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2.
Am J Public Health ; 114(4): 387-397, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38478866

RESUMO

Objectives. To describe all-outcome injurious shootings by police and compare characteristics of fatal versus nonfatal injurious shootings nationally. Methods. From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by US police, identified from Gun Violence Archive. We estimated injury frequency, case fatality rates, and relative odds of death by incident and victim characteristics. Results. A total of 1769 people were injured annually in shootings by police, 55% fatally. When a shooting injury occurred, odds of fatality were 46% higher following dispatched responses than police-initiated responses. Injuries associated with physically threatening or threat-making behaviors, behavioral health needs, and well-being checks were most frequently fatal. Relative to White victims, Black victims were overrepresented but had 35% lower odds of fatal injury when shot. Conclusions. This first multiyear, nationwide analysis of injurious shootings by US police suggests that injury disparities are underestimated by fatal shootings alone. Nonpolicing responses to social needs may prevent future injuries. Public Health Implications. We call for enhanced reporting systems, comprehensive evaluation of emerging reforms, and targeted investment in social services for equitable injury prevention. (Am J Public Health. 2024;114(4):387-397. https://doi.org/10.2105/AJPH.2023.307560).


Assuntos
Armas de Fogo , Violência com Arma de Fogo , Ferimentos por Arma de Fogo , Humanos , Estados Unidos/epidemiologia , Polícia , Razão de Chances , Homicídio
3.
JAMA Netw Open ; 7(3): e240073, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38436959

RESUMO

Importance: American Indian or Alaska Native and Black adults experience elevated rates of firearm injury and death, but both groups are severely underrepresented in research on firearm exposure and behaviors. Objective: To explore geodemographic differences in firearm behaviors and violence exposure among American Indian or Alaska Native and Black adults in the US. Design, Setting, and Participants: In this survey study, nationally representative samples of American Indian or Alaska Native and/or Black adults recruited from KnowledgePanel were surveyed cross-sectionally. Surveys were administered online between April 12 and May 4, 2023. Main Outcomes and Measures: Firearm access, storage, and carrying behaviors and lifetime firearm violence exposure were the primary outcomes. Demographic factors such as age, geographic location, and political affiliation were considered. Data were weighted to geodemographic distributions from the US Census Bureau's 2022 Current Population Survey. Results: Of 3542 participants, 527 (14.9%) were American Indian or Alaska Native (280 [53.1%] female) and 3015 (85.1%) were Black (1646 [54.6%] female). Both groups exhibited high firearm access rates (American Indian or Alaska Native adults: 238 [45.4%; 95% CI, 39.4%-51.7%]; Black adults: 909 [30.4%; 95% CI, 28.0%-32.9%]), predominantly owning handguns for home protection. The groups demonstrated similar firearm storage patterns, and a substantial proportion endorsed always or almost always carrying firearms outside the home (American Indian or Alaska Native adults: 18.9%; Black adults: 15.2%). Self-protection was a common reason for carrying a firearm (American Indian or Alaska Native adults: 104 [84.9%; 95% CI, 74.1%-91.7%]; Black adults: 350 [88.3%; 95% CI, 82.3%-92.4%]), and a minority of participants cited lack of faith in the police (American Indian or Alaska Native adults: 19 [15.2%; 95% CI, 8.2%-26.7%]; Black adults: 61 [15.4%; 95% CI, 10.3%-21.2%]), indicating potential shifts in public safety dynamics. Conclusions and Relevance: In this survey study of American Indian or Alaska Native and Black US adults, a substantial percentage of both groups reported living in homes with firearms, storing firearms loaded and unlocked, frequently carrying firearms outside the home, and having been exposed directly and indirectly to gun violence. These findings underscore the need for nuanced public health campaigns and policies and highlight challenges for law enforcement in contexts of racial disparities and changing legal frameworks.


Assuntos
Exposição à Violência , Armas de Fogo , Violência com Arma de Fogo , Ferimentos por Arma de Fogo , Adulto , Feminino , Humanos , Masculino , Indígena Americano ou Nativo do Alasca
4.
PLoS One ; 19(3): e0299248, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38451933

RESUMO

Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.


Assuntos
Armas de Fogo , Suicídio , Ferimentos por Arma de Fogo , Estados Unidos/epidemiologia , Humanos , Homicídio , Fatores de Risco
5.
N Z Med J ; 137(1591): 55-61, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38452233

RESUMO

AIMS: We observed modern spring-loaded air rifles reaching velocities similar to small-bore rifles, raising concerns about their potential lethality. After encountering two life-threatening thoracic injuries in our practice, we conducted a study to assess the injuries that a commonly available air rifle could cause in a porcine cadaver model. METHODS: We conducted shooting experiments from 5 and 10 metres away using a .22 calibre spring-loaded airgun, firing five shots into the anterolateral chest on the left side at both distances. Additionally, we repeated the experiment with ten shots into 10% ballistics gel behind an explanted chest wall to evaluate chest wall penetration reliability. RESULTS: Out of the ten combined shots, six resulted in lethal or potentially lethal injuries, including multiple cardiac injuries. Moreover, we observed chest wall penetration in 9 out of 10 shots, with an average penetration depth of 106mm. Non-life-threatening injuries appeared to be influenced by shot location rather than an inability to penetrate the chest wall. CONCLUSION: Our study raises significant concerns about the potential lethality of unrestricted air rifles in New Zealand. With muzzle velocities comparable to small-bore rifles, these firearms should be reconsidered in terms of regulation and possibly restricted to gun license holders.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Criança , Humanos , Suínos , Animais , Reprodutibilidade dos Testes , Nova Zelândia , Balística Forense
6.
MedEdPORTAL ; 20: 11390, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38504967

RESUMO

Introduction: Pediatric trauma resuscitations are low-frequency, high-stakes events that require skilled multidisciplinary teams with strong medical knowledge and communication skills. Methods: This pediatric trauma simulation training session included two cases and formats. The first case was designed in a traditional format and featured a 12-month-old child with inflicted blunt head and abdominal trauma. The second case was organized in successive rounds utilizing the rapid cycle deliberate practice (RCDP) model and featured an 18-month-old with gunshot wounds to the abdomen and chest. Educational objectives included effective communication in a multidisciplinary team, timely completion of primary and secondary surveys, awareness of systems and processes related to trauma care, and increasing competency with low-frequency pediatric trauma skills. Necessary equipment included high-fidelity toddler-sized mannequins, chest tube task trainer or applicable mannequin and equipment, intubation equipment and supplies, intraosseous access, and blood products with rapid delivery infusers. This training session was designed for learners in a multidisciplinary team including physician trainees, nurses, and advanced practice providers; adjustments could be made to the team members as desired. Results: Quantitative and qualitative evaluations demonstrated high learner satisfaction and engagement, particularly in the RCDP style of learning. Discussion: Multidisciplinary team practice of pediatric trauma scenarios, particularly utilizing the RCDP simulation model, provides the opportunity to improve teamwork and communication, practice procedural skills, and deepen team members' understanding of and comfort with trauma resuscitations.


Assuntos
Treinamento por Simulação , Ferimentos por Arma de Fogo , Humanos , Criança , Lactente , Aprendizagem , Ressuscitação/educação , Avaliação Educacional
7.
Ulus Travma Acil Cerrahi Derg ; 30(3): 192-202, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506389

RESUMO

BACKGROUND: There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. METHODS: This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. RESULTS: The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. CONCLUSION: The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.


Assuntos
Ferimentos e Lesões , Ferimentos por Arma de Fogo , Humanos , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Serviço Hospitalar de Emergência , Curva ROC , Índices de Gravidade do Trauma , Ferimentos e Lesões/diagnóstico , Valor Preditivo dos Testes
8.
J Am Coll Surg ; 238(4): 671-678, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38445669

RESUMO

BACKGROUND: Firearm violence and school shootings remain a significant public health problem. This study aimed to examine how publicly available data from all 50 states might improve our understanding of the situation, firearm type, and demographics surrounding school shootings. STUDY DESIGN: School shootings occurring in the US for 53 years ending in May 2022 were analyzed, using primary data files that were obtained from the Center for Homeland Defense and Security. Data analyzed included situation, injury, firearm type, and demographics of victims and shooters. We compared the ratio of fatalities per wounded after stratifying by type of weapon. Rates (among children) of school shooting victims, wounded, and fatalities per 1 million population were stratified by year and compared over time. RESULTS: A total of 2,056 school shooting incidents involving 3,083 victims were analyzed: 2,033 children, 5 to 17 years, and 1,050 adults, 18 to 74 years. Most victims (77%) and shooters (96%) were male individuals with a mean age of 18 and 19 years, respectively. Of the weapons identified, handguns, rifles, and shotguns accounted for 84%, 7%, and 4%, respectively. Rifles had a higher fatality-to-wounded ratio (0.45) compared with shooters using multiple weapons (0.41), handguns (0.35), and shotguns (0.30). Linear regression analysis identified a significant increase in the rate of school shooting victims (ß = 0.02, p = 0.0003), wounded (ß = 0.01, p = 0.026), and fatalities (ß = 0.01, p = 0.0003) among children over time. CONCLUSIONS: Despite heightened public awareness, the incidence of school shooting victims, wounded, and fatalities among children has steadily and significantly increased over the past 53 years. Understanding the epidemic represents the first step in preventing continued firearm violence in our schools.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Adulto , Criança , Humanos , Masculino , Estados Unidos/epidemiologia , Adolescente , Adulto Jovem , Feminino , Ferimentos por Arma de Fogo/epidemiologia , Violência , Instituições Acadêmicas , Homicídio
9.
J Am Coll Surg ; 238(4): 681-688, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38465793

RESUMO

BACKGROUND: Firearm-related death rates continue to rise in the US. As some states enact more permissive firearm laws, we sought to assess the relationship between a change to permitless open carry (PLOC) and subsequent firearm-related death rates, a currently understudied topic. STUDY DESIGN: Using state-level data from 2013 to 2021, we performed a linear panel analysis using a state fixed-effects model. We examined total firearm-related death, suicide, and homicide rates separately. If a significant association between OC law and death rate was found, we then performed a difference-in-difference (DID) analysis to assess for a causal relationship between changing to PLOC and increased death rate. For significant DID results, we performed confirmatory DID separating firearm and nonfirearm death rates. RESULTS: Nineteen states maintained a no OC or permit-required law, whereas 5 changed to permitless and 26 had a PLOC before 2013. The fixed-effects model indicated more permissive OC law that was associated with increased total firearm-related deaths and suicides. In DID, changing law to PLOC had a significant average treatment effect on the treated of 1.57 (95% CI 1.05 to 2.09) for total suicide rate but no significant average treatment effect for the total firearm-related death rate. Confirmatory DID results found a significant average treatment effect on the treated of 1.18 (95% CI 0.90 to 1.46) for firearm suicide rate. CONCLUSIONS: OC law is associated with total firearm-related death and suicide rates. Based on our DID results, changing to PLOC is indeed strongly associated with increased suicides by firearm.


Assuntos
Armas de Fogo , Suicídio , Ferimentos por Arma de Fogo , Humanos , Estados Unidos/epidemiologia , Homicídio
10.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38484095

RESUMO

CASE: A 23-year-old right-hand dominant man presented with a high-velocity gunshot wound injury to the right thumb with severe soft-tissue damage, vascular injury, and large osseous defect of the right thumb metacarpal. The patient was successfully treated with metacarpophalangeal joint arthrodesis and metacarpal reconstruction using definitive external fixation, an intramedullary Kirschner wire, and use of the Masquelet bone grafting technique. CONCLUSION: The authors' treatment approach for a mangled thumb injury with definitive external fixation and utilization of the Masquelet technique resulted in restoration of a large osseous defect, avoidance of infection, and limited loss of mobility.


Assuntos
Traumatismos da Mão , Procedimentos de Cirurgia Plástica , Ferimentos por Arma de Fogo , Masculino , Humanos , Adulto Jovem , Adulto , Polegar/cirurgia , Fixadores Externos , Ferimentos por Arma de Fogo/cirurgia , Fixação de Fratura/métodos , Traumatismos da Mão/cirurgia
11.
Front Public Health ; 12: 1324656, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38515599

RESUMO

Background: Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs. Methods: Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors. Results: Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury. Conclusion: SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Humanos , Criança , Segurança , Estudos Transversais , Ferimentos por Arma de Fogo/prevenção & controle , Aconselhamento
12.
J Orthop Surg Res ; 19(1): 126, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321483

RESUMO

BACKGROUND: During the wars in Afghanistan and Iraq most injuries to service members involved the musculoskeletal system. These wounds often occurred around joints, and in some cases result in traumatic arthrotomy-a diagnosis that is not always clear, especially when there is no concomitant articular fracture. The aim of the present study is to evaluate the diagnosis and treatment of peri-articular blast injuries without fracture. METHODS: The study cohort included 12 consecutive patients (12 involved extremities) who sustained peri-articular blast wounds of the extremities without fractures. The diagnosis of penetrating articular injury was based on clinical examination, radiographic findings, or aspiration. A peri-articular wound was defined as any wound, or radio-opaque blast fragment, within 5 cm of a joint. The New Injury Severity Score (NISS) was calculated for each patient. Four patients had upper, and 8 patients had lower extremity injuries. Nine of 12 patients had joint capsular penetration and underwent joint irrigation and debridement. RESULTS: Two patients had retained intra-articular metal fragments. One patient had soft tissue blast wounds within 5 cm of a joint but did not have joint capsule penetration. There were no significant differences (p = 0.23) between the distribution of wounds to upper versus lower extremities. However, there were a significantly greater number of blast injuries attributed to Improvised Explosive Devices (IEDs) than from other blast mechanisms (p = 0.01). CONCLUSION: Extremity blast injuries in the vicinity of joints involving only soft tissues present a unique challenge in surgical management. A high index of suspicion should be maintained for joint capsular penetration so that intra-articular injuries may be appropriately treated.


Assuntos
Traumatismos por Explosões , Fraturas Ósseas , Militares , Lesões dos Tecidos Moles , Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Humanos , Traumatismos por Explosões/cirurgia , Fraturas Ósseas/cirurgia , Extremidades/lesões , Ferimentos Penetrantes/cirurgia , Escala de Gravidade do Ferimento
13.
J Cardiothorac Surg ; 19(1): 64, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321531

RESUMO

BACKGROUND: Gunshot wounds (GSW) to the heart are lethal, and most patients die before they arrive to the hospital. Survival decreases with number of cardiac chambers involved. We report a case of a 17-year-old male who survived a GSW injury involving two cardiac chambers with acute severe tricuspid regurgitation (TR) who subsequently developed cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) support. CASE PRESENTATION: A 17-year-old male sustained a single gunshot wound to the left chest, resulting in pericardial tamponade and right hemothorax. Emergency sternotomy revealed injury to the right ventricle and inferior cavoatrial junction with the adjacent pericardium contributing to a right hemothorax. The cardiac injuries were repaired primarily. Tricuspid regurgitation was confirmed immediately postoperatively. Five days after presentation, the patient developed cardiogenic shock secondary to TR requiring emergent stabilization with ECMO. He subsequently underwent successful tricuspid valve replacement. CONCLUSIONS: This is the first report to our knowledge of successful ECMO support of severe TR due to gunshot injury to the heart.


Assuntos
Oxigenação por Membrana Extracorpórea , Traumatismos Cardíacos , Insuficiência da Valva Tricúspide , Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Masculino , Humanos , Adolescente , Choque Cardiogênico/etiologia , Insuficiência da Valva Tricúspide/complicações , Ferimentos por Arma de Fogo/complicações , Oxigenação por Membrana Extracorpórea/métodos , Hemotórax/complicações , Traumatismos Cardíacos/complicações
14.
Front Public Health ; 12: 1339334, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38327580

RESUMO

Introduction: Firearm injury is the leading cause of death in children. This study uses geospatial mapping to illustrate the burden of pediatric firearm injury in Philadelphia and assesses the relationship between Child Opportunity Index (COI) and injury, hypothesizing that lower COI zip codes would have higher injury and mortality rates. Methods: Pediatric firearm injury data for children aged 0-19 years in Philadelphia, from 2015 to February 2023, was visualized by race/ethnicity, fatal versus non-fatal status, and COI for zip code. COI was then dichotomized as "High" or "Low" based on nationally normed scores and used to compare incidence and odds of mortality. Injury incidence rates by COI were calculated using weighted Poisson regression, to adjust for the total number of children in each COI category. Odds of mortality by COI, adjusted for age, sex and race/ethnicity, were calculated using multivariable logistic regression. Results: Of 2,339 total pediatric firearm injuries, 366 (16%) were fatal. Males (89%), adolescents (95%) and Black children (88%) were predominately affected. Geospatial mapping showed highest burden in North and West Philadelphia, which corresponded with areas of low COI. The incidence rate ratio (IRR) of injury in low COI zip codes was 2.5 times greater than high COI (IRR 2.5 [1.93-3.22]; p < 0.01). After adjusting for age, sex, and race/ethnicity, odds of mortality in low COI zip codes was nearly twice that of high COI zip codes (aOR 1.95 [0.77-4.92]), though did not demonstrate statistical significance (p = 0.16). Conclusion: Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Humanos , Criança , Masculino , Adolescente , Ferimentos por Arma de Fogo/epidemiologia , Philadelphia/epidemiologia , Etnicidade , Modelos Logísticos
15.
Am J Mens Health ; 18(1): 15579883231221390, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38311904

RESUMO

Exploring the post-injury lives of those who have survived gunshot wounds is essential to understanding the entire scope of firearm violence. The lives of Black male firearm violence survivors are transformed in various ways due to their injuries both visible and invisible. This study explored how Black men who suffer from disabilities via a firearm negotiated their masculine identities. Semi-structured, qualitative interviews were conducted with 10 violently injured Black men participating in a hospital-based violence intervention program. Survivors expressed their thoughts on how their injuries impacted their manhood and masculinities. Three themes emerged: (1) perceptions of manhood, (2) loss of independence and burden on others, and (3) and mobility. These themes highlighted and described how their lives were impacted post-injury and characterized their psychological and physical experience of recovery. The research findings suggest the need for more qualitative studies to further explore the relationship between firearm injury, Black masculinity, and perceptions of manhood. While Black men are understudied in health research and invisible in disability research, they continue to be hyper-invisible when discussing violently acquired disabilities.


Assuntos
Atividades Cotidianas , Negro ou Afro-Americano , Pessoas com Deficiência , Masculinidade , Violência , Ferimentos por Arma de Fogo , Humanos , Masculino , Atividades Cotidianas/psicologia , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , População Negra , Efeitos Psicossociais da Doença , Pessoas com Deficiência/psicologia , Armas de Fogo , Estado Funcional , Identidade de Gênero , Hospitalização , Limitação da Mobilidade , Violência/etnologia , Violência/prevenção & controle , Violência/psicologia , Ferimentos por Arma de Fogo/etnologia , Ferimentos por Arma de Fogo/psicologia , Pesquisa Qualitativa
16.
J Urban Health ; 101(1): 1-10, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38334857

RESUMO

We aimed to explore perspectives of teenagers on their exposure to gun violence (GV), their knowledge and attitudes towards firearm injury prevention (FIP) efforts, and how to counsel them about FIP. Teens from two single-sex Bronx Catholic high schools participated in videoconferencing focus groups. Participants completed an online survey collecting demographic information and Likert-scale scoring of attitudes towards GV. Quantitative data was analyzed with descriptive statistics. Focus group discussions were recorded and transcribed. Using Dedoose, two investigators independently coded data and achieved consensus using content analysis. Six focus groups (3 from each school, n = 28 participants) were held from October-November 2020. A total of 27 participants completed the survey. Eighty-one percent of respondents agreed "Doctors should talk to teens about gun safety." During focus groups, participants reported personal, community, and entertainment media exposure to GV. GV elicited many emotions, including fear and frustration. Teens identified factors contributing to GV that should be addressed, including poverty, racism, and mental illness. Most had not received prior FIP education and desired more information from trusted adults. They preferred discussions over written materials and information given over time. Teens were open to doctors counseling on FIP during healthcare visits and suggested including screening questions on surveys, conversations during healthcare maintenance visits, and classroom talks by physicians. Bronx teens are exposed to and distressed by community GV. They desired more FIP education, including physician counseling during healthcare visits. Next steps are to create and test FIP guidance for adolescents.


Assuntos
Armas de Fogo , Violência com Arma de Fogo , Ferimentos por Arma de Fogo , Adulto , Humanos , Adolescente , Ferimentos por Arma de Fogo/prevenção & controle , Violência com Arma de Fogo/prevenção & controle , Aconselhamento , Conhecimentos, Atitudes e Prática em Saúde
18.
Prev Med ; 180: 107892, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38342384

RESUMO

OBJECTIVE: Open-source data systems, largely drawn from media sources, are commonly used by scholars due to the lack of a comprehensive national data system. It is unclear if these data provide an accurate and complete representation of firearm injuries and their context. The study objectives were to compare firearm injuries in official police records with media reports to better identify the characteristics associated with media reporting. METHODS: Firearm injuries were identified in open-source media reports and compared to nonfatal firearm injury (n = 1642) data from official police records between January 1, 2021 to December 31, 2022 in Indianapolis, Indiana. Events were matched on date, location, and event circumstances. Four multivariate, multi-level mixed effects logistic regression models were conducted to assess which survivor, event, and community characteristics were associated with media reporting. Data were analyzed 2023 - January 2024. RESULTS: Media reported 41% of nonfatal shootings in 2021 and 45% in 2022(p < 0.05), which is approximately two out of every five shootings. Shootings involving multiple survivors, children, and self-defense were more likely to be reported, whereas unintentional shootings and shootings that occurred in structurally disadvantaged communities were less likely to be reported. CONCLUSIONS: Findings suggest that relying on media reports of firearm injuries alone may misrepresent the numbers and contexts of shootings. Public health interventions that educate journalists about these important issues may be an impactful firearm violence prevention strategy. Also, it is critical to link data systems at the local level to ensure interventions are designed and evaluated using accurate data.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Criança , Humanos , Estados Unidos , Ferimentos por Arma de Fogo/epidemiologia , Indiana/epidemiologia , Violência , Vigilância da População
19.
JMIR Public Health Surveill ; 10: e47444, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38315521

RESUMO

BACKGROUND:  Current research on firearm violence is largely limited to patients who received care in emergency departments or inpatient acute care settings or who died. This is because standardized disease classification codes for firearm injury only represent bodily trauma. As a result, research on pathways and health impacts of firearm violence is largely limited to people who experienced acute bodily trauma and does not include the estimated millions of individuals who were exposed to firearm violence but did not sustain acute injury. Assessing and collecting data on exposure to firearm violence in ambulatory care settings can expand research and more fully frame the public health issue. OBJECTIVE: The aim of the study is to evaluate the demographic and clinical characteristics of patients who self-reported exposure to firearm violence during a behavioral health visit. METHODS: This study assessed early data from an initiative implemented in 2022 across a national network of ambulatory behavioral health centers to support trauma-informed care by integrating structured data fields on trauma exposure into an electronic health record behavioral health patient assessment form (SmartForm), as such variables are generally not included in standard outpatient medical records. We calculated descriptive statistics on clinic characteristics, patient demographics, and select clinical conditions among clinics that chose to implement the SmartForm and among patients who reported an exposure to firearm violence. Data on patient counts are limited to positive reports of exposure to firearm violence, and the representativeness of firearm exposure among all patients could not be calculated due to unknown variability in the implementation of the SmartForm. RESULTS: There were 323 of 629 (51%) clinics that implemented the SmartForm and reported at least 1 patient exposed to firearm violence. In the first 11 months of implementation, 3165 patients reported a recent or past exposure to firearm violence across the 323 clinics. Among patients reporting exposure, 52.7% (n=1669) were male, 38.8% (n=1229) were Black, 45.7% (n=1445) had posttraumatic stress disorder, 37.5% (n=1186) had a substance abuse disorder (other than nicotine), and 11.7% (n=371) had hypertension. CONCLUSIONS: Current research on firearm violence using standardized data is limited to acute care settings and death data. Early results from an initiative across a large network of behavioral health clinics demonstrate that a high number of clinics chose to implement the SmartForm, resulting in thousands of patients reporting exposure to firearm violence. This study demonstrates that collecting standardized data on firearm violence exposure in ambulatory care settings is feasible. This study further demonstrates that resultant data from ambulatory settings can be used for meaningful analysis in describing populations affected by firearm violence. The results of this study hold promise for further collection of structured data on exposure to firearm violence in ambulatory settings.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Humanos , Masculino , Feminino , Registros Eletrônicos de Saúde , Ferimentos por Arma de Fogo/epidemiologia , Violência , Assistência Ambulatorial
20.
J Surg Res ; 296: 665-673, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38359681

RESUMO

INTRODUCTION: Violent traumatic injury, including firearm violence, can adversely impact individual and community health. Trauma-informed care (TIC) can promote resilience and prevent future violence in patients who have experienced trauma. However, few protocols exist to facilitate implementation of TIC for patients who survive traumatic injury. The purpose of the study is to characterize documentation of TIC practices and identify opportunities for intervention in a single academic quaternary care center. METHODS: This study is a retrospective chart review analyzing the documentation of trauma-informed elements in the electronic medical record of a random sample of youth patients (ages 12-23) admitted for assault trauma to the pediatric (n = 50) and adult trauma (n = 200) services between 2016 and mid-2021. Descriptive statistics were used to summarize patient demographics, hospitalization characteristics, and documentation of trauma-informed elements. Chi-square analyses were performed to compare pediatric and adult trauma services. RESULTS: Among pediatric and adult assault trauma patients, 36.0% and 80.5% were hospitalized for firearm injury, respectively. More patients admitted to the pediatric trauma service (96%) had at least one trauma-informed element documented than patients admitted to the adult service (82.5%). Social workers were the most likely clinicians to document a trauma-informed element. Pain assessment and social support were most frequently documented. Safety assessments for suicidal ideation, retaliatory violence, and access to a firearm were rarely documented. CONCLUSIONS: Results highlight opportunities to develop trauma-informed interventions for youth admitted for assault trauma. Standardized TIC documentation could be used to assess risk of violent reinjury and mitigate sequelae of trauma.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Adulto , Adolescente , Humanos , Criança , Estudos Retrospectivos , Violência , Documentação
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