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OBJECTIVE: To investigate the relationship between racial residential segregation and differences in Black-White disparities in overall firearm homicides across U.S states. METHODS: Using a linear regression, we evaluated the relationship between racial residential segregation, as measured by the index of dissimilarity, and the Black-White firearm homicide disparity ratio in 32 states over the period 1991-2015. To account for clustering of observations within states, we used a generalized estimating equations approach. RESULTS: After controlling for measures of White and Black deprivation, multivariate analysis showed that racial segregation was positively associated with the Black-White firearm homicide disparity. For each 10-point increase in the index of dissimilarity, the ratio of Black to White firearm homicide rates in a state increased by 39%. After controlling for levels of White and Black deprivation, racial segregation remained negatively associated with White firearm homicide rates and positively associated with Black firearm homicide rates. CONCLUSIONS: These findings suggest that racial segregation may increase the disparity in firearm homicide between the Black and White population.
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Negro ou Afro-Americano/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Homicídio/estatística & dados numéricos , Segregação Social , População Branca/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Homicídio/etnologia , Humanos , Análise Multivariada , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/etnologiaRESUMO
This study aimed to investigate the potential differential effects of state-level firearm laws on black and white populations. Using a panel design, authors examined the relationship between state firearm laws and homicide victimization rates among white people and black people in 39 states during the period between 1991 and 2016. Authors modeled homicide rates using linear regression with year and state fixed effects and controlled for a range of time-varying, state-level factors. Results showed that universal background check laws and permit requirement laws were associated with lower homicide rates among both white and black populations, and "shall issue" laws were associated with higher homicide rates among both white and black populations. Laws that prohibit firearm possession among people convicted of a violent misdemeanor or require relinquishment of firearms by people with a domestic violence restraining order were associated with lower black homicide rates, but not with white homicide rates. Author identification of heterogeneity in the associations between state firearm laws and homicide rates among different racial groups has implications for reducing racial health disparities.
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Negro ou Afro-Americano/estatística & dados numéricos , Armas de Fogo/legislação & jurisprudência , Homicídio/estatística & dados numéricos , Homicídio/tendências , População Branca/estatística & dados numéricos , Estudos Transversais , Feminino , Homicídio/etnologia , Humanos , Masculino , Fatores Sexuais , Estados UnidosRESUMO
OBJECTIVE: The objective of this study was to discern the relationship between state-level structural racism and Black-White disparities in police shootings of victims not known to be armed. METHODS: Using a Poisson regression, we evaluated the effect of structural racism on differences between states in Black-White disparities in fatal police shootings involving victims not known to be armed during the period from January 1, 2013 through June 30, 2017. We created a state racism index, which was comprised of five dimensions: (1) residential segregation; and gaps in (2) incarceration rates; (3) educational attainment; (4) economic indicators; and (5) employment status. RESULTS: After controlling for numerous state-level factors and for the underlying rate of fatal shootings of black victims in each state, the state racism index was a significant predictor of the Black-White disparity in police shooting rates of victims not known to be armed (incidence rate ratio: 1.24; 95% confidence interval, 1.02-1.50). For every 10-point increase in the state racism index, the Black-White disparity ratio of police shooting rates of people not known to be armed increased by 24%. CONCLUSION: These findings suggest that structural racism is an important predictor of the Black-White disparity in rates of police shootings of unarmed victims across states.
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Negro ou Afro-Americano/estatística & dados numéricos , Violência com Arma de Fogo/etnologia , Homicídio/etnologia , Polícia/estatística & dados numéricos , Racismo , População Branca/estatística & dados numéricos , Status Econômico , Escolaridade , Emprego , Violência com Arma de Fogo/estatística & dados numéricos , Humanos , Características de Residência , Segregação Social , Estados Unidos/epidemiologiaRESUMO
Cardiac arrhythmias following electrocution injuries can accompany high-voltage or high- intensity currents. Contributing factors to electrical hazard are the type of current, voltage, resistance, and duration of contact and pathway through the body. It is important to monitor for delayed arrhythmias in patients with an electrical injury. We describe a case of a 52-year-old man who presented after an electrical shock injury while grabbing a 5,000-voltage wire at work. In this case report, we discuss the presentation, management, and follow-up recommendations for this type of injury.
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Fibrilação Atrial , Queimaduras por Corrente Elétrica , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial/etiologia , Queimaduras por Corrente Elétrica/complicações , EletrocardiografiaRESUMO
The Resident-Student Education Committee (RSEC) is a novel approach to integrate and expand medical student education within an emergency medicine (EM) residency at a large academic center. There is a paucity of literature on such programs and there is no documentation of longitudinal initiatives with residents serving as specialty-specific advisors to students throughout medical school. The goals of creating the RSEC were to expand and improve the student educational experiences in EM, strengthen the connection between students and EM residents, and foster resident career development through sustainable leadership and teaching opportunities. The RSEC was composed of three divisions: the Preclinical Division aimed to increase student exposure to EM through didactics, skill sessions, simulation, and shadowing; the Clinical Division intended to enhance the student experience during clinical EM rotations through simulation and skill sessions and resident-student socials; and the Mentoring Division focused on advising students applying into EM through informational panels and one-on-one resident mentorship. Outcome measures include students applying into EM residency, which saw an increase from 8.9% prior to the RSEC's creation in 2020 to 12.9% in 2023, despite a national decline in EM applicants. Survey data also indicates favorable student preclinical experiences and improved confidence in clinical skills. The RSEC model, with its structured approach, resident leadership, and clear objectives, presents a sustainable and replicable framework for other residency programs seeking to enhance medical student education and promote resident engagement in teaching. Future directions include expanding shadowing opportunities and procedural skills teaching, introducing career mentorship earlier in the medical education timeline, and tracking outcomes data for continuous assessment and improvement.
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BACKGROUND: Point-of-care ultrasound (POCUS) is a pivotal diagnostic tool for emergent conditions, yet the variable proficiency of emergency physicians (EPs) poses challenges. Inadequate skills may lead to care delays and suboptimal patient evaluation. This manuscript explores an innovative educational intervention deploying a Registered Diagnostic Medical Sonographer (RDMS) credentialed sonographer educator (SE) in a large academic Emergency Department (ED). We sought to evaluate the feasibility of using a SE to address POCUS skills deficiencies and attrition. METHODS: The study involved 26 EPs voluntarily participating in hands-on training with the SE between July 2021-June 2022. The educational sessions addressed machine operation, image acquisition, image interpretation, and electronic medical record documentation of POCUS results. Subjects who consented completed a survey on their comfort level with POCUS before and after the intervention. Results: Survey data indicated increased comfort and competence among participants with basic machine operation, resident POCUS supervision, and ordering and documenting POCUS exams. Post-training, 44% of providers reported performing more POCUS exams, 44% reported documenting their POCUS in the EMR more often clinically, 57% were more likely to encourage residents to perform scans, and 14% were more likely to perform a POCUS before ordering a comprehensive ultrasound. The study also observed an increase in the number of scans performed post-intervention (more than double). The SE intervention addressed challenges such as resource limitations, and feedback from participants highlighted the program's positive impact, particularly in reducing intimidation and fostering a desire for further training. While self-reported data and limited survey completion pose limitations, the increase in POCUS scans and positive feedback underscore the intervention's potential. Conclusions: This pilot study demonstrates the feasibility and initial impact of integrating a SE into an academic ED setting. Further research is warranted to assess the specific effects on provider comfort and clinical decision-making with POCUS. The findings support the value of a dedicated SE in enhancing EPs' POCUS proficiency, promoting ongoing education, and ultimately improving patient care.
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Competência Clínica , Serviço Hospitalar de Emergência , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Humanos , Medicina de Emergência/educação , Feminino , Estudos de Viabilidade , Masculino , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Incorporating opportunities for community engagement into undergraduate medical education (UME) can help learners to identify and address social determinants of health (SDoH). Multiple challenges exist in operationalizing these experiences. METHODS: Using the Assessing Community Engagement (ACE) model, course directors at the Warren Alpert Medical School of Brown University (AMS) mapped community engagement initiatives to the four-year curriculum. FINDINGS: Service-learning, community engagement projects, and clinical rotations at health centers and free clinics aim to equip learners at AMS with the necessary skills to address SDoH. Careful consideration should be given to the time and resources required to facilitate relationships with community-based agencies, learner reflection, program evaluation, and community-level outcomes. CONCLUSIONS: Community engagement activities should be aligned with learning objectives during the pre-clerkship and clerkship stages of the existing UME curricula. Embarking on a curriculum redesign can create opportunities to expand partnerships with local agencies and deepen student engagement.
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Educação de Graduação em Medicina , Educação Médica , Humanos , Faculdades de Medicina , Currículo , Instituições de Assistência AmbulatorialRESUMO
INTRODUCTION: During the COVID-19 pandemic, as society struggled with increasing disease burden, economic hardships, and with disease morbidity and mortality, governments and institutions began implementing stay-at-home or shelter-in-place orders to help stop the spread of the virus. Although well-intentioned, one unintended adverse consequence was an increase in violence, abuse, and neglect. METHODS: We reviewed the literature on the effect the pandemic had on domestic violence, child and elder abuse and neglect, human trafficking, and gun violence. In this paper we explore common themes and causes of this violence and offer suggestions to help mitigate risk during ongoing and future pandemics. Just as these forms of violence primarily target at-risk, vulnerable populations, so did pandemic-related violence target marginalized populations including women, children, Blacks, and those with lower socioeconomic status. This became, and remains, a public health crisis within a crisis. In early 2021, the American College of Emergency Physicians (ACEP) Public Health and Injury Committee was tasked with reviewing the impact the pandemic had on violence and abuse as the result of a resolution passed at the 2020 ACEP Council meeting. CONCLUSION: Measures meant to help control the spread of the COVID-19 pandemic had many unintended consequences and placed people at risk for violence. Emergency departments (ED), although stressed and strained during the pandemic, remain a safety net for survivors of violence. As we move out of this pandemic, hospitals and EDs need to focus on steps that can be taken to ensure they preserve and expand their ability to assist victims should another pandemic or global health crisis develop.
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COVID-19 , Violência Doméstica , Criança , Humanos , Feminino , Idoso , Pandemias/prevenção & controle , COVID-19/epidemiologia , Violência Doméstica/prevenção & controle , SARS-CoV-2 , Serviço Hospitalar de EmergênciaRESUMO
OBJECTIVE: To evaluate the association between US state policies that establish age 18 or 21 years as the minimum purchaser age for the sale of handguns and adolescent suicide rate. DESIGN: Regression discontinuity and difference-in-differences analyses. SETTING: 46 US states without policy changes between 2001 and 2017; Missouri and South Carolina, which lowered the age for handgun sales in 2007 and 2008, respectively; and West Virginia and Wyoming, which increased the age for handgun sales in 2010. PARTICIPANTS: Adolescents aged 13 to 20 years(554 461 961 from 2001 to 2017) in the regression discontinuity analysis, and adolescents aged 18 to 20 years (168 934 041 from 2002 to 2014) in the main difference-in-differences analysis. MAIN OUTCOME MEASURE: Suicide rate per 100 000 adolescents. RESULTS: In the regression discontinuity analysis, state policies that limited the sale of handguns to those aged 18 or older (relative to 21 or older) were associated with an increase in suicide rate among adolescents aged 18 to 20 years equivalent to 344 additional suicides in each state where they were in place between 2001 and 2017. In the difference-in-differences analysis, state policies that limited the sale of handguns to those aged 21 or older were associated with 1.91 fewer suicides per 100 000 adolescents aged 18 to 20 years (95% confidence interval -3.13 to -0.70, permutation adjusted P=0.025). In the difference-in-differences analysis, there were 1.83 fewer firearm related suicides per 100 000 adolescents (-2.66 to -1.00, permutation adjusted P=0.002), with no association between age 21 handgun sales policies and non-firearm related suicides. Separate event study estimates indicated increases in suicide rates in states that lowered the age of handgun sales, with no association in states that increased the age of handgun sales. CONCLUSIONS: A clear discontinuity was shown in the suicide rate by age at age 18 in states that limited the sale of handguns to individuals aged 18 or older. State policies to limit the sale of handguns to individuals aged 21 or older were associated with a reduction in suicide rates among adolescents. Increases in suicide rates were observed after states lowered the age of handgun sales, but no effect was found in states that increased the age of handgun sales.
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Comércio/legislação & jurisprudência , Comportamento do Consumidor/economia , Armas de Fogo/legislação & jurisprudência , Suicídio/estatística & dados numéricos , Adolescente , Fatores Etários , Comércio/tendências , Comportamento do Consumidor/estatística & dados numéricos , Estudos de Avaliação como Assunto , Armas de Fogo/economia , Humanos , Missouri/epidemiologia , Políticas , Análise de Regressão , South Carolina/epidemiologia , Suicídio/etnologia , West Virginia/epidemiologia , Wyoming/epidemiologia , Adulto JovemRESUMO
PURPOSE: This article aims to examine whether state firearm laws impact homicide rates differently in suburban and rural areas compared to large cities in the United States. METHODS: We analyzed serial, cross-sectional data for the 26-year period 1991-2016 using a panel design. We examined the relationship between 6 specific state firearm laws and homicide rates in large cities (those with greater than 100,000 people in 1990) and in all geographic areas outside of these cities. Using a city-level fixed effects negative binomial regression, we modeled the number of homicides as a function of state firearm laws, while controlling for time fixed effects and time-varying state- and city-level sociodemographic factors. FINDINGS: Two policies-universal background checks and "may issue" laws that required a heightened showing of suitability for concealed carry-were associated with lower firearm homicide rates in large cities but were not associated with firearm homicide rates in suburban and rural areas. In contrast, laws that prohibited gun possession by people convicted of a violent misdemeanor were associated with lower firearm homicide rates in suburban and rural areas, but were not associated with firearm homicide rates in large cities. Permit requirements were associated with lower firearm homicide rates in both large cities and suburban and rural areas. CONCLUSIONS: This article provides the first evidence that state firearm laws may have a differential impact on firearm homicide rates in suburban and rural areas compared to urban areas in the United States.
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Armas de Fogo , Ferimentos por Arma de Fogo , Cidades , Estudos Transversais , Homicídio , Humanos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Although there is a disparity in the rates of fatal police shootings of Black victims compared to White victims throughout the nation, the magnitude of this racial disparity varies widely between cities. Examining the reasons behind this vast variation in the racial disparity in fatal police shootings across different localities could be helpful in identifying the underlying causes of this problem. Therefore, the objective of this study was to assess potential causes of the Black-White racial disparities in police shootings at the city level. METHODS: Using a cross-sectional design, we examined the relationship between the level of racial residential segregation in a city and the ratio of the rates of fatal police shootings of Black people compared to White people within that city during the period 2013-2017, using data from 69 of the largest cities in the United States. Using linear regression analysis, we modeled the ratio of Black to White fatal police shooting rates as a function of the level of racial segregation in each city as measured by the index of dissimilarity calculated at the Census block level. We controlled for several factors at the city level that might be expected to influence the rate of police shootings by race/ethnicity, including the level of deprivation of the Black population in economic status, the degree of Black representation in the city's police force, the relative size of the police force, crime rates, racial composition of the city, and city population. RESULTS: The level of racial residential segregation was significantly associated with the racial disparity in fatal police shooting rates. For each one standard deviation increase in the index of dissimilarity, the ratio of Black to White fatal police shooting rates increased by 44.4% (95% confidence interval, 17.1%-71.7%). CONCLUSIONS: Racial residential segregation is a significant predictor of the magnitude of the Black-White disparity in fatal police shootings at the city level. Efforts to ameliorate the problem of fatal police violence must move beyond the individual level and consider the interaction between law enforcement officers and the neighborhoods that they police.
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Negro ou Afro-Americano/estatística & dados numéricos , Polícia , Características de Residência , Segregação Social , População Branca/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Estudos Transversais , Humanos , Modelos Lineares , Estados Unidos/epidemiologia , População Urbana , ViolênciaRESUMO
INTRODUCTION: Determining whether the prevalence of gun ownership is associated with youth suicide is critical to inform policy to address this problem. The objective of this study is to investigate the relationship between the prevalence of household gun ownership in a state and that state's rate of youth suicide. METHODS: This study, conducted in 2018, involved a secondary analysis of state-level data for the U.S. using multivariable linear regression. The relationship between the prevalence of household gun ownership and youth (aged 10-19 years) suicide rates was examined in a time-lagged analysis of state-level household gun ownership in 2004 and youth suicide rates in the subsequent decade (2005-2015), while controlling for the prevalence of youth suicide attempts and other risk factors. RESULTS: Household gun ownership was positively associated with the overall youth suicide rate. For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9% (95% CI=14.0%, 39.8%). CONCLUSIONS: Because states with high levels of household gun ownership are likely to experience higher youth suicide rates, these states should be especially concerned about implementing programs and policies to ameliorate this risk.