Support for new policies to regulate firearms. Results of two national surveys.

BACKGROUND: New policy options are emerging in the debate regarding the regulation of firearms in the United States. These options include the treatment of firearms as consumer products, the design of which can be regulated for safety; denial of gun ownership to those convicted of misdemeanors; and strategies to curtail the illegal sale of guns. The public's opinion of these innovative gun-policy options has not been thoroughly assessed. METHODS: We conducted two telephone surveys of 1200 adults each in the United States in 1996 and 1997-1998. Cognitive interviews and pretests were used in the development of the survey instruments. Potential participants were then contacted by random-digit dialing of telephone numbers. RESULTS: A majority of the respondents favored safety standards for new handguns. These standards included childproofing (favored by 88 percent of respondents), personalization (devices that permit firing only by an authorized person; 71 percent), magazine safeties (devices that prevent firing after the magazine or clip is removed; 82 percent), and loaded-chamber indicators (devices that show whether the handgun is loaded; 73 percent). There was strong support for policies prohibiting persons convicted of specific misdemeanors from purchasing a firearm. Support for such prohibitions was strongest for crimes involving violence or the illegal use of a firearm (83 to 95 percent) or substance abuse (71 to 92 percent). There was also widespread support for policies designed to reduce the illegal sale of guns, such as mandatory tamper-resistant serial numbers (90 percent), a limit of one handgun purchase per customer per month (81 percent), and mandatory registration of handguns (82 percent). Even among the subgroup of respondents who were gun owners, a majority were in favor of stricter gun regulations with regard to 20 of the 22 proposals covered in the poll. CONCLUSIONS: Strong public support, even among gun owners, for innovative strategies to regulate firearms suggests that these proposals warrant serious consideration by policy makers.

Neurological complications associated with pregnancy.

Prospective multidisciplinary audit from both hospital and community has identified neurological complications persisting for more than 6 weeks in association with pregnancy and delivery. They occurred at a frequency of 1 in 2530 deliveries in the North West Thames Region. Extradural analgesia was considered contributory to a neurological disorder in one of 13,007 patients. The woman had prolonged paraesthesiae along a nerve root. The types of sensory, motor and sympathetic neurological problems presented ranged from transient problems to more serious disorders resulting in death in one case. Seven of 19 patients had a continuing neurological disability for more than 1 yr. Although obstetrics may be associated with lumbar and sacral neurological disorders, problems occurred with the same frequency in the upper as in the lower half of the body. Significant morbidity is not being recognized in hospitals where women are being delivered and it is within the community that these disorders are recognized. This has implications for training, audit and risk assessment.

Black-white differences in injury. Race or social class?

In the United States injuries are the leading cause of years of potential life lost and the leading cause of death for persons less than 45 years of age. Minority groups, particularly African-Americans, are disproportionately represented among those persons who die as a result of injury. Homicides account for much of this racial disparity; however, other forms of injury also contribute significantly to the differential. This paper examines death rates due to four types of injuries that contribute most to the black/white mortality gap. Our examination of death rates from 1984 to 1988 reveals no major reduction in the racial gap during the period, despite the initiation of some prevention efforts. We suggest that socioeconomic status rather than race is perhaps the major correlate of the social conditions and lifestyle choices which contribute to these injuries. We propose that injury prevention efforts must target both the causes and the consequences of socioeconomic inequality.

Inequality, culture, and interpersonal violence.

Policymakers often are at odds over what strategies will be most effective at reducing the incidence of violent behavior in high-risk populations. Beginning with the position that social theory and public policy are inextricably linked, the author examines the policy implications of the long-standing debate in the social sciences over the relative contributions of socioeconomic inequality versus cultural differences as causes of violence. While the weight of the scholarly evidence favors neither of these explanations, existing and proposed policies often reflect a preference for the importance of culture. This paper discusses the limitations of that choice and advocates alternative policies that consider the importance of both sets of etiological factors.

Assessment of teratogenicity.

Animal tests for teratogenicity of drugs have more medicolegal and political significance than relevance to human therapeutics. Test conditions differ widely from human therapeutic regimens and major species differences are common. Occasionally the tests will define a drug or group of drugs with an unpleasant potential, and sometimes a mode of action which needs careful exploration in humans will be found. Anecdotal case reports of purported associations between drug use and congenital malformations provide a vast source of misinformation, yet they were responsible for the indictment of thalidomide as a human teratogen. Retrospective studies on patients who have taken a drug in pregnancy are susceptible to recall bias, and at best provide a basis for planned prospective studies which are seldom instituted for fear of medicolegal consequences. Prospective surveillance of drugs already accepted for use in pregnancy and reporting of `adverse reactions' to drugs inadvertently used in pregnancy thus provide the only effective source of information on teratogenicity of psychotropic drugs in humans.

Outcome of pregnancies complicated by severe hypertension and delivered before 34 weeks; stepwise logistic regression analysis of prognostic factors.

The outcome is described for 106 patients with severe hypertension in pregnancy requiring delivery between 26 and 34 weeks. Management was with methyldopa, hydralazine when required and delivery by caesarean section when indicated. Most patients were delivered for cardiotocographic fetal distress or unstable maternal blood pressure. Eighty-five babies (80%) survived and were well at follow-up at 1 year; the perinatal mortality was 123/1000 total births. One patient had postpartum eclampsia, one had pulmonary oedema and one had transient renal failure, but all mothers left hospital well. Stepwise logistic regression analysis showed that the primary positive factor for survival of a healthy baby was gestational age, which was strongly correlated with birthweight. The need for caesarean section as an emergency, hypotension after parenteral hydralazine, intrauterine growth retardation, and severe proteinuria were adverse factors. Intraventricular haemorrhage had a major adverse effect on neonatal survival; it was predisposed to by prolonged maternal hypertension and by low gestational age.

Pregnancy and lupus: prognostic indicators and response to treatment.

A cohort study was undertaken of 18 consecutive pregnancies in 16 patients with systemic lupus erythematosus without significant renal impairment. Of these, eight each had at least two previously unexplained pregnancy failures, 10 had elevated anticardiolipin antibodies, nine had the lupus anticoagulant and five had antibodies to Ro. Twelve live births resulted but a Downs syndrome baby died in the perinatal period. Fetal morbidity was confined to four cases of fetal growth retardation, all in mothers positive for anticardiolipin antibodies, and fetal distress in another two. There were no cases of the neonatal lupus syndrome. There was one maternal death. An obstetric history of at least two previously unexplained pregnancy failures and the presence of maternal anticardiolipin or anti-Ro antibodies accurately predicted fetal loss in six of seven cases. No other serological risk factors for fetal loss were identified. We were unable to show that suppression of antibodies in those mothers with at least two previously unexplained pregnancy failures improved fetal outcome.

Antibacterial activity in human amniotic fluid: dependence on divalent cations.

Antibacterial activity, tested against Bacillus subtilis, was present in all 34 samples of human amniotic fluid collected between 37 and 41 weeks gestation. High-molecular-weight (beta-lysin) antibacterial activity was reduced after treatment with ethylene diamine tetra-acetic acid (EDTA), but not after treatment with 1, 10-phenanthroline or diphenylthiocarbazone. The activity was restored following incubation with magnesium, calcium, or zinc. Low-molecular-weight antibacterial activity (less than 1000 daltons) in acid-alcohol extracts was reduced after treatment with dithizone, but not after treatment with EDTA or 1, 10 phenanthroline. Activity was restored after treatment with manganese, cobalt or zinc. High-molecular-weight (beta-lysin) activity was therefore biochemically similar to serum beta-lysin but biochemically different from the low-molecular-weight antibacterial component of amniotic fluid.