RESUMEN
Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants: This study used deidentified aggregated data including 13â¯812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Exposures: Firearm ownership and access. Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year. Results: Worldwide, it was estimated that 251â¯000 (95% uncertainty interval [UI], 195â¯000-276â¯000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209â¯000 (95% UI, 172â¯000 to 235â¯000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161â¯000 deaths [95% UI, 107â¯000-182â¯000]); additionally, 27% were firearm suicide deaths (67â¯500 [95% UI, 55â¯400-84â¯100]) and 9% were unintentional firearm deaths (23â¯000 [95% UI, 18â¯200-24â¯800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34â¯700 deaths [95% UI, 24â¯900-39â¯700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). Conclusions and Relevance: This study estimated between 195â¯000 and 276â¯000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.
Asunto(s)
Armas de Fuego/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Heridas por Arma de Fuego/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Salud Global/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Distribución por Sexo , Adulto JovenRESUMEN
Australian Aboriginal people are some of the most researched people on earth, yet their life expectancy and other well-being indices lag significantly behind non-Aboriginal Australians. The reach of evidence-based practice (EBP) in social interventions has not yet informed Aboriginal policy even though it is based on clinical expertise and systematic research. This is due to criticism of the processes of EBP, most commonly its supposed limitations and misperceptions, which are easily refuted. EBP continues to be a tool that is needed to inform practice across all disciplines of human service, and needs to be the core value of any intervention with indigenous peoples.
Asunto(s)
Práctica Clínica Basada en la Evidencia/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Nativos de Hawái y Otras Islas del Pacífico/psicología , Servicio Social/organización & administración , Australia , Programas de Gobierno/organización & administración , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/organización & administración , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Whistleblowing by health professionals is an infrequent and extraordinary event and need not occur if internal voices are heard. Mannion and Davies' editorial on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations" asks the question whether whistleblowing ameliorates or exacerbates the 'deaf effect' prevalent in healthcare organisations. This commentary argues that the focus should remain on internal processes and hearer courage .