Differences Between Sexual and Nonsexual Homicides of Women in the United States: Findings From the National Violent Death Reporting System

Sexual homicide (SH) is the most severe outcome of sexual violence and disproportionately affects women. While SH is rare (<1% in the U.S.) and gravely understudied, it is among the most violent, feared, and well publicized forms of murder. Thus, examining predictors is pertinent to identifying targets for prevention and response efforts. Secondary analysis of 2015–2018 National Violent Death Reporting System data on 6461 female homicide victims age 20–64 was conducted to determine if SH represents a unique killing characterized by specific offender, victim, and incident profiles. Law enforcement and coroner/medical examiner narratives were reviewed to identify cases with sexual elements ( N=324). Logistic regression estimated odds ratios with 95% confidence intervals. Findings highlight important differences between SH and non-SH. SH victims were more likely to be single (AOR=1.7, p=.006), have a substance abuse problem (AOR=1.4, p=.04), or engaged in prostitution (AOR=10.4, p<.001). SH suspects were more likely to be male (AOR=2.5, p=.04), use an illicit substance in the preceding hours (AOR=1.6, p=.03), or had recent contact with police (AOR=1.6, p=.01). SH was more likely to occur in a hotel/motel (AOR=3.0, p=.002), by asphyxiation (AOR =13.38, p<.001), be perpetrated against an acquaintance (AOR=1.64, p=.007), or be precipitated by another serious crime (AOR=2.1, p<.001). Findings advance our understanding of SH victim, suspect, and incident profiles, which can help to better inform police/investigative practices and crime prevention strategies/interventions as well as to improve how SH cases are managed in correctional programs for offenders who have the opportunity for release back into society.

Understanding Escalation Through Intimate Partner Homicide Narratives

The study aims to expand our understanding of escalation from intimate partner violence to intimate partner homicide (IPH) by exploring the known circumstances leading up to a lethal event. The study draws on qualitative data from law enforcement reports and coroner/medical examiner reports within the National Violent Death Reporting System to identify themes preceding and surrounding IPH incidents. Findings support the utility of risk assessments in identifying escalation while illustrating the complex ways that violence between current or former intimate partners can escalate to lethality, particularly the role of separation and the use of firearms.

Exploratory Case Study of Suicide among a Sample of 9/11 Survivors

Background: Previous research has found higher than expected suicide mortality among rescue/recovery workers (RRWs) enrolled in the World Trade Center Health Registry (WTCHR). Whether any enrollee suicides are related to the decedents’ experiences on 9/11 is unknown. We abstracted medical examiner file data to learn more about 9/11-related circumstances of suicides among WTCHR enrollees. Methods: We identified 35 enrollee suicide cases that occurred in New York City using linked vital records data. We reviewed medical examiner files on each case, abstracting demographic and circumstantial data. We also reviewed survey data collected from each case at WTCHR enrollment (2003–2004) and available subsequent surveys to calculate descriptive statistics. Results: Cases were mostly non-Hispanic White (66%), male (83%), and middle-aged (median 58 years). Nineteen decedents (54%) were RRWs, and 32% of them worked at the WTC site for >90 days compared to 18% of the RRW group overall. In the medical examiner files of two cases, accounts from family mentioned 9/11-related circumstances, unprompted. All deaths occurred during 2004–2018, ranging from one to four cases per year. Leading mechanisms were hanging/suffocation (26%), firearm (23%), and jump from height (23%). Sixty percent of the cases had depression mentioned in the files, but none mentioned posttraumatic stress disorder. Conclusions: RRWs may be at particular risk for suicide, as those who worked at the WTC site for long periods appeared to be more likely to die by suicide than other RRWs. Mental health screening and treatment must continue to be prioritized for the 9/11-exposed population. More in-depth investigations of suicides can elucidate the ongoing impacts of 9/11.

FORENSIC MEDICAL ASSESSMENT OF MORPHOLOGICAL CHANGES AT DIFFERENT POSTMORTEM INTERVAL

Purpose: The postmortem interval (PMI) evaluation is one of priorities while performing a forensic medical examination of corpse. To date, there is lack of information of morphological postmortem changes of some internal organs. Considering the persistent need to develop the method for a precise assessment of PMI, postmortem changes in these potentially informative organs were evaluated. The aim of study was to analyze morphological postmortem changes in prostate and uterus. Materials and Methods: histological samples of 40 prostate tissues and 40 uterus (n=80) from corpses of deceased aged 18-75 years. Only cases with known time of death were included to study, the time of death was taken from police reports. Exclusion criteria were cases of violent death, cases of death with massive blood loss, tumors of studied internal organs, cases when diagnosis was not made by a forensic medical examiner. The PMI of studied cases ranged from 1 to 6 days. Histological slides were made with a staining by hematoxylin and eosin, x200 magnification, using Olympus ВХ41 and Olympus ВХ46 microscopes, Olympus SC50 camera. Postmortem morphological changes were evaluated by a calculation of blank spaces percentage in microscopical structures using a JS-based program. Connection between PMI and morphological changes was calculated by the Spearman’s rank correlation. Results: the average percentage of blank spaces in uterus tissues was smaller than in prostate tissues (1,99 and 9,65 relatively). The slower growing of blank spaces was in uterus. In prostate samples, a notable increase of blank spaces was observed between 48 and 72 hours after the death. After this period, the increase slowed down and then an increase was observed again between 120 and 144 hours after the death. In uterus samples, a slight acceleration observed between 72 and 120 hours after the death and then slowing down between 120 and 144 hours after the death. Blank spaces in evaluated histological slides were increasing directly proportional to the PMI, a statistically significant interconnection was defined (p < 0.05). Conclusions: The morphological postmortem changes in prostate and uterus were developing at certain time frames. Blank spaces percentage, in studied histological slides, were increasing directly proportional to the PMI increase, a statistically significant interconnection was defined. Therefore, the results of study show the possibility of the evaluation of a postmortem time interval by assessing such morphological changes in these organs, which could be used in forensic medical cases.

Using Point-in-Time Homeless Counts to Monitor Mortality Trends Among People Experiencing Homelessness in Los Angeles County, California, 2015‒2019

Objectives. To report trends in mortality rates, mortality rate ratios (MRRs), and causes of death among people experiencing homelessness (PEH) in Los Angeles County, California, by using annual point-in-time homeless counts and to compare findings to published longitudinal cohort studies of homeless mortality. Methods. We enumerated homeless deaths and determined causes by using 2015–2019 medical examiner‒coroner data matched to death certificate data. We estimated midyear homeless population denominators by averaging consecutive January point-in-time homeless counts. We used annual demographic surveys of PEH to estimate age- and gender-adjusted MRRs. We identified comparison studies through a literature review. Results. Mortality rates increased from 2015 to 2019. Drug overdose was the leading cause of death. Mortality was higher among White than among Black and Latino PEH. Compared with the general population, MRRs ranged from 2.8 (95% confidence interval [CI] = 2.7, 3.0) for all causes to 35.1 (95% CI = 31.9, 38.4) for drug overdose. Crude mortality rates and all-cause MRRs from comparison cohort studies were similar to those in the current study. Conclusions. These methods can be adapted by other urban jurisdictions seeking to better understand and reduce mortality in their homeless populations. (Am J Public Health. 2021;111(12):2212–2222. https://doi.org/10.2105/AJPH.2021.306502 )

Suicide in Older Adult Men Is Not Related to a Personal History of Participation in Football

Introduction: It is reasonable to estimate that tens of millions of men in the United States played high school football. There is societal concern that participation in football confers risk for later-in-life mental health problems. The purpose of this study is to examine whether there is an association between a personal history of playing high school football and death by suicide.Methods: The subjects were obtained from the Lieber Institute for Brain Development (LIBD) brain donation program in collaboration with the Office of the Medical Examiner at Western Michigan University Homer Stryker MD School of Medicine. Donor history was documented via medical records, mental health records, and telephone interviews with the next-of-kin.Results: The sample included 198 men aged 50 or older (median = 65.0 years, interquartile range = 57–75). There were 34.8% who participated in contact sports during high school (including football), and 29.8% participated in high school football. Approximately one-third of the sample had suicide as their manner of death (34.8%). There was no statistically significant difference in the proportions of suicide as a manner of death among those men with a personal history of playing football compared to men who did not play football or who did not play sports (p = 0.070, Odds Ratio, OR = 0.537). Those who played football were significantly less likely to have a lifetime history of a suicide attempt (p = 0.012, OR = 0.352). Men with mood disorders (p &lt; 0.001, OR = 10.712), substance use disorders (p &lt; 0.020, OR = 2.075), and those with a history of suicide ideation (p &lt; 0.001, OR = 8.038) or attempts (p &lt; 0.001, OR = 40.634) were more likely to have suicide as a manner of death. Moreover, those men with a family history of suicide were more likely to have prior suicide attempts (p = 0.031, OR = 2.153) and to have completed suicide (p = 0.001, OR = 2.927).Discussion: Suicide was related to well-established risk factors such as a personal history of a mood disorder, substance abuse disorder, prior suicide ideation, suicide attempts, and a family history of suicide attempts. This study adds to a steadily growing body of evidence suggesting that playing high school football is not associated with increased risk for suicidality or suicide during adulthood.

Simulation of aerosol dispersion during medical examinations

The main route of transmission of the SARS-CoV2 virus has been shown to be airborne. The objective of this study is to analyze the aerosol dispersion and potential exposure to medical staff within a typical medical examination room during classical airway procedures. The multiphase simulation of the aerosol particles in the airflow is based on a Lagrangian-Eulerian approach. All simulation cases with surgical mask show partially but significantly reduced maximum dispersion distances of the aerosol particles compared to the cases without surgical mask. The simulations have shown that medical examiner are exposed to large amount of aerosol particles, especially during procedures such as laryngoscopy where the examiner's head is directly in front of the patient's face. However, exposure can be drastically reduced if the patient wears a mask which is possible for the most of the procedures studied, such as otoscopy, sonography, or anamnesis.

Improvements in Toxicology Testing to Identify Fentanyl Analogs and Other Novel Synthetic Opioids in Fatal Drug Overdoses, Connecticut, January 2016–June 2019

Objectives Drug overdose deaths in Connecticut increasingly involve a growing number of fentanyl analogs and other novel nonfentanyl synthetic opioids (ie, novel synthetics). Current postmortem toxicology testing methods often lack the sophistication needed to detect these compounds. We examined how improved toxicology testing of fatal drug overdoses can determine the prevalence and rapidly evolving trends of novel synthetics. Methods From 2016 to June 2019, the Connecticut Office of the Chief Medical Examiner increased its scope of toxicology testing of suspected drug overdose deaths in Connecticut from basic to enhanced toxicology testing to detect novel synthetics. The toxicology laboratory also expanded its testing panels during this time. We analyzed toxicology results to identify and quantify the involvement of novel synthetics over time. Results From 2016 to June 2019, 3204 drug overdose deaths received enhanced toxicology testing; novel synthetics were detected in 174 (5.4%) instances. Ten different novel synthetics were detected with 205 total occurrences. Of 174 overdose deaths with a novel synthetic detected, most had 1 (n = 146, 83.9%) or 2 (n = 26, 14.9%) novel synthetics detected, with a maximum of 4 novel synthetics detected. Para-fluorobutyrylfentanyl/FIBF, furanylfentanyl, and U-47700 were most identified overall, but specific novel synthetics came in and out of prominence during the study period, and the variety of novel synthetics detected changed from year to year. Conclusions Enhanced toxicology testing for drug overdose deaths is effective in detecting novel synthetics that are not identified through basic toxicology testing. Identifying emerging novel synthetics allows for a timely and focused response to potential drug outbreaks and illustrates the changing drug market.

Driving under the influence: a multi-center evaluation of vehicular crashes in the era of cannabis legalization

BackgroundEleven states have instituted laws allowing recreational cannabis use leading to growing public health concerns surrounding the effects of cannabis intoxication on driving safety. We hypothesized that after the 2016 legalization of cannabis in California, the use among vehicular injury patients would increase and be associated with increased injury severity.MethodsSan Diego County’s five adult trauma center registries in were queried from January 2010 to June 2018 for motor vehicle or motorcycle crash patients with completed toxicology screens. Patients were stratified as toxicology negative (TOX−), positive for only THC (THC+), only blood alcohol >0.08% (ETOH+), THC+ETOH, or THC+ with any combination with methamphetamine or cocaine (M/C). County medical examiner data were reviewed to characterize THC use in those with deaths at the scene of injury.ResultsOf the 11,491 patients identified, there were 61.6% TOX−, 11.7% THC+, 13.7% ETOH+, 5.0% THC+ETOH, and 7.9% M/C. THC+ increased from 7.3% to 14.8% over the study period and peaked at 14.9% post-legalization in 2017. Compared with TOX− patients, THC+ patients were more likely to be male and younger. THC+ patients were also less likely to wear seatbelts (8.5% vs 14.3%, p<0.001) and had increased mean Injury Severity Score (8.4±9.4 vs 9.0±9.9, p<0.001) when compared with TOX− patients. There was no difference in in-hospital mortality between groups. From the medical examiner data of the 777 deaths on scene, 27% were THC+.DiscussionTHC+ toxicology screens in vehicular injury patients peaked after the 2016 legalization of cannabis. Public education on the risks of driving under the influence of cannabis should be a component of injury prevention initiatives.Level of evidenceIII, Prognostic