Violência doméstica: a pandemia de covid-19 provocou subnotificação de casos e/ou aumento de sua ocorrência? / Violencia doméstica: ¿la pandemia covid-19 ha causado un subreporte de casos y/o un aumento en su ocurrencia? / Domestic violence: has the covid-19 pandemic caused under-reporting of cases and/or an increase in their occurrence?

Introdução: O cenário pandêmico trouxe à tona e de forma potencializada alguns indicadores preocupantes acerca da violência domésticacontra a mulher.Dessa maneira, questiona-se: a pandemia de COVID-19 provocou diferença no número de ocorrências de casos de Violência Doméstica?Objetivo:Comparar a ocorrência de casos de violência doméstica contra mulheres em um estado brasileiro nos períodos de 2015 a 2018 e 2019a 2021 segundo dados da Polícia Civil do estado.Metodologia:Trata-se de um estudo documental e descritivo, realizado com dados secundários. As informações foram colhidas através da ouvidoria da Polícia Civil em 11 de março de 2021,a partir dos registros de boletins de ocorrências policiais sobre violência doméstica contra a mulher dos anos de 2015 a 2021.Resultados:Durante os anos de 2015 a 2021 foram registrados um total de 26.671 boletins de ocorrência por violência contra a mulher. De 2015 a 2018,a média mensal foi de 360,1ocorrênciase durante a pandemia, de 2019 a 2021, a média mensal foi de 360,9ocorrências. Notou-se um discreto aumento na quantidade de boletins de ocorrência feito durante a pandemia deCOVID-19, com destaque para 2020, que apresentou média mensal de 387,4ocorrências, período mais recrudescido da pandemia. A principal violência perpetrada foi a lesão corporal dolosa principalmente contra mulheres de 18 a 24 anos, que trabalhavam em casa ou estavam desempregadas.Conclusão:Apesar da falta de diferenças expressivas entre os anos pré e pós-pandemia, a análise reforça a urgência de discutir os fatores subjacentes à violência contra a mulher, especialmente a violência doméstica. Destaca-se a importância de medidas preventivas e de apoio às vítimas para enfrentar esse problema social. É essencial promover políticas visando uma sociedade mais segura e igualitária para todas as mulheres (AU).

Introduction:The pandemic scenario has brought to light, and in a intesified manner, some concerning indicators regarding domestic violence against women. Thus, the question arises: did the COVID-19 pandemic make a difference in the number of domestic violence cases? Objective: To compare the occurrence of domestic violence cases against Brazilian women in the periods from 2015 to 2018 and 2019 to 2021 according to data from the state's Civil Police. Methodology: This is a documentary and descriptive study, conducted with secondary data. The information was collected through the Civil Police ombudsman on March 11, 2021, based on police reports of domestic violence against women from 2015 to 2021. Results: During the year of 2015 to 2021, a total of 26,671 police reports of violence against women were registered. From 2015 to 2018, the monthly average was 360.1 occurrences, and during the pandemic, from 2019 to 2021, the monthly average was 360.9 occurrences. There was a slight increase in the number of police reports during the COVID-19 pandemic, with a peak in 2020, which had a monthly average of 387.4 occurrences, the most intense period of the pandemic. The main violence perpetrated was intentional bodily harm, mainly against women aged 18 to 24, who were either working from home or unemployed. Conclusion: Despite the lack of significant differences between pre and post-pandemic years, the analysis reinforces the urgency of discussing the underlying factors of violence against women, especially domestic violence. The importance of preventive measures and support for victims to address this social problem is emphasized. It is essential to promote policies aimed at a more equal and safer society for all women (AU).

Introducción: El escenario pandémico ha sacado a la luz algunos indicadores preocupantes sobre la violencia doméstica contra las mujeres. Entonces, surge la pregunta: ¿la pandemia de COVID-19 ha provocado una diferencia en el número de ocurrencias de casos de Violencia Doméstica?Objetivo:Comparar la ocurrencia de casos de violencia doméstica contra las mujeres en un estado brasileño en los períodos de 2015 a2018 y de 2019 a 2021 según datos de la Policía Civil del estado. Metodología:Se trata de un estudio documental y descriptivo, realizado con datos secundarios. La información fue recabada a través de la Defensoría del Pueblo de la Policía Civil el 11 de marzo de 2021,a partir de los registros de las denuncias policiales sobre violencia intrafamiliar contra las mujeres de 2015 a 2021.Resultados:De 2015 a 2021 se presentaron un total de 26.671 denuncias policiales por violencia contra las mujeres. De 2015 a 2018, el promedio mensual fue de 360,1 ocurrencias y durante la pandemia, de 2019 a 2021, el promedio mensual fue de 360,9 ocurrencias. Hubo un ligero aumento en el número de denuncias policiales realizadas durante la pandemia de COVID-19, especialmente en 2020, que tuvo un promedio mensual de 387,4 ocurrencias, el período más severo de la pandemia. La principal violencia perpetrada fueron lesiones corporales intencionales, principalmente contra mujeres de 18 a 24 años, que trabajaban en el hogar o estaban desempleadas.Conclusión:A pesar de la falta de diferencias significativas entre los años pre y post pandemia, el análisis refuerza la urgencia de discutir los factores que subyacen a la violencia contra las mujeres, especialmente la violencia doméstica. Se destaca la importancia de las medidas preventivas y de apoyo a las víctimas para hacer frente a esta problemática social. Es esencial promover políticas encaminadas a lograr una sociedad más segura e igualitaria para todas las mujeres (AU).

Statistics of Rare Events.

Rare events can sometime arise in clinical development of treatments. For example, CYPIDES was a single-arm study of the CYP11A1 inhibitor ODM-208 to treat metastatic prostate cancer.1 Preclinical testing of the compound identified elevated thyroid-stimulating hormone (TSH) and bilirubin in rats and dogs. Unusual findings in preclinical testing focus attention and magnify evidence if similar results occur in humans. By analogy, imagine a murder trial in which the only evidence against the defendant arose from a database search of DNA matching the partial profile found at the crime scene. Multiple people could match, so without other evidence, the perpetrator could be any of them.

Mortal Systemic Exclusion Yielded Steep Mortality-Rate Increases In People Experiencing Homelessness, 2011-20.

The number and percentage of people in the US dying while homeless has increased in recent years. However, information about the causes of death most prevalent among this population, and about how cause-specific mortality rates may be shifting over time, has been limited to locally specific data. Using a unique data set of 22,143 homeless decedents in twenty-two localities across ten states and Washington, D.C., from the period 2011-20, we found large increases in all-cause and cause-specific homeless mortality rates. The largest increases in cause-specific homeless mortality rates in the ten-year period were for deaths related to drug and alcohol overdose, diabetes, infection, cancer, homicide, and traffic injury. We discuss implications of these results and posit that people experiencing homelessness are systematically excluded from the life-affirming institutions of housing and health care, in an example of mortal systemic exclusion. The findings have important implications for existing local and federal policy approaches to homelessness.

Modeling the Relationship Between Firearm Restrictions, Medicaid Expansion, and Political Partisanship with Pediatric Firearm Mortality Costs.

INTRODUCTION: Firearms are now the leading cause of pediatric mortality in the U.S., but few studies have investigated the economic impact of these deaths. Thus, this study determined whether multiple different gun-related measures, political partisanship and Medicaid expansion were related to the costs of pediatric gun deaths. METHODS: Each states' medical costs, years of potential life lost (YPLL), and value of statistical life (VSL) lost due to pediatric gun deaths were extracted from the WISQARS database from 2015 to 2020. Seven firearm laws or restrictiveness measures (assault weapons bans, child access prevention laws, firearm registration and permit to purchase requirements, safe storage laws, Giffords Law Center ranking, and the number of firearm provisions), the Cook Partisan Voting Index (PVI), and Medicaid expansion status were determined across states. Unadjusted analyses compared each measure and (1) medical costs, (2) VSL, and (3) YPLL for each state. These were repeated using adjusted analyses, controlling for poverty, educational attainment, poor mental health, and race. RESULTS: Of the 9 variables assessed, unadjusted analyses revealed that 8 variables were significantly associated with increased medical costs, all 9 were associated with higher VSL and 8 were associated with higher YPLL due to pediatric firearm-related mortality. Multivariable analyses revealed that 7 variables were associated with medical costs, 7 were associated with VSL and 6 were associated with YPLL. CONCLUSION: States with fewer gun laws and those which have not adopted Medicaid expansion were more likely to experience a higher economic burden due to pediatric gun deaths. Quantifying the costs of these deaths can demonstrate the social toll of gun violence to policymakers and the general public. LEVEL OF EVIDENCE: III.

Evaluating the Feasibility of a Novel Firearm Injury Prevention Program for Pre-adolescent Children Through Health Care and Community-Based Partnerships: The Future Healers Program Pilot Study.

BACKGROUND: Firearm violence is an American public health crisis that negatively impacts children and disproportionately affects Black youth. Few firearm injury prevention programs have been described in pre-adolescent children. The Future Healers Program is a novel collaboration constructed via partnership between the medical school, trauma center, academic surgery department, and local non-profit community organization. Our study sought to evaluate if (1) partnering with community organizations facilitated recruitment of children with prior exposure to firearm violence and (2) the health care community was a potential trusted partner appropriate for program delivery. METHODS: Children aged 4-13 were recruited to join the program via news outlets and social media and in partnership with a local non-profit organization. Of the children and parents participating in the program, 48% (44/92) and 59% (38/64), respectively, completed an IRB-approved survey study. Pearson's chi-square, percentages, and 95% confidence intervals evaluated differences between children and caregivers on sociodemographic characteristics, firearm exposure (FE), firearm violence exposure (FVE), and perception of health care. Participant's residence was geocoded in relationship to incidents of firearm injury (2008-2021) in the same region. RESULTS: Caregivers (95%) and children (84%) reported substantial exposure to firearm violence and resided in areas with frequent firearm injury incidents. Notably, 82% of caregivers and 66% of children reported having a family member injured by gunfire. A high percentage of caregivers (79%) and children (91%) self-reported trust in the health care system. CONCLUSION: Partnerships between community organizations and health care systems can develop prevention programs that effectively recruit and engage pre-adolescent children impacted by firearm violence.

Vehicular homicide or cardiovascular event? The importance of the autopsy findings.

We present the case of a 61 years old woman who was hit by a car, resulting in fractures of the pubic bone, left ischium-pubis ramus and right femur, with need of hip replacement surgery. In the next days she was affected by two episodes of acute coronary syndrome, treated with coronary angioplasty surgery. After undergoing total hip replacement surgery an episode of asystole caused her death. A full autopsy showed coronary stenosis and chronic ischemic heart disease associated with a recent myocardial infarction. The pre-existing condition of T.L. could not be ignored but the initial traumatic event and the subsequent fractures played a further co-occurrent causal role. The initial trauma represented the first step of the phenomenological chain that led to a series of adverse cardiological events and to an irreversible asystole, so that the car driver should be partly considered accountable for the death of the woman.

Left out in the cold: Homicide amongst persons experiencing homelessness.

BACKGROUND: There is no American population-level study comparing the characteristics of homicides involving victims who were vs were not experiencing homelessness at time of death. We aim to identify variables surrounding homeless homicide that are unique, and intervenable. METHODS: In this retrospective cohort study, we reviewed the National Violent Death Reporting System (NVDRS) from 2003 to 2018 and compared the characteristics surrounding homicides of victims who were not-homeless (cohort 1) vs experiencing homelessness (cohort 2) at death. We utilized the available perpetrator data to characterize the average perpetrator for each cohort. We considered housing status to be our primary predictor and recorded NVDRS variables, such as age of victims and likelihood to know perpetrators, to be our primary outcomes. RESULTS: 81,212 Homicide Victims and 60,982 Homicide Perpetrators were included in analysis. Homeless cohort victims were more likely younger, White, male, and to have a known mental health or substance abuse disorder. PEH were also more likely to have co-morbid mental health and substance abuse disorders but were roughly half as likely to be getting treatment for said disorders. Circumstances surrounding incidents, including geographic location, mechanism of injury, and premeditation, varied; homeless cohort victims were more likely to die in random acts of violence, but were less likely to die via firearm. CONCLUSIONS: There is room for targeted interventions against homeless homicides. LEVEL OF EVIDENCE: Epidemiological, Level IV.

Factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States: A 13-year retrospective analysis of the National Inpatient Sample database.

BACKGROUND: Suicide is a significant cause of mortality in the United States, accounting for 14.5 deaths/100,000. Although there are data on gender disparity in suicide/self-inflicted injury rates in the United States, few studies have examined the factors associated with suicide/self-inflicted injury in females. OBJECTIVE: To determine factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States. METHODS: Hospitalizations for suicide or self-inflicted injuries were identified using the National Inpatient Sample database from 2003-2015 using sample weights to generate national estimates. Independent predictors of suicide/self-inflicted injuries were identified using multivariable regression models. Interaction term analysis to identify the interaction between race/ethnicity and income were conducted. RESULTS: There were 1,031,693 adult women hospitalizations in the U.S. with a primary diagnosis of suicide/self-inflicted injury in the study period. The highest suicide/self-inflicted injury risk was among women aged 31-45years (OR = 1.23, CI = 1.19-1.27, p < 0.05). Blacks in the highest income strata had a 20% increase in the odds of suicide/self-inflicted injury compared to Whites in the lowest socioeconomic strata (OR = 1.20, CI = 1.05-1.37, p <0.05). Intimate partner violence increased suicide/self-inflicted injury risk 6-fold (OR = 5.77, CI = 5.01-6.65, p < 0.05). CONCLUSION: Suicide risk is among women aged 31-45 years, higher earning Black women, intimate partner violence victims, uninsured, and current smokers. Interventions and policies that reduce smoking, prevents intimate partner violence, addresses racial discrimination and bias, and provides universal health coverage are needed to prevent excess mortality from suicide deaths.

Feminicide in Cali Colombia: Aview from public health / Feminicidio en Cali Colombia: Una mirada desde la salud pública / Feminicídio em Cali Colômbia: Uma visão da saúde pública

Introduction:In most cases, violence against women is committed by their partners or ex-partners and this violence is a global public health problem that almost always ends in their death. Femicide is understood as the murder of a woman just for the fact of being a female individual, perpetuating gender inequality. Objective:To analyze femicide in Cali from its epidemiological characterization. Materials and methods:A descriptive population-based study was carried out using secondary sources that included 287 recordsof violent deaths of women. 53 cases between 2017 and 2019 were identified and analyzed, which were investigated and classified as femicide by the Crimes Against Women Unit of the Prosecutor's Office. The epidemiological characterization was conducted based on the information provided, which was useful to identify the study variables: age, method, place of occurrence, imprisonment of perpetrator, and sentence. Results:Femicide occurred between the ages of 9 and 89, with stabbing being the most commonly used killing method. A conviction was executed only in 18.9% of the total cases. Conclusions: Femicide occurs at any age and has a high impunity degree mostly because of an ineffective judicial system.

Introducción: En la mayoría de ocasiones, la violencia contra la mujer, es cometida por su pareja o expareja, siendo un problema de salud pública mundial que casi siempre termina en un feminicidio. Este se entiende como el asesinato de una mujer por el hecho de serlo, perpetuando la inequidad de género.Objetivo: Visibilizar el feminicidio en Cali a partir de su caracterización epidemiológica.Materiales y métodos: Se realizó un estudio descriptivo de base poblacional de fuentes secundarias, a partir de 287 registros de muertes violentas en mujeres, de los cuales se identificaron y analizaron 53 casos atendidos en la unidad devida de delitos contra la mujer de la Fiscalía entre el 2017 al 2019, tipificados como feminicidio. La caracterización epidemiológica se realizó con base en la información suministrada que permitió identificar las variables de estudio: edad, mecanismo, lugar de ocurrencia, medida de aseguramiento del victimario y sentencia.Resultados: El feminicidio se presentó entre los 9 y 89 años, el mecanismo más utilizado fue el arma corto punzante. Sólo en el 18,9% se ha dictado sentencia condenatoria.Conclusiones: El feminicidio se presenta en cualquier edad, tiene un alto grado de impunidad en muchas ocasiones por la ineficiencia del sistema judicial.

Introdução: Na maioria das vezes, a violência contra a mulher é cometida pelo companheiro ou ex-parceiro, tratando-se de um problema de saúde pública mundial que quase sempre culmina em feminicídio. Isso é entendido como o assassinato de uma mulher pelo fato de ser uma delas, perpetuando a desigualdade de gênero. Objetivo:Tornar visível o feminicídio em Cali a partir de sua caracterização epidemiológica. Materiais e métodos:Foi realizado um estudo descritivo de base populacional de fontes secundárias, a partir de 287 registros de mortes violentas de mulheres, dos quais foram identificados e analisados 53 casos, atendidos na unidade de vida por crimes contra a mulher da denúncia publica (fiscalia) entre 2017 e 2019, classificados como feminicídio. A caracterização epidemiológica foi realizada com base nas informações prestadas que permitiram identificar as variáveis do estudo: idade, mecanismo, local de ocorrência, medida de segurança do agressor e pena. Resultados:O feminicídio ocorreu entre as idades de 9e 89 anos, o mecanismo mais utilizado foi arma branca. Apenas em 18,9% houve condenação. Conclusões:O feminicídio ocorre em qualquer idade, tem alto grau de impunidade em muitas ocasiões devido à ineficiência do sistema judicial.

The murder of the surgeon Antonio Parrozzani and the relationship between sexual disorders and paranoid thinking.

In this study we aimed to describe the relationship between sexual disorders and paranoid thinking describing the historical case of murder of the famous surgeon Antonio Parrozzani and the pathological personality of his murderer. Parrozzani was killed by Francesco Mancini, his patient in the past. Mancini was obsessed by his sexual problems due to hypothetical injuries after an inguinal hernia surgery, made by Parrozzani. Following treatment, the murderer likely lived his surgery as a traumatic event and developed a paranoid thinking against the surgeon, breaking out with the dramatic homicide. Parrozzani's case highlights the strong relationship between paranoia and sexuality, and likewise this relationship can be considered as a prodromic factor for a psychotic onset. Moreover, this case, supported by two psychiatric assessments of murderer, remembers once again the association between violence and paranoia. Therefore, clinicians should take into account the danger of the possible presence of paranoid obsession together with sexual problems, to prevent psychosis onset or violent acts related to paranoid delusions.

Trends in disparities research on trauma and acute care surgery outcomes: A 10-year systematic review of articles published in The Journal of Trauma and Acute Care Surgery.

ABSTRACT: This is a 10-year review of The Journal of Trauma and Acute Care Surgery (JTACS) literature related to health care disparities, health care inequities, and patient outcomes. A retrospective review of articles published in JTACS between January 1, 2013, and July 15, 2022, was performed. Articles screened included both adult and pediatric trauma populations. Included articles focused on patient populations related to trauma, surgical critical care, and emergency general surgery. Of the 4,178 articles reviewed, 74 met the inclusion criteria. Health care disparities related to gender (n = 10), race/ethnicity (n = 12), age (n = 14), income status (n = 6), health literacy (n = 6), location and access to care (n = 23), and insurance status (n = 13) were described. Studies published on disparities peaked in 2016 and 2022 with 13 and 15 studies respectively but dropped to one study in 2017. Studies demonstrated a significant increase in mortality for patients in rural geographical regions and in patients without health insurance and a decrease in patients who were treated at a trauma center. Gender disparities resulted in variable mortality rates and studied factors, including traumatic brain injury mortality and severity, venous thromboembolism, ventilator-associated pneumonia, firearm homicide, and intimate partner violence. Under-represented race/ethnicity was associated with variable mortality rates, with one study demonstrating increased mortality risk and three finding no association between race/ethnicity and mortality. Disparities in health literacy resulted in decreased discharge compliance and worse long-term functional outcomes. Studies on disparities in JTACS over the last decade primarily focused on location and access to health care, age, insurance status, and race, with a specific emphasis on mortality. This review highlights the areas in need of further research and funding in the Journal of Trauma and Acute Care Surgery regarding health care disparities in trauma aimed at interventions to reduce disparities in patient care, ensure equitable care, and inform future approaches targeting health care disparities. LEVEL OF EVIDENCE: Systematic Review; Level IV.

A tale of two cities: Policing and firearm homicides in Boston and Philadelphia.

BACKGROUND: Recent political movements have raised questions about the effectiveness of police funding, but the impact of law enforcement budgets on firearm violence is unknown. We hypothesized that department funding and measures of police activity would be associated with decreased shootings and firearm homicides (FHs) in two major cities with different police funding patterns. METHODS: We collected data from the following sources: district attorney's offices, police departments, Federal Bureau of Investigation Uniform Crime Reporting program, the Centers for Disease Control, the Annual Survey of Public Employment and Payroll, and the American Community Survey. Data included demographics, police department budgets, number of officers, homicide clearance rates, firearms recovered, shootings, and FHs, 2015 to 2020. Totals were normalized to population and number of shootings. We used panel linear regression to measure associations between policing variables, shootings, and FHs while adjusting for covariates. RESULTS: Firearm homicides significantly increased in Philadelphia. In Boston, the trend was less clear, although there was an increase in 2020. Police budget normalized to shootings trended toward a decrease in Philadelphia and an increase in Boston. The number of firearms recovered annually appeared to increase in Boston but peaked midstudy in Philadelphia. In multivariable analyses, police budget was associated with neither shootings nor FHs. However, increased firearm recovery was associated with lower shooting ( ß = -0.0004, p = 0.022) and FH ( ß = -0.00005, p = 0.004) rates. CONCLUSION: Philadelphia and Boston demonstrated differences in police funding, 2015 to 2020. While budget is not associated with shootings or FHs, firearm recovery is suggesting that removal of firearms from circulation remains key. The impact this has on vulnerable populations requires further investigation. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019: Injury Diagnosis Matrix, Incident Context, and Public Health Considerations.

INTRODUCTION: The epidemic of gun violence in the United States (US) is exacerbated by frequent mass shootings. In 2021, there were 698 mass shootings in the US, resulting in 705 deaths and 2,830 injuries. This is a companion paper to a publication in JAMA Network Open, in which the nonfatal outcomes of victims of mass shootings have been only partially described. METHODS: We gathered clinical and logistic information from 31 hospitals in the US about 403 survivors of 13 mass shootings, each event involving greater than 10 injuries, from 2012-19. Local champions in emergency medicine and trauma surgery provided clinical data from electronic health records within 24 hours of a mass shooting. We organized descriptive statistics of individual-level diagnoses recorded in medical records using International Classification of Diseases codes, according to the Barell Injury Diagnosis Matrix (BIDM), a standardized tool that classifies 12 types of injuries within 36 body regions. RESULTS: Of the 403 patients who were evaluated at a hospital, 364 sustained physical injuries-252 by gunshot wound (GSW) and 112 by non-ballistic trauma-and 39 were uninjured. Fifty patients had 75 psychiatric diagnoses. Nearly 10% of victims came to the hospital for symptoms triggered by, but not directly related to, the shooting, or for exacerbations of underlying conditions. There were 362 gunshot wounds recorded in the Barell Matrix (1.44 per patient). The Emergency Severity Index (ESI) distribution was skewed toward higher acuity than typical for an emergency department (ED), with 15.1% ESI 1 and 17.6% ESI 2 patients. Semi-automatic firearms were used in 100% of these civilian public mass shootings, with 50 total weapons for 13 shootings (Route 91 Harvest Festival, Las Vegas. 24). Assailant motivations were reported to be associated with hate crimes in 23.1%. CONCLUSION: Survivors of mass shootings have substantial morbidity and characteristic injury distribution, but 37% of victims had no GSW. Law enforcement, emergency medical systems, and hospital and ED disaster planners can use this information for injury mitigation and public policy planning. The BIDM is useful to organize data regarding gun violence injuries. We call for additional research funding to prevent and mitigate interpersonal firearm injuries, and for the National Violent Death Reporting System to expand tracking of injuries, their sequelae, complications, and societal costs.

Use of CO-oximetry to confirm carboxyhemoglobinemia in cats involved in secondary arson homicide.

The body of a deceased human and 4 deceased cats were found in a house while a fire was being extinguished. As a result of these findings, arson, homicide, and animal death investigations were opened. As part of the animal death investigation, all of the cats were submitted for veterinary forensic autopsies. All cats had soot on the fur and had soot deposits within the oral cavity, esophagus, and respiratory tract. Two cats had soot within the stomach. Cardiac blood was analyzed for carboxyhemoglobin using a CO-oximeter, and all cats had levels >65%. The cause of death was determined to be due to toxic smoke inhalation from the structure fire. Case findings support the potential use of CO-oximeter for determination of carboxyhemoglobin levels in cats and continued research in this area of forensic practice.

Discursividades pós-modernas: leitura do fenômeno social da polarização / Une lecture du phénomène social de polarisation par l'analyse des discours postmodernes / Postmodern discourses: reading the social phenomenon of polarization

O crescimento da discursividade social acerca de fenômenos como o feminicídio, a violência machista, racista, homofóbica e religiosa, além da hostilidade crescente de alguns grupos identitários ao valores conservadores da sociedade ocidental judaico-cristã, indicam que uma cultura do ódio floresceu no laço social polarizado. Os afetos de amor e ódio se apresentam no início da constituição do sujeito em estado de desligamento, mas se fundem quando prevalece o amor do Outro primordial ao infante desamparado. É a hegemonia do amor que promove a fusão pulsional. Se a civilização triunfa, se o Outro primordial alcança impor o predomínio do amor sobre o ódio, o sujeito se constitui graças ao recalque dos impulsos destrutivos e se torna capaz de alimentar a esperança no futuro, amar e trabalhar. Os afetos são o que existe de mais real na relação dos seres falantes ao Outro. Seja para amá-lo, seja para odiá-lo, seja para ignorá-lo, a existência do Outro simbólico é, para cada um, uma dimensão real em jogo no laço social. O Outro da modernidade é liberal, progressista e acredita que a igualdade de oportunidades cresce com o acesso universal à educação e à saúde. E o Outro da nossa pós-modernidade? É fragmentado, não há referências coletivas universais? É pessimista ou a esperança utópica se tornou inimiga darealidade?

La croissance de la discursivité sociale sur des phénomènes tels que le féminicide, la violence sexiste, raciste, homophobe et religieuse, en plus de l'hostilité croissante de certains groupes identitaires aux valeurs conservatrices de la société occidentale judéo-chrétienne, indiquent qu'une culture de la haine s'est diffusée dans le lien social polarisé. Les affects d'amour et de haine apparaissent au début de la constitution du sujet dans un état de détachement, mais se confondent lorsque l'amour de l'Autre primordial pour l'enfant sans défense l'emporte. C'est l'hégémonie de l'amour qui favorise la fusion pulsionnelle. Si la civilisation triomphe, si l'Autre primordial parvient à imposer la prédominance de l'amour sur la haine, le sujet se constitue grâce au refoulement des pulsions destructrices et devient capable de nourrir l'espoir en l'avenir, d'aimer et de travailler. Les affects sont ce qu'il y a de plus réel dans la relation entre les êtres parlants et l'Autre. Qu'on l'aime, qu'on le déteste ou qu'on l'ignore, l'existence de l'Autre symbolique est, pour chacun, une véritable dimension en jeu dans le lien social. L'Autre de la modernité est libéral, progressiste et croit que l'égalité des chances augmente avec l'accès universel à l'éducation et à la santé. Et qu'en est-il de l'Autre de notre postmodernité? Est-il fragmenté, n'y a-t-il pas de références collectives universelles? Est-il pessimiste? L'espoir utopique est-il devenu l'ennemi de la réalité?

The growth of social discursivity about phenomena such as feminicide, sexist, racist, homophobic and religious violence, in addition to the growing hostility of some identity groups towards the conservative values of Western Christian culture, indicate that a culture of hate has flourished in a progressively polarized social bond. The affections of love and hate appear at the beginning of the constitution of the subject in a state of detachment, but merge when the love of the primordial Other for the helpless infant prevails. It is the hegemony of love that promotes the fusion of the drive. If civilization triumphs, if the primordial Other manages to impose the predominance of love over hate, the subject is constituted thanks to the repression of destructive impulses and becomes capable of nourishing hope in the future, through love and work. Affections are what is most real in the relationship between talking beings and the Other. Whether to love it, to hate it, or to ignore it, the existence of the symbolic Other is, for each one, a real dimension at play in the social bond. The Other of modernity is liberal, progressive and believes that equal opportunities grow with universal access to education and health. What to say of the Other of our postmodernity? Is it fragmented, are there no universal collective references? Is it pessimistic? Has utopian hope become the enemy of reality?

Trends in mass shootings in the United States (2013-2021): A worsening American epidemic of death.

BACKGROUND: Mass shootings represent a significant problem in the United States (US). This study aimed to examine trends in mass shootings in the US over time. METHODS: Retrospective mass shooting data (1/2013-12/2021) were collected from the Gun Violence Archive. A scatterplot was constructed showing predicted (extrapolated from 2013 to 2019) versus actual total mass shootings in 2020 and 2021. Multivariate linear regressions were performed to evaluate trends in mass shootings over time, associated with gun law strength. RESULTS: Mass shooting incidents, injuries, and deaths in 2020 and 2021 exceeded extrapolations from previous years. When comparing 2019 to 2020, stronger gun laws were associated with decreased monthly mass shooting deaths. For these same strong gun law states, monthly mass shooting deaths decreased when comparing 2019 to 2021 and comparing 2020 to 2021. CONCLUSIONS: US mass shootings have increased over the past decade. Stronger gun laws appear associated with fewer monthly mass shooting-related deaths. Firearm-related legislation may at least partially, curtail the worsening of this substantial "American problem" of mass shootings.

Firearm legislation: The association between neighboring states and crude death rates.

BACKGROUND: Few studies have examined the impact of interstate differences in firearm laws on state-level firearm mortality. We aim to study the association between neighboring states' firearm legislation and firearm-related crude death rate (CDR). METHODS: The CDC Web-based Injury Statistics Query and Reporting System was queried for adult all-intent (accidental, suicide, and homicide) firearm-related CDR among the 50 states from 2012 to 2020. States were divided into five cohorts based on the Giffords Law Center Annual Gun Law Scorecard, and two groups were constructed: Strict (A, B, C) and Lenient (D, F). We examined the effect of (1) a single incongruent neighbor, defined as "Different" if the state is bordered by ≥1 state with a grade score difference >1, and (2) the average grade of all neighboring states, defined as "Different" if the average of all neighboring states resulted in a grade score difference >1. RESULTS: Strict states with similar average neighbors had significantly lower CDR compared with Strict states with different average neighbors (2.98 [1.91-5.06] vs. 3.87 [2.37-5.94], p = 0.02), while Lenient states with similar average neighbors had significantly higher CDR compared with Lenient states with different average neighbors (6.02 [4.56-8.11] vs. 4.7 [3.95-5.35], p = 0.002). Lenient states surrounded by all similar Lenient states had the highest CDR, which was significantly higher than Lenient states with ≥1 different neighbor (6.52 [5.09-8.96] vs. 5.19 [3.85-6.61], p < 0.001). However, Strict states with ≥1 different neighbor did not have higher CDR compared with Strict states surrounded by all similar Strict states (3.39 [2.17-5.35] vs. 3.14 [1.91-5.38], p = 0.5). CONCLUSION: We report a lopsided neighboring effect whereby Lenient states may benefit from at least one Strict neighbor, while Strict states may be adversely affected only when surrounded by mostly Lenient neighbors. These findings may assist policymakers regarding the efficacy of their own state's legislation in the context of incongruent neighboring states. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

Feminicídio seguido de suicídio: a organização da mídia na prestação de serviço para evitar casos das violências correlacionadas / Femicide followed by suicide: the organization of the media in providing service in order to prevent cases of the correlated violence / Feminicidio seguido de suicidio: la organización de los medios de comunicación en la prestación de servicios para evitar casos de las violencias correlacionadas

O presente artigo tem como objetivo estudar as reportagens jornalísticas que noticiam casos de feminicídio seguido de suicídio, e analisar qual o papel da mídia na conscientização do público sobre as violências correlacionadas. Com muitos estigmas, o tema ainda é pouco abordado pelo jornalismo de forma esclarecedora e em formato de prestação de serviço, uma vez que ambos os assuntos ainda são tabus para a sociedade. Dessa forma, este estudo se propõe a ampliar o debate, a partir dos autores Durkheim, Blázquez e Christofoletti. A pesquisa também é pautada com dois manuais para jornalistas, o da Organização Mundial da Saúde (OMS), sobre como falar do suicídio; e o da plataforma Universa UOL, sobre como abordar o feminicídio. Ao longo do trabalho, percebe-se que o jornalismo precisa refletir sobre seu papel na prevenção de casos como esses e a respeito de como exercê-lo

This article aims to study the journalistic reports that report cases of femicide followed by suicide, and to analyze the role of the media in raising the public awareness of correlated violence. With many stigmas, the subject is still little addressed by journalism in an enlightening way and in order to provide service, since both subjects are still taboo subjects for society. Thus, this study proposes to broaden the debate, based on the authors Durkheim, Blázquez and Christofoletti. The research is also guided by two manuals for journalists: that elaborated by the World Health Organization (WHO), on how to talk about suicide; and that presented by the Universa UOL platform, on how to approach femicide. Throughout the work, it is clear that journalism needs to reflect on its role in preventing cases like these and how to exercise it

Este artículo tiene como objetivo estudiar los reportajes periodísticos que divulgan casos de feminicidio seguido de suicidio, y analizar el papel de los medios de comunicación en la sensibilización de la población sobre la violencia correlacionada. Con muchos estigmas, el tema es aún poco abordado por el periodismo de manera esclarecedora y con el fin de prestar un servicio, ya que los dos temas siguen siendo tabúes para la sociedad. Así, este estudio propone ampliar el debate, apoyándose en los autores Durkheim, Blázquez y Christofoletti. La investigación también se guía por dos manuales para periodistas: el elaborado por la Organización Mundial de la Salud (OMS), sobre cómo hablar sobre el suicidio; y el presentado en la plataforma Universa UOL, sobre cómo abordar el feminicidio. A lo largo del trabajo, queda claro que el periodismo necesita reflexionar sobre su papel en la prevención de casos como estos y sobre cómo ejercerlo

State Gun Regulations and Reduced Gun Ownership are Associated with Fewer Firearm-Related Suicides Among Both Juveniles and Adults in the USA.

BACKGROUND: Few studies have investigated the relationship between specific gun regulations and gun ownership with the firearm-related suicide rate among juveniles and adults across U.S. states. Therefore, this study seeks to determine if gun ownership rates and gun restrictions are related to the firearm-related suicide rate in both the pediatric and adult populations. METHODS: Fourteen measures of state gun law restrictions and gun ownership were collected. These included Giffords Center ranking, gun ownership percentages, and 12 specific firearm laws. Unadjusted linear regressions modeled the relationship between each individual variable and the rate of firearm-related suicides for adults and children across states. This was repeated using a multivariable linear regression adjusting for poverty, poor mental health, race, gun ownership, and divorce rates by state. P values of <0.004 were considered significant. RESULTS: In the unadjusted linear regression, 9 of 14 firearm-related measures were statistically associated with fewer firearm-related suicides in adults. Similarly, 9 of 14 measures were found to be associated with fewer firearm-related suicides in the pediatric population. In the multivariable regression, 6 of 14 vs. 5 of 14 measures were statistically associated with fewer firearm-related suicides in the adult and pediatric populations, respectively. CONCLUSIONS: Ultimately, this study found that increased state gun restrictions and lower gun ownership rates were associated with fewer firearm related suicides among juveniles and adults in the US. This paper provides objective data to help lawmakers as they create gun control legislation that can potentially decrease the rate of fire-arm related suicide. LEVELS OF EVIDENCE: II.