forensic nurse - News & Views

WASHINGTON — The health-related costs of rape, physical assault, stalking and homicide by intimate partners exceed $5.8 billion each year. Of this total, nearly $4.1 billion are for direct medical and mental healthcare services and productivity losses account for nearly $1.8 billion, according to a report by the Centers for Disease Control and Prevention (CDC).

"Violence against women harms more than its direct victim," Health and Human Services Secretary Tommy G. Thompson stated. "It also harms the children, the abuser and the entire health of all our families and communities. For the health of our country, it is critical that we stop this cycle now."

CDC Director Dr. Julie Gerberding added, "Violent acts against women don’t end with visits to the emergency room. They are a major public health problem that we are committed to preventing. Intimate partner violence costs women and their families a high-price financially, physically and emotionally. We must continue to do all we can to prevent the pain, anguish and health problems that result from intimate partner violence."

The report estimates the incidence, prevalence and healthrelated costs of non-fatal and fatal intimate partner violence (IPV) against women. It also identifies future research needs and highlights CDC priorities for IPV prevention research. IPV is defined as violence committed by a spouse, ex-spouse, current or former boyfriend or girlfriend.

"CDC is actively involved in ongoing efforts to prevent violence against women," said Sue Binder, MD, director of the CDC Injury Center. "This report provides information that is crucial in helping communities demonstrate the impact violence against women has on society."

CDC researchers examined the data from the 1995 National Violence Against Women Survey for the incidents of IPV, the costs, how healthcare was used, and how much work-related time was lost for women who were assaulted by intimate partners. This report reflects the most current and reliable data that is available on IPV and its related health costs.

Because of the data limitations, the costs presented in the report likely underestimate the economic burden of IPV in the United States. The report points out that these cost figures are not comprehensive, excluding such important costs as those related to the legal and justice systems. Therefore, the costs should not be used for analyzing benefit-cost ratios for IPV prevention programs. However, the report may be useful in calculating the health-related cost savings from reducing IPV and associated injuries and for evaluating the impact of IPV on specific sub-sectors of the economy, such as consumption of medical resources.

• Developing a guide to identify promising prevention programs and interventions for batterers • Funding programs to support rape prevention and education efforts in all 50 states, the District of Columbia and eight territories, providing for education in communities about the extent of sexual assault and the development of programs to prevent it.

• Funding 14 state domestic violence coalitions to develop and implement community coordinated responses. This initiative coordinates services and mobilizes communities to respond to and prevent domestic violence.

• Funding projects to help monitor and track intimate partner violence in five states. The goal is to help reduce IPV through the collection of timely and credible data that are useful for planning, implementing and evaluating prevention programs.

For more information on intimate partner violence, visit the CDC’s Web site at: http://www.cdc.gov/injury

3-5 Crime Scene Analysis/Reconstruction
University of North Texas, Denton, Texas
Contact: Edward Hueske, (940) 565-4988

4-7 Forensic Medical Investigation - A Comprehensive Review
Hyatt Regency Wichita, Wichita, Kan.
Contact: CClifton@C2andCo.com
www.C2andCo.com

6-10 Medicolegal Death Investigator Training Course
Saint Louis University School of Medicine, Division of Forensic Pathology and will be
Contact Mary Fran Ernst, (314) 268-5970
http://medschool.slu.edu/masters

10-14 Annual New England Seminar in Forensic Sciences
Colby College, Waterville, Maine
(207) 872-3386
www.colby.edu/spec.prog/cme.htm

29-Oct. 2 International Symposium on Human Identification
Pointe Hilton Tapatio Cliffs Resort, Phoenix
Contact: Mary McCarthy, (608) 298-4651

1-3 Custody and Caring: International Conference on the Nurse’s Role in the Criminal Justice System
Saskatoon, Saskatchewan, Canada
Contact: (306) 966-8360
www.usask.ca/nursing/cne/

13-17 Advanced Bloodstain Pattern Analysis Course
University of North Texas, Denton, Texas
Contact: Edward Hueske, (940) 565-4988

20-24 Society of Forensic Toxicologists annual meeting
Doubletree Hotel-Lloyd Center, Portland, Ore.
Contact: Kent G. Johnson, (503) 413-2069
www.soft-tox.org

23-25 Association for Crime Scene Reconstruction annual workshop and training conference
The Westin, Oklahoma City, Okla.
Contact: Tim Bevel, (405) 447-4469
www.acsr.org

California Forensic Nurse Captures Prestigious AAFS Award

Forensic nurse Sharon Crowley, RN, MN, was honored in February by the American Academy of Forensic Sciences (AAFS) as winner of the prestigious General Section Achievement Award.

Crowley is the public health nurse and STD coordinator for the Disease Control Unit of the Santa Cruz, Calif. department of health, as well as the pediatric SART examiner/FCNS for Santa Clara Valley Medical Center’s Center for Child Protection in San Jose, Calif. She has years of experience in medical-legal examinations of adult and child sexual assault, child physical abuse, suspect examinations, elder abuse and rape-homicide victims.

Crowley, a clinical nurse specialist, is the author of Sexual Assault: the Medical- Legal Examination. She also is a fellow of the AAFS and a founding member of the International Association of Forensic Nurses (IAFN).

Victims of Child Abuse May Suffer from Hidden Head Injuries

PHILADELPHIA — Abused children may have hidden head injuries that go undetected by routine examination and screening, according to new research from The Children’s Hospital of Philadelphia. The researchers recommend that healthcare personnel perform brain scans to screen for occult (hidden) head injuries in children with suspected abuse injuries who are less than 6 months of age or who present with high-risk injuries, including rib fractures, multiple skeletal fractures or facial injuries.

The research team found that children with suspected high-risk child abuse injuries had a high incidence of occult head injuries, even when their neurological examinations were otherwise normal. Those head injuries, such as scalp swelling, skull fractures and more serious intracranial injuries, were often missed by routine physical, neurological and ophthalmologic exams and skeletal surveys but were detected by brain scans, which are not universally used for screening in this highrisk population. The study, published in the June issue of Pediatrics, was the first to estimate the prevalence of occult head injury in a high-risk cohort of abused children.

"Head injury is the leading cause of death among abused children under age two years," says David M. Rubin, MD, MSCE, a physician at Safe Place: The Center for Child Protection and Health at The Children’s Hospital of Philadelphia, and lead author of the study.

"Because asymptomatic head injury can be difficult to diagnose, especially in young children, it is necessary to use additional measures to determine which children have sustained these injuries so we can intervene early to prevent death, long-term neurological damage or future abuse," Rubin adds.

Children’s Hospital researchers studied hospital records for 51 children under age 2 who presented with suspected abuse injuries between 1998 and 2001. Patients were included if they had one of the following "high-risk" characteristics or injuries: age less than 6 months for any abusive injury, rib fractures, more than one fracture of any type, or facial injury. The children underwent routine screening measures and a brain scan using computed tomography (CT) or magnetic resonance imaging (MRI) technology. Also, patients included in the study had normal neurological examination on admission and showed no overt signs of head injuries.

Of the 51 patient records with complete data, 19 (37 percent) showed signs of occult head injuries with more than half suffering from intracranial injuries. Skeletal survey alone missed 5 of the 19 children with an occult head injury. An ophthalmologic examination was performed on 14 patients to determine the presence of retinal hemorrhages, a sign of head trauma. No evidence of hemorrhage was present in any of the children, suggesting ophthalmologic exam is not an accurate screening measure for occult head injury in asymptomatic children. Children with head injury were also found to be younger than children without head injury, with all but one of the headinjured children less than one year of age.

The study results support a recommendation for universal CT or MRI screening in all children under 6 months of age with any signs of abuse and children under one year of age with high-risk injuries, including rib fractures, multiple fractures and facial injuries. "Additional research is also needed to help determine the presence of occult head injury in the broader population of children who are abused, and whether universal or targeted screening would be most appropriate," adds Cindy W. Christian, MD, medical director of Safe Place and coauthor of the study.

Mute Witnesses: Trace Evidence Analysis
Edited by Max M. Houck
Academic Press, 2001

The spirit of this thin yet ambitious and information-packed text is captured in the introduction, where editor Max M. Houck and British forensic scientist Ken Wiggins write, "While our discipline has obviously caught the public’s imagination, we still struggle to convince detectives, attorneys and juries of the value of trace evidence. Often characterized as "could have" evidence that only weakly associates the suspect, victim and crime scene, trace evidence is so much more. DNA, despite the public and professional accolades, only answers the question ‘Who?’ Trace evidence may be able to tell you ‘what, where, how and when.’" The authors, representing many disciplines of forensic science and law enforcement, do much to demonstrate the breadth and depth of trace evidence in criminal investigations. The numerous case studies illustrate the fascinating techniques and technology employed to turn up the often-microscopic mute witnesses that speak volumes.