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Brady PQ, Zedaker SB, McKay K, Scott D. The Darker the Skin, the Greater the Disparity? Why a Reliance on Visible Injuries Fosters Health, Legal, and Racial Disparities in Domestic Violence Complaints Involving Strangulation. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7602-7629. [PMID: 36695177 DOI: 10.1177/08862605221145726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The reliance on external injuries for justice is misguided given that assault injuries may be less visible among victims of color due to increased melanin in the skin. To date, however, less is known whether racial/ethnic disparities extend to officers' identification of signs of nonfatal strangulation (NFS). The current study estimates the extent of NFS indicators identified by officers who completed a standardized strangulation assessment in 133 family violence complaints. Breathing difficulties were the most common symptoms identified by officers (98%), followed by external signs (89%), and symptoms of impeded blood circulation (87%). Compared to cases involving White/Asian survivors, officers were less likely to identify external injuries on Black survivors' neck, chin, and chest/shoulders. While racial/ethnic differences did not emerge for symptoms of disrupted airflow, Hispanic survivors were twice as likely to report losing control of bodily functions. Implications for policy and practice are discussed.
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Affiliation(s)
- Patrick Q Brady
- The University of Northern Colorado, Greeley, USA
- The University of Colorado Colorado Springs, USA
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Chalmers K, Parameswaran R, Dussault N, Farnan J, Oyola S, Carter K. Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3244-3278. [PMID: 35658735 DOI: 10.1177/08862605221104522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.
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Affiliation(s)
- Kristen Chalmers
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
| | - Ramya Parameswaran
- 166668University of California San Francisco Health, San Francisco, CA, USA
| | - Nicole Dussault
- Duke University Medical Center, 169103Duke University, Durham, NC, USA
| | - Jeanne Farnan
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Medicine, 2462University of Chicago, Chicago, Il, USA
| | - Sonia Oyola
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Family Medicine, 2462University of Chicago, Chicago, Il, USA
| | - Keme Carter
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Medicine, 2462University of Chicago, Chicago, Il, USA
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Lohner L, Nigbur L, Klasen C, Witzel I, Garland J, Ondruschka B, Anders S. Vaginal injuries after consensual sexual intercourse - a survey among office-based gynecologists in Hamburg, Germany. Forensic Sci Med Pathol 2022; 18:352-358. [PMID: 35716294 PMCID: PMC9587115 DOI: 10.1007/s12024-022-00488-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
Studies on the occurrence of injuries following consensual sexual intercourse (CSI) among patients treated by office-based gynecologists are lacking. This survey aimed to assess the presence and medical relevance of vaginal injuries after CSI in gynecological office-based practice, associated risk factors, and their significance for forensic medical assessment practice. All office-based gynecologists in Hamburg, Germany (n = 316), were asked to fill in a one-page questionnaire via a fax survey. The questionnaire covered various aspects such as having observed CSI-related injuries, injury severity, risk factors, and concomitant factors (bleeding, need for surgical care, hospitalization). Response rate was 43.2% (n = 115). Overall, 83.5% of office-based gynecologists reported having observed vaginal injuries after CSI at least once and 59.1% repeatedly. Regarding maximum injury severity, 52.1% observed mucosal erosions, 32.3% mucosa penetrating injuries, and 14.6% injuries penetrating the vagina. Having observed bleeding was reported by 56.3%, 28.1% had to perform surgical suture care, and hospital admission was initiated by 20.8%. Menopause (37.5%), use of objects (19.8%), alcohol, and/or drug use (16.7%) were reported as the most frequently observed associated risk factors. Vaginal injuries after CSI have been observed by the majority of office-based gynecologists in Hamburg involving a wide spectrum of severity, including the necessity of surgical care and hospital admission. Complementing published work in clinical and emergency medicine, these findings are highly relevant to the forensic evaluation of injuries in an allegation of sexual assault, as the severity of a vaginal injury in this setting does not necessarily support a conclusion on the issue of consent.
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Affiliation(s)
- L. Lohner
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - L. Nigbur
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - C. Klasen
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I. Witzel
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Garland
- Forensic and Scientific Services, Coopers Plains, Brisbane, Australia
| | - B. Ondruschka
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - S. Anders
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
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Female genital injury-which findings have to be considered physiological using colposcopy with and without toluidine blue dye? Forensic Sci Med Pathol 2021; 17:634-642. [PMID: 34613594 PMCID: PMC8629788 DOI: 10.1007/s12024-021-00417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
Abstract
This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.
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Sommers MS, Fargo JD. Discriminating between consensual intercourse and sexual assault: Genital-anal injury pattern in females. J Forensic Leg Med 2021; 79:102138. [PMID: 33657467 DOI: 10.1016/j.jflm.2021.102138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Assessment of genital-anal (GA) injuries following sexual assault promotes health and assists prosecutors to build a case. The pattern of injuries may help differentiate between consensual and non-consensual intercourse, bolster the survivors' credibility, and increase prosecutions in sexual assault cases. OBJECTIVES To identify the constellation of G-A injury-related characteristics that most effectively discriminated between consensual sexual intercourse and sexual assault in females when controlling for intercourse-related variables. METHODS We employed a comparative study with two groups: a prospective cohort group with consensual participants and a group derived from an existing sexual assault registry. In the prospective cohort, we performed a sexual assault forensic examination at baseline and following consensual sexual intercourse with females ≥21 years. We compared their injury patterns to the injury records of females ≥21 years who were sexual assaulted. RESULTS We enrolled a sample of 834 females: 528 consensual (63.3%) participants and 306 non-consensual (36.7%) registry cases. After controlling for race/ethnicity, age, and time between intercourse and examination, logistic regression analyses showed that the presence of an external genital tear increased the odds of non-consensual intercourse more than two times (adjusted odds ratio [AOR] = 2.70, 95% CI = 1.28-5.56). Logistic regression analyses also showed that the odds of non-consensual sexual intercourse were significantly greater with a lower prevalence and frequency of external and internal genital redness, lack of condom use and lubrication, and presence of anal penetration. Latent class analysis identified high and low G-A injury prevalence subgroups among both consensual and non-consensual samples. One subset of results emerged that may be indicative of non-consensual as compared to consensual intercourse: a higher prevalence of external genital and anal tears. CONCLUSION External genital tears occurred more frequently in the non-consensual sample and increased the odds of non-consensual intercourse more than two times. Anal tears, swelling, and ecchymosis and anal penetration were markers for non-consensual intercourse and should increase suspicion for lack of consent.
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Affiliation(s)
- Marilyn S Sommers
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104, 513-314-9967, USA.
| | - Jamison D Fargo
- Utah State University Department of Psychology, 2810 Old Main Hill, Logan, UT 84322, 435-797-8558, USA.
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Moumneh R, Ahmed Chowdhury M, Hussain Y, Noor Akhtar H. Social accountability: A student perspective. CLINICAL TEACHER 2020; 18:93. [PMID: 32989923 DOI: 10.1111/tct.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
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Bruise detection and visibility under alternate light during the first three days post-trauma. J Forensic Leg Med 2019; 69:101893. [PMID: 32056810 DOI: 10.1016/j.jflm.2019.101893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/05/2019] [Accepted: 12/17/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cutaneous bruises are often hard to detect particularly on individuals with a darker complexion. Researchers and federal agencies have recommended the use of alternate light to aide in the assessment of subtle injury. However, studies are limited in their evaluation of wavelength performance during the first few days of bruise healing. The purpose of this pilot study was to examine whether an alternate light source (ALS) improves detection of bruises when compared to normal light typical of clinical practice during the first three days following induction. METHODS A sample of eight healthy adults between 22 and 36 years of age with diverse skin color were recruited for this study. One bruise was induced on each participant by dropping a 4-oz (113g) steel ball through a 5-ft (1.5 m) vertical pipe onto the anterior surface of the forearm. Using the ALS, bruises were assessed under 14 different combinations of ultraviolet and short narrowband visible wavelengths and filters along with overhead fluorescent "examination" lighting. Participants were examined 3 to 4 times per day at approximately 4-h intervals for three consecutive days post induction. RESULTS Repeated bruise assessments on 8 subjects resulted in 59 bruise assessments and 885 total observations under the different wavelengths and filters combinations. A bruise was detectable in 46 (78%) of the assessments, with bruise ages ranging from 30 min to 57 h. Twenty (34%) bruises not detectable under normal light were visible with ASL. Multilevel modeling revealed a strong association between time and detection for shorter wavelengths, such as 365 nm (ultraviolet) and 450 nm. CONCLUSION The results of our study suggest alternate light is more likely to detect faint bruises than normal lighting during the first three days post injury. However, more research is needed to determine which wavelengths and filter combinations are most effective during that time frame.
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Sommers MS, Fargo JD, Regueira Y, Brown KM, Beacham BL, Perfetti AR, Everett JS, Margolis DJ. Are the Fitzpatrick Skin Phototypes Valid for Cancer Risk Assessment in a Racially and Ethnically Diverse Sample of Women? Ethn Dis 2019; 29:505-512. [PMID: 31367171 DOI: 10.18865/ed.29.3.505] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Fitzpatrick Skin Phototypes (FSP) were developed to classify skin color and response to ultraviolet radiation. FSP are used clinically to assess risk for sunburn and skin cancer. Our aim was to determine the criterion-related validity of self-reported FSP when compared with skin color and sunburn history, controlling for age, race/ethnicity, and seasonality/geography. We performed a secondary analysis of data (N=466) from an observational study. The racial/ethnic composition of the sample was 45% White/White Hispanic (WWH), 40% Black/Black Hispanic (BBH), and 15% Other Identities. Outcome measures were self-reported FSP and sunburn history, as well as physiological measures of skin color (L* lightness/darkness, a* redness/greenness, b* yellowness/blueness). Correlation between FSP and L* was -.77 (95% CI -.81, -.73; P<.001). Although 60% of the variance in FSP was accounted for by L* values for the entire sample, only 5% of the variance was accounted for among BBH participants (r=-.23), and up to 30% for WWH/Other Identity participants (r=-.48 and -.52). Multiple regression analysis indicated L* and b* values, sunburn history, and race/ethnicity, but not geography/seasonality or a* values significantly and collectively accounted for 72% of the variance in FSP. While the criterion validity of FSP was established by the strong relationship between L* values and FSP for the entire sample, when examined at the level of individual racial/ethnic subgroups, criterion validity of FSP was not demonstrated. When self-reported FSP are used for clinical skin assessment and sun cancer screening, they provide a restricted range of options for people with darker skin that does not capture variations in their skin color. Inaccuracy of clinical data may lead to unequal treatment or inadequate cancer risk assessment.
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Affiliation(s)
| | | | | | | | | | - Angela R Perfetti
- Perleman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - David J Margolis
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA
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Sommers MS, Regueira Y, Tiller DA, Everett JS, Brown K, Brignone E, Fargo JD. Understanding rates of genital-anal injury: Role of skin color and skin biomechanics. J Forensic Leg Med 2019; 66:120-128. [PMID: 31299484 DOI: 10.1016/j.jflm.2019.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE A series of studies suggest that non-Hispanic White women have significantly more injuries than non-Hispanic Black women after sexual assault and consensual sexual intercourse. One explanation for this difference is that the degree of skin protection may vary as skin mechanics and skin pigmentation vary. The aim of the study was to determine the association among genital-anal injury, skin color, skin viscoelasticity and skin hydration in women following consensual sexual intercourse when controlling for age, smoking history, body mass index (BMI), sun exposure, and health status. PROCEDURES We employed a prospective cohort study design to enroll women 21 years of age or older at two study sites. They underwent two data collection sessions, baseline and follow-up after consensual sexual intercourse. Baseline genital-anal injury identification occurred with a standard forensic examination (direct visualization, nuclear staining with toluidine blue contrast, and colposcopy examination) and measurements of other variables (skin color, skin viscoelasticity, skin hydration, age, smoking history, body mass index [BMI], sun exposure, and health status). Participants were then asked to have consensual sexual intercourse with a male partner of their choice and to return for a second forensic examination for injury detection. Genital-anal injury was regressed on skin color, skin viscoelasticity, skin hydration, age, smoking history, BMI, sun exposure, and health status. FINDINGS We enrolled 341 participants, 88 non-Hispanic White (25.8%), 54 non-Hispanic Black (15.8%), 190 Hispanic/Latina (55.7), and 9 Other Identities (2.6%). At baseline the genital-anal injury prevalence was 57.77% and at follow-up after consensual sexual intercourse, injury prevalence was 72.73%. External genital injury prevalence was associated with increased L* (lightness) values (Adjusted Odds Ratio [AOR] = 1.98, 95% Confidence Interval [CI] = 1.03, 4.04) and decreased skin elasticity (AOR = 0.96, 95% CI = 0.93, 0.99) at baseline. Increased skin hydration was associated with a significantly higher frequency of external, internal, anal, and total genital-anal injuries (Adjusted Rate Ratio [ARR] > 1.27) at follow-up. Also at the follow-up examination, Hispanic/Latina participants had significantly lower external genital and total genital-anal injury prevalence and frequency as compared to non-Hispanic White participants (AOR < 0.40). CONCLUSIONS Our findings provide qualified support for the importance of skin color during the forensic examination. Women with lighter skin tones may have skin that is more easily injured than women with darker tones. In contrast, external genital injuries may be more easily identified in women with light as compared to dark skin, a situation that is important in both the health care and criminal justice systems. Additionally, women with decreased viscoelasticity and increased hydration may be more easily injured. These findings support the need to develop forensic procedures that are effective in people across the range of skin colors and to interpret forensic findings considering the innate properties of the skin.
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Affiliation(s)
- Marilyn S Sommers
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA, 19104, USA.
| | - Yadira Regueira
- University of Puerto Rico School of Nursing, Medical Sciences Campus, Box 365067, San Juan, PR, 00936, USA.
| | - Deborah A Tiller
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA, 19104, USA.
| | - Janine S Everett
- Franklin and Marshall College, 415 Harrisburg Avenue, Lancaster, PA, 17603, USA.
| | - Kathleen Brown
- University of Pennsylvania, Fagin Hall, 418 Curie Boulevard, Philadelphia, PA, 19104, USA.
| | - Emily Brignone
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA.
| | - Jamison D Fargo
- Utah State University Department of Psychology, 2810 Old Main Hill, Logan, UT, 84341, USA.
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Rossman L, Solis S, Stevens J, Wynn B, Jones JS. Effect of menstrual bleeding on the detection of anogenital injuries in sexual assault victims. Am J Emerg Med 2019; 37:1203-1204. [DOI: 10.1016/j.ajem.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
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The effects of skin pigmentation on the detection of genital injury from sexual assault. Am J Emerg Med 2019; 37:974-975. [DOI: 10.1016/j.ajem.2018.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022] Open
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Hanlon KL. Cross-polarised and parallel-polarised light: Viewing and photography for examination and documentation of biological materials in medicine and forensics. J Vis Commun Med 2018; 41:3-8. [PMID: 29318893 DOI: 10.1080/17453054.2018.1420418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cross-polarisation, with regard to visible light, is a process wherein two polarisers with perpendicular orientation to one another are used on the incident and reflected lights. Under cross-polarised light birefringent structures which are otherwise invisible become apparent. Cross-polarised light eliminates glare and specular highlights, allowing for an unobstructed view of subsurface pathology. Parallel-polarisation occurs when the polarisers are rotated to the same orientation. When cross- or parallel-polarisation is applied to photography, images can be generated which aid in visualisation of surface and subsurface elements. Improved access to equipment and education has the potential to benefit practitioners, researchers, investigators and patients.
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Affiliation(s)
- Katharine L Hanlon
- a Division of Media Services , Mayo Clinic Florida , Jacksonville , FL , USA.,b Division of Pediatric Dermatology , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
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Song SH, Fernandes JR. Comparison of Injury Patterns in Consensual and Nonconsensual Sex: Is It Possible to Determine if Consent was Given? Acad Forensic Pathol 2017; 7:619-631. [PMID: 31240011 DOI: 10.23907/2017.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/27/2017] [Accepted: 09/08/2017] [Indexed: 11/12/2022]
Abstract
Matters of sexual consent and sexual assault are hotly debated issues among professionals and laypersons alike. A widespread misconception of sexual assault is that most victims of sexual assault sustain significant physical trauma. It is the purpose of this review article to compare the patterns of physical injury (both genital and extragenital) in victims of sexual assault and participants of consensual sex to conclude if physical injury alone can indicate whether consent was given. Interpretations of injury have great forensic significance as it can influence the outcome of sexual assault cases. Several articles indicate that extragenital injuries are commonly found in sexual assault victims (46%-82%) and that most of such injuries are deemed minor. Articles report a wide range of genital injury detection rates in both sexual assault victims (6%-87%) and consensual sex participants (6%-73%). Usage of different examination techniques may partly explain the wide range of detection rates reported. Out of all those who sustained genital injuries, only a small portion of people required hospitalization. In both consensual and sexual assault cases, genital injuries in the 6 o'clock position were most common. Studies of genital injury lacked standardization of factors that significantly influence the results, such as time to examination after sex, examination techniques, and injury severity scales. Therefore, medicolegal personnel should be aware that sexual assault victims can present with a wide range of physical trauma and should avoid relying on physical trauma alone to conclude whether consent was present.
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Affiliation(s)
- Sung Hoon Song
- McMaster University Faculty of Health Sciences - Health Sciences
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Aldous A, Magnus M, Roberts A, DeVore H, Moriarty T, Hatch Schultz C, Zumer M, Simon G, Ghosh M. Challenges in conducting research on sexual violence and HIV and approaches to overcome them. Am J Reprod Immunol 2017; 78. [PMID: 28467001 DOI: 10.1111/aji.12699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/04/2017] [Indexed: 11/28/2022] Open
Abstract
Studies have implicated sexual violence as a strong correlate of HIV acquisition in women. Characterizing how such violence affects the female immune system may provide insight into the biological mechanisms of HIV transmission and ultimately improve global HIV prevention strategies. Little research has been carried out in this domain, and the obstacles to investigation can be daunting. Here, we describe methodological challenges encountered and solutions explored while implementing a study of dysregulation of immune biomarkers potentially indicative of increased HIV susceptibility in women following sexual assault. Challenges included accessing sexual assault survivors and defining sexual assault, promoting study participant well-being during research engagement, reducing selection and information bias, collecting and processing biological samples, and adjusting for confounders such as reproductive tract infections and emotional and physical abuse. We found that many survivors of sexual assault welcomed the attention from study staff and felt empowered by the opportunity to help other women at risk for violence. Well-trained research staff and well-articulated community and medical partnerships were key methods to overcoming challenges while promoting the safety and welfare of vulnerable study participants.
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Affiliation(s)
- Annette Aldous
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Afsoon Roberts
- Division of Infectious Diseases, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Heather DeVore
- District of Columbia Forensic Nurse Examiners, Washington, DC, USA
| | | | | | - Maria Zumer
- Medical Faculty Associates, Inc., The George Washington University, Washington, DC, USA
| | - Gary Simon
- Division of Infectious Diseases, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Mimi Ghosh
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Feeney H, Chiaramonte D, Campbell R, Greeson MR, Fehler-Cabral G. Anogenital and Physical Injuries in Adolescent Sexual Assault Patients: The Role of Victim-Offender Relationship, Alcohol Use, and Memory Impairment. JOURNAL OF FORENSIC NURSING 2017; 13:52-61. [PMID: 28525429 DOI: 10.1097/jfn.0000000000000148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prior research has documented high rates of anogenital and physical injuries among adolescent sexual assault patients. Although a number of factors related to rates of injury detection in adolescents have been identified, there may be additional features of the assault that are disclosed in the patient history that could be important indicators of injury risk. The purpose of the current study was to expand this literature by examining whether factors that are salient in sexual assaults committed against adolescents-victim-offender relationship, substance use, and memory impairment-are associated with documented anogenital and physical injury rates. Results indicated that victim-offender relationship, substance use, and assault memory are significantly related to the number of anogenital injuries and, particularly, the number of physical injuries detected in adolescent sexual assault patients. These results highlight the importance of a comprehensive patient history, including assessment of alcohol and drug use and memory impairment, to guide the medical forensic examination.
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Affiliation(s)
- Hannah Feeney
- Author Affiliations: 1Department of Psychology, Michigan State University; 2Department of Psychology, DePaul University; and 3Harder + Company Community Research
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Bruce AC, Cao Y, Henry C, Peirce SM, Laughon K. Preclinical Assessment of Safety and Efficacy of Fluorescent Dye for Detecting Dermal Injuries (the injuries were both abrasions and incision) in a Murine Model. J Forensic Sci 2016; 61:1493-1497. [DOI: 10.1111/1556-4029.13173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/29/2015] [Accepted: 01/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony C. Bruce
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Yiqi Cao
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Catherine Henry
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Shayn M. Peirce
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Kathryn Laughon
- School of Nursing; University of Virginia; PO Box 800826 Charlottesville VA 22903
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Exploring Genitoanal Injury and HIV Risk Among Women: Menstrual Phase, Hormonal Birth Control, and Injury Frequency and Prevalence. J Acquir Immune Defic Syndr 2016; 71:207-12. [PMID: 26334741 DOI: 10.1097/qai.0000000000000824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Genital, anal, and oral injuries sustained from sexual intercourse may explain HIV transmission among women. We determined the variability in genitoanal injury frequency and prevalence in women after consensual sexual intercourse, exploring the role of menstrual phase and hormonal birth control. METHODS We used a longitudinal observational design with a convenience sample of 393 women aged 21 years and older. Participants had a baseline interview with gynecological examination, followed by consensual sexual intercourse with a male partner and a second gynecological examination. We analyzed injury prevalence with logistic regression and injury frequency with negative binomial regression among women who were (1) menstrual, not using hormonal birth control, (2) menstrual, using hormonal birth control, or (3) menopausal. We also compared injury among menstrual women in the follicular, ovulatory, and luteal phases. FINDINGS Women using hormonal birth control had 38% more external genitalia injuries [adjusted rate ratio (ARR) = 1.38, P = 0.030] and more than twice the anal injuries (ARR = 2.67, P = 0.005) as the nonhormonal birth control menstruating group. Menopausal women had more than 3 times the anal injuries (ARR = 3.36, P = 0.020) than those in the nonhormonal menstrual group. Among menstrual women, those in the follicular phase had a greater prevalence and frequency of external genitalia injuries than those in other phases. INTERPRETATION Increased rates of postcoital genitoanal injuries are noted among women using hormonal birth control and/or in the follicular phase of menstruation. Biological factors that influence women's risk for HIV warrant further investigation.
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Scafide KN, Sheridan DJ, Taylor LA, Hayat MJ. Reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour. Injury 2016; 47:1258-63. [PMID: 26997134 DOI: 10.1016/j.injury.2016.01.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/25/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bruising is one of the most common types of injury clinicians observe among victims of violence and other trauma patients. However, research has shown commonly used qualitative description of cutaneous bruise colour via the naked eye is subjective and unreliable. No published work has formally evaluated the reliability of tristimulus colourimetry as an alternative for assessing bruise colour, despite its clinical and research applications in accurately assessing skin colour. The purpose of this study was to systematically evaluate the test-retest and inter-observer reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour. METHODS Two researchers obtained repeated tristimulus colourimetry measures of cutaneous bruises with participants of diverse skin colour. Measures were obtained using the Minolta CR-400 Chomameter. Commission Internationale d'Eclairage (CIE) L*a*b* colour space was used. Data was analysed using intraclass correlation coefficients (ICC), Cronbach's alpha, and minimal detectable change (MDC) on all three L*a*b* values. RESULTS The colorimeter demonstrated excellent test-retest or intra-rater reliability (L* ICC=0.999; a* ICC=0.973; b* ICC=0.892) and inter-rater reliability (L* ICC=0.997; a* ICC=0.976; b* ICC=0.982). CONCLUSIONS With consistent placement, the tristimulus colourimetry is reliable for the objective assessment and documentation of cutaneous bruise colour for purposes of clinical practice and research. Recommendations for use in practice/research are provided.
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Affiliation(s)
| | | | - Laura A Taylor
- Uniformed Services University of the Health Sciences, United States
| | - Matthew J Hayat
- Georgia State University, School of Public Health, United States
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SOUTO RQ, ARAÚJO FKCD, XAVIER AFC, CAVALCANTI AL. Rape against Brazilian Women: Characteristics of Victims and Sex Offenders. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1613-9. [PMID: 26811812 PMCID: PMC4724734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Violence against women is a serious social problem and affects mainly young women. This study aimed to evaluate sexual violence against women in Campina Grande, Brazil. METHODS A retrospective study with analysis of 886 forensic medical reports of sexual violence from the Institute of Legal Medicine of Campina Grande, Brazil, was conducted between January 2005 and December 2009. Sociodemographic variables related to victims, offenders and aggressions were analyzed. Significance level of 5% was adopted. RESULTS Two hundred and ninety-one cases of rape (32.8%) were confirmed, the majority of victims aged between 0 and 19 years (89.9%), were single (98.8%) and had low educational level (86.9%), with association with marital status (P = 0.02). The sex offender was known to the victim in 84.2% of cases and in 93.8% of cases, he acted alone. There was an association between rape and the relationship with the offenders (P = 0.01) and the age of the offenders (P = 0.03). The rape occurred in most cases at the home of victims (49.3%), with the use of violence in 72.3% of cases, but only 5.7% of the victims exhibited physical injuries. There was an association between rape and variables date of occurrence (P = 0.001), previous virginity (P = 0.001) and violence during practice (P = 0.001). CONCLUSION Over one third of women were victims of rape, predominantly adolescents, unmarried and with low educational level. The offenders were known to the victims, and acted alone in most situations, making use of physical violence.
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Affiliation(s)
| | | | | | - Alessandro L. CAVALCANTI
- Dept. of Public Health, State University of Paraiba, Campina Grande, Brazil,Corresponding Author:
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20
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Schmidt Astrup B, Lykkebo AW. Post-coital genital injury in healthy women: A review. Clin Anat 2014; 28:331-8. [PMID: 25346095 DOI: 10.1002/ca.22476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/08/2022]
Abstract
Female genital injury following penile sexual intercourse in healthy women is a matter of importance and debate in many parts of society. However, the literature on the subject is sparse. There are a few studies regarding minor injury that does not require treatment in adult, pre-menopausal women, a single study of adolescent women, and none regarding post-menopausal women. Larger lesions requiring treatment are described casuistically. The purpose of this article is to provide a short, easy-to-read review of the literature regarding the prevalence and nature of female genital injury following consensual sexual intercourse in otherwise healthy women.
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Affiliation(s)
- Birgitte Schmidt Astrup
- Department of Forensic Pathology, Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark
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21
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Macroscopically detected female genital injury after consensual and non-consensual vaginal penetration: a prospective comparison study. J Forensic Leg Med 2013; 20:884-901. [PMID: 24112341 DOI: 10.1016/j.jflm.2013.06.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 05/26/2013] [Accepted: 06/30/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence, type and pattern of macroscopically detected female genital injury after consensual and non-consensual vaginal penetration to further an understanding of the forensic significance of genital injury in women reporting sexual assault. A secondary aim was to identify any effect of a range of possible variables upon the likelihood of genital injury resulting from vaginal penetrative sexual intercourse. STUDY DESIGN Two groups of reproductive age women (aged 18-45 years) were prospectively recruited within 72 h of a single episode of vaginal penetrative sex, and macroscopically examined for the presence of bruises, abrasions and lacerations at twelve external and internal genital sites. Forty one women who presented for forensic examination after reporting a sexual assault to police were recruited to the non-consensual group and 81 women who presented for routine cervical screening or with sexual health concerns to a primary health care service to the consensual group. Each group was examined by a different group of doctors, all of whom were experienced in both forensic genital examination and gynaecological examination of healthy and diseased sexually active women. Data collection and examination protocols were the same for both groups. RESULTS The key finding was a statistically significant difference in genital injury prevalence between women who were vaginally penetrated non-consensually and consensually; 53.7% of the non-consensual group (22/41) and 9.9% of the consensual group (8/81) were found to have at least one genital injury [OR 10.57, CI (4.07, 27.42), p < 0.00001]. Penetration with finger/s and possible pre-existing genital 'infection' were found to be significantly associated with the presence of injury in the univariate analysis after adjusting for consent. Logistic regression demonstrated that women penetrated without consent were 19.5 times more likely to sustain at least one genital injury, than those penetrated consensually [OR 19.53, CI (6.03, 63.24)] and that a penetration scenario that included finger/s was 4.2 times more likely to result in at least one genital injury than penetration without finger involvement [OR 4.25, CI (1.42, 12.78)], when controlling for other variables in the model. Whilst a comparatively low injury prevalence in the consensual group limited interpretation, results revealed possible differences in genital injury typology and pattern resulting from non-consensual and consensual vaginal penetration. Lacerations were seen after both consensual and non-consensual vaginal penetration, while abrasions and bruises were seen exclusively in the non-consensual group. CONCLUSION This study demonstrated a significant consent group difference in genital injury prevalence and the highest macroscopically detected genital injury prevalence rate resulting from non-consensual vaginal penetration identified to date. Results also indicate that vaginal penetration with finger/s increases the likelihood of sex-related injury. The difference in type of injury sustained as a result of non-consensual and consensual vaginal penetration was an unexpected finding, and warrants further investigation. These results highlight the importance of a standardised means of detecting genital injury based on consistent injury definitions, examination protocols, and examiner experience and suggest that macroscopic genital examination may be uniquely placed to detect consent group differences in injury typology and pattern if they exist.
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Kelly DL, Larkin HJ, Cosby CD, Paolinetti LA. Derivation of the Genital Injury Severity Scale (GISS): A concise instrument for description and measurement of external female genital injury after sexual intercourse. J Forensic Leg Med 2013; 20:724-31. [DOI: 10.1016/j.jflm.2013.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 03/20/2013] [Accepted: 04/28/2013] [Indexed: 10/26/2022]
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Sommers M, Beacham B, Baker R, Fargo J. Intra- and inter-rater reliability of digital image analysis for skin color measurement. Skin Res Technol 2013; 19:484-91. [PMID: 23551208 DOI: 10.1111/srt.12072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND We determined the intra- and inter-rater reliability of data from digital image color analysis between an expert and novice analyst. METHODS Following training, the expert and novice independently analyzed 210 randomly ordered images. Both analysts used Adobe(®) Photoshop lasso or color sampler tools based on the type of image file. After color correction with Pictocolor(®) in camera software, they recorded L*a*b* (L*=light/dark; a*=red/green; b*=yellow/blue) color values for all skin sites. We computed intra-rater and inter-rater agreement within anatomical region, color value (L*, a*, b*), and technique (lasso, color sampler) using a series of one-way intra-class correlation coefficients (ICCs). RESULTS Results of ICCs for intra-rater agreement showed high levels of internal consistency reliability within each rater for the lasso technique (ICC ≥ 0.99) and somewhat lower, yet acceptable, level of agreement for the color sampler technique (ICC = 0.91 for expert, ICC = 0.81 for novice). Skin L*, skin b*, and labia L* values reached the highest level of agreement (ICC ≥ 0.92) and skin a*, labia b*, and vaginal wall b* were the lowest (ICC ≥ 0.64). CONCLUSION Data from novice analysts can achieve high levels of agreement with data from expert analysts with training and the use of a detailed, standard protocol.
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Fisher BS, Kaplan A, Budescu M, Fargo J, Tiller D, Everett J, Sommers M. The influence of anogenital injury on women's willingness to engage with the criminal justice process after rape. VIOLENCE AND VICTIMS 2013; 28:968-983. [PMID: 24547675 DOI: 10.1891/0886-6708.vv-d-12-00109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical-legal-social science research has documented that nongenital and/or anogenital injuries play a significant role throughout the criminal justice system from victims reporting to judges determining the length of a sentence. What remains an open question is whether the documentation of anogenital injury influences women's willingness to engage in the criminal justice system. A sample of women age 21 years and older residing in an urban area were asked about willingness to report to police, file charges, and work with the courts to prosecute after rape. Questions were framed with a qualifying statement about the forensic examination being able to detect injury related to forced sexual intercourse. Results show that women had a high willingness to act if the examination could detect anogenital injury and women with and without a history of forced sexual intercourse had significant differences in their responses to these questions. Implications for health care, criminal justice system, and future research are discussed.
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Affiliation(s)
- Bonnie Sue Fisher
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH 45221-0389, USA.
| | - Alyssa Kaplan
- New York Presbyterian Weill Cornell Medical Center, USA
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Abstract
The background of this article is that assessment and quantification of skin color is important to health care; color is one indicator of overall health and is linked to oxygenation, tissue perfusion, nutritional status, and injury. The purpose is to describe how skin color varies across racial/ethnic groups so that the information can be applied to clinical practice. The method used is cross-sectional, descriptive design (n = 257). We recorded self-defined race/ethnicity and used a spectrophotometer to measure skin color at two anatomic sites. Skin color variables included L* (light/dark), a* (red/green), and b* (yellow/blue). As regards results, we found significant differences in L*, a*, and b* values by site and race/ethnicity in White, Asian, and Biracial participants. L*: F(3, 233) = 139.04, p < .01 and F(3, 233) = 118.47, p < .01. Black participants had significantly lower mean L* values and wider ranges of L*, a*, and b* as compared with other groups. In regard to application, these findings suggest that clinicians and researchers should plan and provide care based on skin color, rather than race/ethnicity.
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Everett JS, Sommers MS. Skin viscoelasticity: physiologic mechanisms, measurement issues, and application to nursing science. Biol Res Nurs 2012; 15:338-46. [PMID: 22544517 DOI: 10.1177/1099800411434151] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Skin is the primary interface between health care providers and patients and is assessed clinically to predict physiological stability or instability. The biomechanical properties of human skin, most notably elasticity and viscoelasticity, are critical to its protective function. In this article, the authors describe the physiological basis for skin elasticity and viscoelasticity. The authors discuss the role of viscoelasticity in nursing science and consider avenues for scientific exploration of the skin's biomechanical properties, including applications in pressure ulcer research, injury, and healing. They also discuss the Cutometer® as one option for measurement of viscoelasticity in clinical and bench research protocols.
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Affiliation(s)
- Janine S Everett
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
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Sommers MS, Brown KM, Buschur C, Everett JS, Fargo JD, Fisher BS, Hinkle C, Zink TM. Injuries from intimate partner and sexual violence: Significance and classification systems. J Forensic Leg Med 2012; 19:250-63. [PMID: 22687765 DOI: 10.1016/j.jflm.2012.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/05/2012] [Accepted: 02/13/2012] [Indexed: 11/28/2022]
Abstract
UNLABELLED While intimate partner violence (IPV) and sexual violence (SV) are highly associated with injury, the healthcare and legal significance of these injuries is controversial. PURPOSE Herein we propose to explore the significance of injury in IPV and SV and examine the current status of injury classification systems from the perspectives of the healthcare and criminal justice systems. We will review current injury classification systems and suggest a typology of injury that could be tested empirically. FINDINGS Within the published literature, we found that no commonly accepted injury typology exists. While nuanced and controversial issues surround the role of injury detection in the sexual assault forensic examination, enough evidence exists to support the continued pursuance of a scientific approach to injury classification. We propose an injury typology that is measurable, is applicable to the healthcare setting and criminal justice system, and allows us to use uses a matrix approach that includes a severity score, anatomic location, and injury type. We suggest a typology that might be used for further empirical testing on the validity and reliability of IPV and SV injury data. CONCLUSION We recommend that the community of scientists concerned about IPV and SV develop a more rigorous injury classification system that will improve the quality of forensic evidence proffered and decisions made throughout the criminal justice process.
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Affiliation(s)
- Marilyn S Sommers
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104, USA.
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Baker RB, Fargo JD, Shambley-Ebron D, Sommers MS. A source of healthcare disparity: race, skin color, and injuries after rape among adolescents and young adults. JOURNAL OF FORENSIC NURSING 2010; 6:144-150. [PMID: 21175535 PMCID: PMC3678126 DOI: 10.1111/j.1939-3938.2010.01070.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Differences in anogenital injury resulting from rape may occur because of racial or skin color differences in adult women. It is critical to determine if these differences also are associated with differences in injury prevalence and frequency in adolescents and young adults. In a retrospective review of medical records, we examined whether Black adolescent/young adult females had different anogenital injuries as compared to White females following rape. Next, we examined whether skin color differences explained a significant amount of the racial difference in injuries. We reviewed charts of 234 female victims of rape ages 14 to 29. Overall injury prevalence was 62.8%. Race was significantly associated with frequency of injuries in several anatomical locations, with White victims having a higher frequency of injuries than Black victims. Skin color was significantly associated with injury frequency in many anatomical locations, with victims with light skin sustaining more injuries than victims with dark skin. Even when skin color was included in the relationship, race remained a statistically significant factor, suggesting that the relationship between race and injuries may be more complicated than merely a skin color difference that has been mislabeled a racial difference.
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Affiliation(s)
- Rachel B Baker
- Cincinnati Children's Hospital Medical Center, and University of Cincinnati College of Nursing, Cincinnati, Ohio 45229, USA.
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Zink T, Fargo JD, Baker RB, Buschur C, Fisher BS, Sommers MS. Comparison of methods for identifying ano-genital injury after consensual intercourse. J Emerg Med 2009; 39:113-8. [PMID: 19217245 DOI: 10.1016/j.jemermed.2008.08.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 08/02/2008] [Accepted: 08/11/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Microtrauma occurs after consensual intercourse. Understanding the injury pattern from consensual intercourse may enlighten our understanding of the ano-genital injury after sexual assault. OBJECTIVE The purpose of this report is to compare consensual intercourse-related ano-genital injury prevalence by using three different forensic examination techniques: 1) direct visual inspection, 2) colposcopy, and 3) toluidine-blue contrast application. METHODS Using a descriptive, comparative design, 120 female volunteers, aged 21 years or older, were examined after consensual sexual intercourse using the above techniques. Ano-genital injuries were noted using the TEARS classification (Tears, Ecchymoses, Abrasions, Redness, and Swelling). RESULTS Direct visualization and colposcopy yielded similar ano-genital injury findings. However, more tears and abrasions of the external genitalia were identified with toluidine-blue than with direct visual inspection or colposcopy (p < 0.05). More tears were identified on the anus with toluidine-blue as compared to direct visualization (p < 0.05), but not colposcopy. Fewer ecchymoses were identified on the internal genitalia and fewer areas of redness were identified on both the external and internal genitalia when toluidine-blue was used, as compared to either direct visualization or colposcopy (p < 0.05). CONCLUSIONS The scientific community needs to continue to build information about ano-genital injury prevalence after consensual sexual intercourse. Understanding the ano-genital injury patterns, including frequency and prevalence, that occur with consensual sexual intercourse will help to identify the difference between injury related to consensual vs. non-consensual sexual intercourse. At this time, toluidine-blue staining may add value to the sexual assault forensic examination. It is the health care provider's role to collect all possible evidence and the courts' role to determine what evidence is admissible and to ensure a rightful conviction.
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Affiliation(s)
- Therese Zink
- Department of Family and Community Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Sommers MS, Fargo JD, Baker RB, Fisher BS, Buschur C, Zink TM. Health disparities in the forensic sexual assault examination related to skin color. JOURNAL OF FORENSIC NURSING 2009; 5:191-200. [PMID: 19947958 PMCID: PMC3683456 DOI: 10.1111/j.1939-3938.2009.01054.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin.
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Affiliation(s)
- Marilyn S Sommers
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
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