico-legal findings.The study was based on 418 examined victims of sexual assault during the year 1998. Victims were referred from investigating police authorities. All examinations were performed with the use of colposcopy by physicians with special training in forensic medicine. Two groups of victims were defined:•a first group of victims examined in emergency within 72h after the last sexual assault;•a second group of victims examined after 72h. About 86% of the cases were female victims. The mean age of the cases of the first group was 22.4 years. Conversely, 76% of the victims examined after 72h were under the age of 15 years. Vulnerability was present in 31% of the cases examined in emergency, including disabled and pregnant victims. Sexual assault happened once in 87% of the cases of the first group and in 64% of the cases of the second group. The victim’s home was the most frequent place of sexual assault (35% of the cases of the first group and 56% of the cases of the second group). The assailant was a stranger in 51% of the cases of the first group. In the second group of the victims, the assailant was a family member in 58% of the cases (the father in 30% of the cases). There was a single assailant in the majority of the cases for the two groups. Threats were used by the assailant in 66% of the victims examined in emergency and in 33% of the cases of the second group. The type of sexual assault was penetration in the majority of the cases for the two groups. Vaginal, oral and anal penetration was respectively involved in 55, 23 and 13% of the cases of the first group. General body trauma was found in 39.1% of the cases examined in emergency and in 6.3% of the cases of the second group. Genital trauma occurred in 35.7% of the cases of the first group and in 19.5% of the cases of the second group. Hymenal, vulvo-vaginal and anal lesions were respectively found in 11, 20 and 7% of the cases examined in emergency. Toxicological analysis was performed in 14.3% of the cases examined in emergency. In 47% of the tested cases, drug was detected. Cytology was performed in 61.5% of the cases examined in emergency. Detection of spermatozoa was found in 30.3% of these cases.Our study has shown that sexual assault victims had different characteristics according to the time between the sexual assault and the examination. Public health campaigns against sexual abuse and rape as well as medical management of the sexually assaulted victims should adapt to the needs and the characteristics of these two different populations of victims.

Collaborative Problem-Solving Partnerships: Advancing Community Policing Philosophy to Domestic Violence Victim Services

Throughout the last three decades, victims and victim advocates have significantly advanced victim's rights and services and have altered the fabric of police-victim interactions from viewing victims as necessary witnesses (Laszlo and Burgess, 1979; Waller, 1990) to engaging victims and victim organizations as collaborative partners in developing victim-oriented criminal justice services. As criminal justice agencies seek to engage stakeholders in problem-solving strategies, victims and victim organizations are becoming active partners in prevention, intervention, and restitution initiatives, and have been instrumental in tailoring criminal justice systems services to the needs of special populations. This paper describes four ongoing efforts to effect prevention, intervention, and restitution activities for special populations of victims and, in particular, to advancing community policing and community government in or for special populations. Within the historical contexts of the victim's movement, these efforts manifest the expanding role of victims as collaborative partners of police (including tribal police), prosecutors, and the courts.

Patent Foramen Ovale and Recurrent Stroke

Clinical management of patients with acute stroke and the approach used for secondary prevention depends upon clarification of pathogenesis. Although most strokes are a consequence of cerebrovascular disease, ≈15% to 20% of ischemic (nonhemorrhagic) strokes have been attributed to cardiogenic embolism.1 In practice, determination of the stroke mechanism is fraught with uncertainty, particularly when the possibility of thromboembolism emanating from atherosclerotic lesions in the aorta or cervical arteries is considered. When cardiogenic embolism is suspected, cardiac ultrasound is the principal method used to identify the potential source. The finding of left atrial enlargement has been shown to bear a significant relationship to the risk of stroke in a multivariate analysis of population-based data from the Framingham Heart Study2. The most frequent confounding variable is atrial fibrillation, occurring in >2 million patients in North America and in over half of all patients with cardiogenic embolism. Criteria for selection of patients with acute ischemic stroke for transesophageal echocardiography (TEE) to search for a potential cardiac source of embolism are controversial, particularly because cardiogenic embolism is often an uncertain diagnosis that is inferred merely on the basis of the finding of potential cardiac source. Even after extensive investigation, ≈40% of ischemic stroke patients have no clearly identifiable pathogenesis (cryptogenic stroke).3 In one study, 62% of patients younger than 60 years of age without an obvious source of cerebral infarction and 23% of those with arterial lesions had potential sources of cardiogenic embolism identified by TEE ( P =0.0007 for the difference).4 See p 2625 Among the cardiac anomalies detected by TEE that have been implicated as risk factors for stroke are patent foramen ovale (PFO) and atrial septal aneurysm (ASA).5,6⇓ The foramen ovale, a remnant of the fetal circulation, remains patent through adulthood in ≈1 in 4 …

Locally Efficient Estimation of a Multivariate Survival Function in Longitudinal Studies

We consider estimation of the joint distribution of multivariate survival times T = (T1,…,Tk), which are subject to right-censoring by a common censoring variableC. Two estimators are proposed: an initial inverse-probability-of-censoring weighted (IPCW) estimator and a one-step estimator. Both estimators incorporate information on available time-independent and time-dependent prognostic factor (covariate) data. The IPCW estimator is consistent and asymptotically normal (CAN) under coarsening at random (CAR) and a correct specification of a model for the hazard of censoring given the past covariate and failure data. The one-step estimator is a locally efficient doubly robust estimator. That is, (i) it is CAN under the assumption of CAR and either (but not necessarily both) correct specification of a model for the hazard of censoring given the past or correct specification of a model for the conditional distribution of T given past failure and covariate information, and (ii) it is efficient when both these models are correctly specified. The proposed methodology does not require that the time variables T1,…,Tk be ordered, although our methods cover this important special case. In particular, our estimators can be used to estimate the gap time distributions associated with an ordered series of events. The proposed methodology is an improvement over currently available approaches in a number of ways. Specifically, when censoring and failure are dependent because the hazard of censoring depends on both past failure and covariate history, our one-step estimator is the only estimator with the double-robustness property. When censoring can be assumed to be independent of the failure and covariate processes, our locally efficient one-step estimator, unlike the maximum likelihood estimator (MLE) of van der Laan but like the estimators of Dabrowska, Prentice and Cai, and Bickel, does not require smoothing and so will perform well in moderate size samples even if k is large, say 7 or 8; furthermore, unlike all previous estimators, our estimator exploits the information available in past covariate as well as failure history and so will be efficient (nearly efficient) even when the components of T are highly dependent, whenever the specified model for the conditional distribution of T given past failure and covariate information is correct (nearly correct). We examine the finite sample performance of our estimators in a simulation study. Finally, we apply our estimators to data on time to wound excision and time to wound infection in a population of burn victims.

Safety measures in traffic and hospital morbimortality in craniocerebral trauma in the Distrito Federal

The study analyzed the effectiveness of safety measures (seat belt, velocity control) in traffic. The parameters were the decrease in number and severity in head injury trauma (HIT). Epidemiological study, based on the evaluation of secondary data about head injury. The data were analyzed between two periods, before (1992) and after (1997) measures implementation. We compared the indices (per 100.000 population) of victims in the two periods. In 1992 there were 125.5 victims, and in 1997 there were 155.8. From this total in group 1 we had 26.2 cases of HIT with 5.2 deaths, in 1997 we had 62.1 with 4.1 deaths. About severity: in the first period were 9.6 cases severe or moderate head injury, in group 2 there were 8.1 cases. There was an increase in the number of victims of HIT caused by automobile accidents in this period, however the severity of the trauma showed a small decrease, possibly security measures were not efficiently in reducing the number of cases but may have been successful in reducing deaths related to this accidents.

Injury Severity Score versus New Injury Severity Score for penetrating injuries.

The New Injury Severity Score (NISS) was introduced in 1997 to improve outcome prediction based on anatomical severity scoring in trauma victims. Studies on populations of blunt trauma victims indicate that the NISS, predicts better than the Injury Severity Score (ISS) mortality post-injury, which is why the NISS has been recommended as the new "gold standard" for severity scoring. However, so far the accuracy of the NISS for penetrating injuries has not been validated against the ISS. ISS and NISS scores were collected retrospectively for 1,787 war- and landmine victims in North Iraq. All victims only had penetrating injuries. The two tests were compared for prediction of short-term mortality and post-operative complications using Receiver Operating Characteristics (ROC) analysis. Both the ISS and the NISS predicted mortality with high accuracy (ROC area under curve 0.9). There were no significant differences between the two tests. The predictive accuracy for post-operative complications was moderate for both tests (ROC-AUC < 0.8), with the NISS performing significantly better than the ISS. The NISS does not perform better than the ISS in penetrating injuries. However, this study was done on a low-risk trauma population, thus the results should not be extrapolated to high severity trauma. Due to statistical shortcomings in studies previously published, studies on far larger cohorts are necessary before the NISS should be adopted as the new "gold standard" for severity scoring.

The Victim-Perpetrator Overlap and Routine Activities

The overlap between the populations of victims and perpetrators, as well as the differences between victims who are perpetrators and those who are not, are explored using data from a cross-sectional survey of violence among a random sample ( n = 3,007) of the general population in Bogotá, Colombia. The findings show that about a third of the population have been both a victim and perpetrator of violence, whereas another third have been only victims. Victims who have not been perpetrators differ in their demographic profile and routine activities from those who have but tend to be similar to the general population. Given the large overlap between victims and perpetrators, interventions used to reduce aggression and offending might also have an impact on victimization in this population. Risk factors different from those hypothesized in the routine activities theory among victims who are not perpetrators of violence need to be explored.

Y-STR DNA amplification as biological evidence in sexually assaulted female victims with no cytological detection of spermatozoa

Identification of spermatozoa is the biological evidence most often sought in specimens from rape victims. Absence of spermatozoa usually terminates biological investigations, and the victim’s testimony can be contested. We assessed the utility and reliability of PCR amplification using Y-chromosomal STR polymorphisms in specimens from female victims of sexual assault with negative cytology. One hundred and four swabs without spermatozoa detected by cytology were collected from 79 alleged sexually assaulted female victims and amplification of Y-STR and of amelogenin was performed. Overall, Y-chromosome was detected and evidenced sexual penetration in 28.8% of swabs. In the population of victims examined more than 48 h after the sexual assault, Y-STR were still evidenced in 30% of the cases. These results show that swabs should be taken from victims for Y-chromosome DNA typing even after long delays between sexual assault and medical examination.

Circumstances leading to a change to prone sleeping in sudden infant death syndrome victims.

In addition to usual prone sleeping, unaccustomed prone sleeping represents a significant risk factor for sudden infant death syndrome (SIDS). However, little information is available regarding the circumstances leading caretakers to change the infant's sleep position to prone position in SIDS victims. To determine, in a population of SIDS victims, the timing of a change to prone sleeping and the reason for that change in infants who were originally nonprone sleepers. Case series analysis from a questionnaire administered between 1991 and 1997 to parents and other caretakers of SIDS victims in the province of Quebec (Canada). One hundred fifty-seven SIDS cases occurring in the province during the study. Of the 157 SIDS cases studied, 139 were found in the prone position, although only 93 infants usually slept prone. Of the 64 nonprone sleepers, 34 had been changed to prone by the parents or another caretaker before death, and 18 had apparently turned to prone for the first time. In the 34 cases changed to prone, the change occurred <1 week before death for 21 infants; for 16 of those infants, death occurred the first or second time that they slept prone. In 56% of the cases changed from a nonprone to prone sleeping position, a caretaker other than the parents had precipitated the change. Ongoing campaigns to decrease the risk of SIDS should emphasize the risk of unaccustomed prone sleeping to both parents and secondary caretakers.

Confronting paralyzing crime

There is a newly emerging population of crime victims that is made up of inner‐city African‐Americans. This population of crime victims is called invisible, because its members are paralyzed after brushes with random acts of violence. As a result of their paralysis, they disappear from conventional arenas such as work, recreation, and some social gatherings. The sad reality of this victimization is that despite the calamity it brings to the victims, it could potentially drain the public health and criminal justice systems. The authors of this article contend there are preventive strategies that could reduce this growing population.

Personal watercraft crash injuries: an emerging problem.

The increased popularity of personal watercraft (PWC) has resulted in an increase in PWC-related injuries. In an effort to better understand the problem, a retrospective review of 37 victims of such injuries seen at a Level I trauma center and fatalities examined by the medical examiner were analyzed. Fourteen percent of the victims were passengers, two of whom were struck from behind, resulting in severe injuries. Twelve patients died of their injuries. For six victims, the cause of death was drowning; only one of these victims was wearing a personal flotation device. Two patients sustained transected aortas, 20% had brain injuries, 20% had spinal fractures, and 48% had skeletal and skull fractures. Abdominal organ injuries were present in only 13.5% of the victims, but they were significant, with liver, spleen, and kidney lacerations and aortic and renal artery injuries. In this population of victims of PWC crashes meeting preestablished trauma criteria or on-scene deaths, injuries were significant. Many of the drowning deaths may have been prevented with the use of personal flotation devices. The potential for serious intra-abdominal injury must be recognized and dealt with appropriately.

Morphometric methods for studying the prefrontal cortex in suicide victims and psychiatric patients.

Neurochemical studies demonstrate altered numbers of monoaminergic receptors in the prefrontal cortex in suicide and depression victims, implicating dysfunction of the prefrontal cortex in the neuropathology of suicide and psychiatric disorders. Neuroimaging studies in vivo have revealed an altered pattern of cortical metabolism and reductions in frontal lobe volume in patients with schizophrenia (SCZ) or depression. However, the precise morphopathology underlying these abnormalities and their relevance to suicide are unknown. Our recent three-dimensional cell counting of dorsolateral prefrontal cortex from 16 postmortem SCZ brains (10 suicide completers) revealed cellular changes (increased neuronal density, and reduced laminar width and neuronal size) that may be associated with neuroimaging observations. Evaluation of the same morphometric parameters in the prefrontal cortex in seven bipolar brains (three committed suicide) revealed similarities (decreased cortical and laminar thickness) and differences (unchanged overall neuronal density and laminar densities) between morphopathology of SCZ and bipolar disorder. In another population of suicide victims with major depression (nonpsychotic), further morphopathological differences from SCZ and similarities to bipolar disorder were observed in the prefrontal cortex. From these data we can conclude that the morphopathology observed in brain tissue from suicide victims appears to vary based on psychiatric symptomatology. In order to confirm this hypothesis and to establish the specificity of morphometric findings in relation to psychiatric disorders and suicide, additional studies are warranted in nonsuicide subjects with SCZ, major depression, or bipolar disorder.

Differential performance of TRISS-like in early and late blunt trauma deaths.

(1) To independently validate the Trauma and Injury Severity Score-Like (TRISS-Like) model derived by Offner et al. (Revision of TRISS for intubated patients. J Trauma. 1992;32:32-35) in a population of Canadian blunt trauma victims, and (2) to compare the ability of this model to predict mortality in early and late trauma deaths. Prospective cohort of blunt trauma cases with Injury Severity Score > 12 identified from the Ontario Trauma Registry over a 5-year period. The TRISS-Like model consisting of age, Injury Severity Score, systolic blood pressure, and best motor response of the Glasgow Coma Scale was evaluated as to its ability to predict mortality by determining the sensitivity, specificity, and the area under the receiver operating characteristic curve. The sample was then divided into early (< or = 7 days) and late mortality subgroups in which model performance was evaluated with respect to time of death. A total of 7,703 patients were included in this analysis. The overall mortality was 12.3%. The TRISS-Like model allowed for assessment of an additional 23% of patients than would standard TRISS and performed with a sensitivity of 97.1%, specificity of 39.8% and an area under the receiver operating characteristic curve of 0.873. Analysis of mortality with respect to time demonstrated that 75% of deaths occurred by day 7. The specificity and receiver operating characteristic area increased in the early (< or = 7 days) subgroup, 46.5% and 0.935, respectively, compared with 20.8% and 0.778 in the late mortality group. TRISS-Like demonstrated similar performance to that reported with the standard TRISS model but with the additional advantage that it is more generalizable because it can be applied to intubated patients. TRISS-Like demonstrated substantially superior performance in early trauma deaths compared with those that occurred late. This differential performance may be because the model does not include risk factors for late mortality.