HealthDay: Neurologists Should Screen Patients for Abuse: Experts

People with certain disorders might be more vulnerable to violence, says American Academy of Neurology

By Robert Preidt

Wednesday, January 25, 2012

WEDNESDAY, Jan. 25 (HealthDay News) -- Neurologists should screen their patients for abuse by family members, caregivers or other people, the American Academy of Neurology says in a new position statement.

Problems to look for include elder, sexual, child, financial and emotional abuse; bullying, cyberbullying and violence.

Certain neurologic disorders, such as Parkinson's disease, Alzheimer's disease or stroke, may raise the risk for abuse and neglect, the academy said.

The statement outlines 10 principles for neurologists to use when meeting with patients. These include integrating questions about abuse into a patient's medical history and routinely checking patients for past and ongoing violence.

The academy is also offering free training to members interested in learning how to deal with domestic violence issues in their communities.

"Neurologists see patients with neurologic disorders that may make them more susceptible to abuse or neglect. They also see patients with neurologic issues that may be either directly or indirectly related to mistreatment," statement lead author Dr. Elliott Schulman, of Lankenau Medical Center in Wynnewood, Penn., said in an academy news release.

More than 90 percent of all injuries caused by intimate partner violence occur to the head, face or neck and can result in traumatic brain injury, according to the statement.

It also noted that people with neurologic disorders such as stroke, Alzheimer's disease or Parkinson's disease may be at increased risk for abuse and neglect.

"By routinely asking about violence and abuse, the neurologist increases the opportunity for both identifying ongoing abuse and intervening when appropriate," Schulman said. "In addition to further physical and emotional harm, consequences of not asking about abuse might include failure of treatments and, when children are exposed to abuse, perpetuation of the cycle of abuse from generation to generation."

The statement appears Jan. 25 in the online issue of the journal Neurology.

SOURCE: American Academy of Neurology, news release, Jan. 18, 2012

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Copyright (c) 2012 HealthDay. All rights reserved.

Centers for Disease Control and Prevention (CDC) Releases Latest Data on Deaths

“Surveillance for Violent Deaths — National Violent Death Reporting System, 16 States, 2008,” appears in the August 26, 2011 online edition of Morbidity and Mortality Weekly Report Surveillance Summaries (MMWR). 

 

Report Highlights:

The new report compiled data on 16,138 deaths in 2008 from 16 NVDRS states. A majority of these deaths were:

• Suicides (58.7%)
• Homicide/legal intervention deaths (26.4%)
• Deaths of undetermined intent (14.5%)

NVDRS provides a comprehensive picture by combining once fragmented pieces of information from:

• Death certificates
• Coroner/medical examiner reports
• Toxicology results
• Law enforcement reports
• And other reports related to each death

Data are used to inform prevention efforts by providing a more complete understanding of the circumstances preceding deaths in these 16 states.

To Learn More:

• View an electronic copy of this document.
• Data from the NVDRS states is available online through WISQARS™ (Web-based Injury Statistics Query and Reporting System)
• About CDC’s violence prevention efforts: www.cdc.gov/violenceprevention
• Follow the CDC on Facebook: www.facebook.com/vetoviolence

ABSTRACT

HOMICIDE PATTERNS

"Escalated interpersonal conflicts with an intimate partner, a friend, or another acquaintance remained the primary preceding circumstances for homicide. These circumstances were vastly more common than random acts of violence, hate crimes, or drive by shootings. For incidents with male victims, arguments with an acquaintance other than an intimate partner most often preceded homicide. Homicides with female victims were most often a result of intimate partner violence. Similar findings were provided in previous reports and studies (7--9,21). These findings provide more evidence that homicides are most commonly perpetrated by someone known to the victim, and strategies designed to reduce interpersonal and relationship conflicts might be valuable for prevention efforts.

Homicide-followed-by-suicide (i.e., homicide-suicide) incidents continued to be rare in 2008. However, they did account for the greatest proportion of violent incidents that involved multiple deaths. Similar to other reports and previous data years, perpetrators of homicide-suicide incidents were mostly white males of mid-late adulthood (i.e., aged 35--54 years) and victims were mostly females who were either current of former intimate partners of the perpetrator (21,23,24). As expected, intimate partner problems were among the most common circumstances preceding these incidents (7--9,21); however, job/financial problems and mental health problems were two to three times more common among perpetrators in 2008 versus those in 2007.  

PREVENTION OPPORTUNITIES

NVDRS continues to show that interpersonal conflicts and relationship problems, particularly with an intimate partner, are common circumstances preceding a violent event.

 In addition to demonstrating the need to address the situational stressors highlighted in this report, prevention strategies also need to focus on community level factors. For example, changing cultural and social norms (e.g., attitudes condoning the use of violence as a means of resolving conflict) and addressing the social and economic conditions within communities that often give rise to violence (e.g., inequities with regard to the distribution of and access to resources and opportunities, social isolation and lack of connectedness among persons, families, and communities) might further help prevent violence.

CONCLUSION

Accurate, timely, and comprehensive surveillance data can be used to monitor the occurrence of violence-related fatal injuries and assist public health and other authorities in the development, implementation, and evaluation of programs and policies that reduce and prevent violent deaths and injuries at the national, state, and local levels (36,37). Continued development and expansion of NVDRS is critical to the public health and criminal justice communities at the federal, state, and local levels that work to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with the ultimate goal of full national representation, including all 50 states, the District of Columbia, and U.S. territories. 

CIRCUMSTANCES - Circumstances preceding fatal injury, by manner of death --- National Violent Death Reporting System, 16 states, 2008 (ABSTRACTED)

SUICIDE/UNDETERMINED

• Intimate partner problem: problems with a current or former intimate partner that appear to have contributed to the suicide.
• Other legal problem: decedent was facing civil legal problems (e.g., a child custody or civil lawsuit).
• Perpetrator of interpersonal violence in previous month: decedent perpetrated interpersonal violence (e.g., being sought by police for assault or having been issued a restraining order resulting from recent violence) during the previous month.
• Victim of interpersonal violence in previous month: decedent was the target of interpersonal violence in the past month.

 HOMICIDE

• Other argument, abuse, conflict: conflict between decedent and suspect was over something other than money, property, or drugs.
• Jealousy ("lovers' triangle"): jealousy or distress over an intimate partner's relationship or suspected relationship with another person led to the homicide.
• Intimate-partner violence--related: homicide is related to conflict between current or former intimate partners; includes the death of actual intimate partners and nonintimate partner decedents killed to cause pain to an intimate partner (e.g., child or parent).

Key STATS - Suicides

30.9% - Intimate Partner Problem - 32.2% of Males and 25.9% Females who commit suicide.

27.9% - Crisis in past or impending 2 weeks - 29% Males and 24% Females

74.6% - Depression - 74.2% Males and 75.4 Females

9.3% - Anxiety - 8.4% Males and 11.4% Female

1.6% - PTSD

KEY STATS - Homicides

22.9% Married

10.2% Spouse/Intimate partner (current or former)

.8% Other intimate partner involvement

18.1% Females Age 35-44

18.7% Males Age 20-24

53.5% Black, Non-hispanic Males

50.7% White Females

52.2% Mudered at home

18.4% Intimate partner-violence-related - 7.6% Males and 51.6% Females

24.3% Assault/Homicide

KEY STATS - Undetermined Death

11.1% Intimate partner problem 

14.7% Crisis in past or impending 2 weeks

To see entire report, please visit the CDC's website.

Study ties bullying, domestic violence

June 13, 2011 

Boston.com

Boys who are bullies are nearly four times as likely as non-bullies to grow up to physically or sexually abuse their female partners, a study led by researchers from the Harvard School of Public Health found. With growing public concern over bullying, the authors said they wanted to examine the tie to domestic abuse because both abusers and bullies are driven by the desire to exert control over another person.

The researchers surveyed 1,491 men between ages 18 and 35 who were recruited from three Boston community health centers. Of the 241 men who reported being violent toward a partner in the previous year, 64.3 percent said they had bullied other children during their school days. After using statistical methods to account for other factors that affect both bullies and abusers, such as exposure to parental violence, the researchers found that the 92 participants who said they had frequently engaged in bullying were 3.8 times more likely to have later abused their adult partners.

Domestic Abuse Often Escapes Notice of ER Staff: Study

Most not identified as victims when treated in emergency department
By Robert Preidt (* link will not be available after 06/16/2011)
Friday, March 18, 2011

Related MedlinePlus Pages

• Domestic Violence
• Emergency Medical Services

FRIDAY, March 18 (HealthDay News) -- Three of four domestic violence victims treated in hospital emergency departments are not identified as victims of abuse, a new study reveals.

Researchers at the University of Pennsylvania School of Medicine analyzed court, police and emergency department (ED) records from a semi-rural county in Michigan between 1999 and 2002, and found that 80 percent of women who reported domestic assaults to police came to an emergency department at least once during the four years after the reported assault.

Most of the women sought ED care frequently, an average of seven times each during the study period.
However, only 28 percent of the women were ever identified in EDs as victims of domestic violence. The study authors speculated that the reason for this is likely because most of their ED visits were for medical complaints, not injuries associated with abuse. Among these patients, only 3.8 percent of emergency visits were reported to be mainly due to an assault.

Victims of domestic violence were four times more likely to be identified if they went to the ED on the day of the assault. They were also more likely to be identified if they were transported to the hospital by police or if their chief complaints involved mental health issues such as suicidal behavior or substance abuse issues such as overdoses.

The study is to be published online this week in the Journal of General Internal Medicine.
 
The findings highlight the need for emergency department staff to screen women who don't appear to be at risk for domestic violence, said the study authors.

"Emergency departments are a safety net for women with health issues of all kinds, but our study shows we're not doing a good enough job of assessing our patients' entire situation," Dr. Karin V. Rhodes, director of the division of emergency care policy research in the emergency medicine department, said in a university news release.

"There is no reason in the age of information technology that we should not provide routine screening and referrals to the social services patients can use to protect themselves from future violence," she added.

SOURCE: University of Pennsylvania, news release, March 16, 2011

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Copyright (c) 2011 HealthDay. All rights reserved.

More Health News on:

Domestic Violence

Emergency Medical Services

Survey Finds Much Victimization of Children Goes Unreported

Percentage of cases revealed to authorities has risen, experts say, but many remain hidden

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_107309.html (*this news item will not be available after 04/04/2011)

By Randy Dotinga

Tuesday, January 4, 2011

TUESDAY, Jan. 4 (HealthDay News) -- Nearly 60 percent of 10-to-17-year-olds surveyed in a new study say they were victims of violence, abuse or crime in the past year. However, fewer than half said that authorities ever learned about what happened.
Researchers led by David Finkelhor of the University of New Hampshire surveyed youths 10 to 17 years old and parents of children up to 9 years old in 2008. More than 4,500 children were involved in the survey.

More than 58 percent of the kids said they'd been victimized in the past year, including reports of bullying. Of these, just shy of 46 percent said authorities knew of at least one of the incidents.

Authorities were more likely to know about incidents that were more serious, such as certain cases of sexual assault, kidnapping and gang or group assaults, the survey found.

"However, even emotional bullying (51.5 percent), neglect (47.8 percent) and theft (46.8 percent) were often known to authorities," the authors wrote. Kids were less likely to report assaults by peers and siblings, dating violence, sexual exposure (such as flashing) and statutory rape.

"Childhood/adolescent abuse is frequently described as a hidden problem, and victimization studies regularly have shown that much abuse goes undisclosed," the study authors wrote. "The hidden nature of childhood victimization has multiple sources. Clearly, children and adolescents are easily intimidated by offenders and fear retaliation."

The authors added that, in many cases, young people and their families choose to deal with incidents "informally," fearing the consequences of police and court involvement.

The study did find, though, that authorities are more aware of victimization than during an earlier survey, conducted in 1992.

"However, the study also shows that a considerable portion of childhood/adolescent exposure to victimization is still unknown to authorities," the authors wrote. "The study suggests that outreach needs to be particularly enhanced toward boys, Hispanics and higher-income groups. It also suggests that disclosure promotion should be directed toward episodes that involve family members and peer perpetrators."

The study is published in the January issue of Archives of Pediatrics & Adolescent Medicine.

SOURCE: Archives of Pediatrics & Adolescent Medicine, news release, Jan. 3, 2011

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Copyright (c) 2011 HealthDay. All rights reserved.

Cost of Injury and Violence in the United States

from CDC's National Center for Injury Prevention and Control. 

 CDC's Injury Center is pleased to announce the release of the new WISQARS^TM (Web-based Injury Statistics Query and Reporting System) Cost of Injury Reports.* 
 

WISQARS™ data can be used to learn more about the public health and economic burden associated with unintentional injury and violence-related injury in the United States.
 
The Cost of Injury Reports module provides cost estimates for injury deaths, hospitalizations, and emergency department visits where the patient was treated and released. 
 
The new module allows users to create reports of: medical costs (e.g., treatment and rehabilitation), work loss costs (e.g., lost wages, fringe benefits, and self-reported household services), and combined costs (medical plus work loss) based on a number of variables including: intent and mechanism (cause) of injury, body region and diagnosis of injury, geographic location (for deaths only), sex, and age.

 
Learn More

• Cost of Injury Reports Module
• About Cost of Injury Reports
• WISQARS^TM

* WISQARS^TM Cost of Injury Reports are based on lifetime medical and lifetime work loss costs in 2005. This was the most recent year of unit cost data available at the time the module was developed. NCIPC plans to update these estimates to more recent years in the future.

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Doctors Overlook Signs of Child - In Pediatrics, Domestic Violence

MedPage Today

By Chris Emery, Contributing Writer, MedPage Today
Published: November 30, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Physicians often misdiagnose bone fractures caused by child abuse as accidental breaks, particularly if the child is male and the doctor is not a pediatrician, a new study found.

Of children who suffered fractures from abuse, about 20% had at least one previous medical visit during which a doctor missed signs of the problem (95% CI 15.8 to 26.0), according to a report published online Nov. 30 in Pediatrics. It took a median of eight days after the initial visit before doctors correctly assessed abuse during a subsequent examination.

Doctors were most likely to misdiagnose abusive fractures if the patients were boys, had breaks in the limbs, or were seen in a primary care setting or general emergency room, as opposed to a pediatric emergency department.

"This study is the first to report the frequency of delayed recognition of abusive fractures in children," Kathy Boutis, MD, MSc, of the Hospital for Sick Children, University of Toronto, and colleagues wrote. "One-fifth of children with abusive fractures were missed at initial physician visits, which is comparable to that reported for other types of abuse; however, we do not know how many cases of abusive fractures are never detected."

While fractures are common signs of child abuse and repeat injuries occur in 35% of child abuse cases, previous research suggested that doctors have difficulty distinguishing breaks caused by accidents from those resulting from abuse -- and thus miss a chance to prevent further abuse.

However, the frequency at which cases of abuse are overlooked was unknown.

The authors assessed 258 cases of children younger than 3 years treated for abusive fractures at Toronto Hospital for Sick Children between January 1993 and December 2007. The children had seen physicians previously for treatment of fractures. Of the children, 54 had a least one previous visit with a physician at which abuse was missed, the study found.

Abuse-related fractures were nearly twice as likely to be missed in boys as in girls. "Although the reason for this is unclear, injuries in general occur more often in boys, which may bias a clinician in assuming that the cause of a fracture is accidental," the authors wrote.

Of the 145 children with breaks to an extremity, 28% (95% CI 20.8 to 35.8) were cases of abuse that were overlooked. About a third of the cases of abuse that were missed on the initial visit were the result of physicians not diagnosing fractures from radiographs.

"This study suggests that front-line physicians should strongly consider consulting a radiologist when the presence of a fracture may lead to increased suspicion of abuse," the authors wrote.

They also suggested that physicians carefully check for other risk factors of abuse in children with fractures and that they err on the side of performing skeletal surveys for children who are at higher risk.

They cautioned that the study was retrospective, and that some cases of abuse may have been overlooked by the researchers because they were never referred to the child protection team at the hospital.

On the other hand, complex cases may not have been referred to the child abuse team, which may have elevated the estimate of the percentage of abuse cases that are overlooked on a child's initial physician visit for a fracture.

"However," the authors wrote, "child abuse is under-recognized, and there is also the possibility that we are underestimating the proportion of cases missed."

The study was funded by the Canadian Hospitals Injury Reporting and Prevention Program.

The authors reported no financial conflicts of interest.

Primary source: Pediatrics
Source reference:
Boutis K, et al "Delayed identification of pediatric abuse-related fractures" Pediatrics 2009; DOI: 10.1542/peds. 2008-3794.