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.

A pilot clinical trial of the Screening and Tool for Awareness and Relief of Trauma for survivors of gun violence.

BACKGROUND: Survivors of gun violence have significant sequelae including reinjury with a firearm and mental health disorders that often go undiagnosed and untreated. The Screening and Tool for Awareness and Relief of Trauma (START) is a targeted behavioral mental health intervention developed for patients who come from communities of color with sustained and persistent trauma. METHODS: In this pilot study, we evaluate the feasibility of completing a randomized controlled trial to test the START intervention. Using a mixed methods study design, we used both quantitative and qualitative data collection to assess the START intervention and the feasibility of completing a randomized controlled trial. The purpose of this study was to estimate important study parameters that would enable a future randomized controlled trial. RESULTS: We were able to make conclusions about several crucial domains of a behavioral intervention trial: (1) recruitment and retention-we had a high follow-up rate, but our recruitment was low (34% of eligible participants); (2) acceptability of the intervention-the addition of audiovisual resources would make the tools more accessible; (3) feasibility of the control-more appropriate for a stepped wedge cluster randomized controlled trial design; (4) intervention fidelity-there was an 81% concordance rate between the fidelity survey results and the audio recordings; (5) approximate effect size-there was a 0.4-point decrease in the PTSD Checklist-Civilian Version in the control compared with a 10.7-point decrease in the treatment group for the first month. CONCLUSION: While it was feasible to conduct a randomized controlled trial, our findings suggest that a stepped wedge cluster randomized controlled trial design may be the most successful trial design for the START intervention. In addition, the inclusion of a "credible messenger" to recruit participants into the study and the development of audiovisual resources for START would improve recruitment and effectiveness. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

Survivor's remorse.

ABSTRACT: In urban, large metropolitan trauma centers, we are accustomed to seeing the most gruesome morbidity and mortality in medicine. By far, the most devastating morbidity and mortality to observe are those inflicted on one human being to another. Gun violence is pervasive in this industrialized country, and it impacts us all. Staff, residents, and faculty in trauma centers bear the brunt of this trauma, second only to the families and communities that suffer the loss of loved ones. This burden is especially heavy for health care workers who share the same ethnic background of those who are disproportionately affected by interpersonal gun violence. Survivors of gun violence exist on a spectrum of chronic illness that ranges in physical and mental morbidity and social disruption in loss of wages and capabilities. This disease not only infects those wounded or killed but also transmits through communities and generations. Urban violence exists because of historic and systematic racism. It continues to persist because racism creates inequities in the quality of education, housing, and investment in urban environments, exacerbated by residential segregation. For two providers, a trainee and a faculty member of African descent, conscious of the determinants that create gun violence, it is overwhelming. We, as health care providers, must tell our stories and the stories of those whose voices are not empowered. We can hope that, by sharing these experiences, we stimulate action and change by raising the moral consciousness of those unaware of the tragedies we witness every day.

Trauma dental y lesiones faciales por armas de aire comprimido: reporte de un caso / Dental trauma and facial injuries by airguns: a case report

Las armas de aire comprimido son utilizadas desde hace muchos años con distintos usos que van desde el tiro recreativo hasta el control de plagas. Las más comunes son aquellas que disparan ''balines" o esferas metálicas que pueden llegar a tener capacidad de penetrar tejidos dependiendo del tipo de carga y de la longitud del cañón. Se presenta un caso clínico de un masculino que fue agredido con un arma tipo pistola con carga de CO2 que recibió un impacto a nivel facial y sufrió laceración en piel de labio y fractura dental complicada.

Air guns have been used for many years for a variety of purposes ranging from recreational shooting to pest control. The most common are those that shoot "pellets" or metallic spheres that can penetrate tissues depending on the type of load and the length of the barrel. A clinical case is presented of a male who was assaulted with a CO2-loaded pistol-type weapon, hit at facial level, and suffered laceration of the lip's skin and complicated dental fracture.

Tratamento de fratura órbito-zigomática decorrente de acidente com projétil de bala de borracha / Treatment of orbito-zygomatic fracture due to accident with rubber bullet project / Tratamiento de fractura orbito-cigomática por accidente com proyecto bala de goma

Objetivo: Relatar um caso clínico de um paciente com fratura zigomático orbitária vítima de tiro de bala de borracha e mostrar a importância de um planejamento adequado. Relato de caso: Paciente do sexo masculino, 19 anos de idade, deu entrada no Hospital de Urgências de Teresina, relatando ter sofrido uma agressão por bala de borracha durante uma manifestação. Foi observado no exame clínico: aumento de volume, equimose palpebral superior e dificuldade de abertura bucal. Na imagem foi observado, projétil de borracha na região zigomática esquerda, fraturas de zigoma com comunicação na região de pilar zigomático, fratura com deslocamento na região de margem Infraorbital e fratura na sutura fronto-zigomática. Foi proposto para o caso clínico, cirurgia sob anestesia geral com acesso intrabucal para fixação do pilar zigomático com placa do sistema 2.0mm, acesso superciliar para fixação da sutura fronto-zigomática com placa 1.5mm, e reconstrução do assoalho orbitário com malha de titânio. Conclusão: No pós-operatório o paciente não apresenta relato de enoftalmia, distopia ou diplopia, ausência de dor e déficits visuais.

Objective: To report a clinical case of a patient with zygomatic-orbital fracture, victim of rubber bullet shooting and show the importance of an adequate planning. Case Report: A 19-year-old male patient was admitted to the Teresina Emergency Hospital, reporting having suffered an aggression by rubber bullet during a demonstration. On clinical examination was observed: increased volume, upper eyelid ecchymosis and difficulty opening the mouth. In the image it was observed, rubber bullet in the left zygomatic region, zygoma fractures with communicationin the region of the zygomatic pillar, fracture with displacement in the region of infraorbital margin and fracture in the fronto-zygomatic suture. It was proposed for the clinical case, surgery under general anesthesia with intraoral access for fixation of the zygomatic pillar with a 2.0 mm plate, superciliary access for fixation of the fronto-zygomatic suture with a 1.5 mm plate, and reconstruction of the orbital floor with titanium mesh. Conclusion: Postoperatively, the patient did not report enophthalmia, dystopia or diplopia, absence of pain and visual deficits.

Objetivo: Informar de un caso clínico de un paciente confractura zigomática-orbital víctima de un disparo de bala de goma y mostrar la importancia de una planificación adecuada. Reporte de caso: Paciente masculino, de 19 años, fue admitido enel Hospital de Urgencias de Teresina, informando haber sufrido una agresión por bala de goma durante una manifestación. Se observó en elexamen clínico: aumento de volumen, equimosis del párpado superior y dificultad para abrir la boca. En la imagen se observó, bala de goma en la región cigomática izquierda, fractura del cigoma con comunicación en la región del pilar cigomático, fractura con desplazamiento en la región del margen infraorbitario y fractura en la sutura fronto-cigomática. Se propuso para el caso clínico, cirugía bajo anestesia general conacceso intraoral para fijacióndel pilar cigomáticocon sistema de placas de 2,0 mm, acceso superciliar para fijación de la sutura fronto-cigomática de placas de 1,5 mm, y reconstrucción del suelo orbitario con malla de titanio. Conclusión: En el post operatorio, la paciente no presentó informes de enoftalmia, distopía o diplopía, ausencia de dolor y déficit visual.

Project Inspire pilot study: A hospital-led comprehensive intervention reduces gun violence among juveniles delinquent of gun crimes.

BACKGROUND: Gun violence disproportionately affects young Black men, but the impact extends to families and communities. Those at highest risk are teens delinquent of gun crimes. While there is no nationally accepted juvenile rate of recidivism, previous literature reveals rearrest rates from 50% to 80% in high-risk youth, and some reports show that up to 40% of delinquent juveniles are incarcerated in adult prisons before the age of 25 years. We hypothesize that Project Inspire, a hospital-led comprehensive intervention, reduces recidivism among high-risk teens. METHODS: Led by a level 1 trauma center, key community stakeholders including the juvenile court, city, and city police department joined forces to create a community-wide program aimed at curbing gun violence in high-risk individuals. Participants, aged 13 to 18 years, are selected by the juvenile gun court. They underwent a rigorous 3-week program with a curriculum incorporating the following: trauma-informed training and confidence building, educational/professional development, financial literacy, entrepreneurship, and career-specific job shadowing and mentorship. Rates of recidivism were measured annually. RESULTS: Project Inspire has hosted two classes in 2018 and 2019, graduating nine participants aged 14 to 17 years. Sixty-seven percent were Black. All were males. At 1 year, none of the graduates reoffended. At 2 years, one participant reoffended. At 3 years, no additional participants reoffended. No graduate reoffended as a juvenile. Thus, the overall rate of recidivism for Project Inspire is 11% to date. Eighty-nine percent of graduates received a diploma, general educational development, or obtained employment. CONCLUSION: Project Inspire is a hospital-led initiative that effectively reduces recidivism among juveniles delinquent of gun crimes. This sets the framework for trauma centers nationwide to lead in establishing impactful, comprehensive, gun-violence intervention strategies. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level V.

Does lower use of academic affiliation by university faculty in top U.S. newspapers contribute to misinformation about abortion?

BACKGROUND: University faculty are considered trusted sources of information to disseminate accurate information to the public that abortion is a common, safe and necessary medical health care service. However, misinformation persists about abortion's alleged dangers, commonality, and medical necessity. METHODS: Systematic review of popular media articles related to abortion, gun control (an equally controversial topic), and cigarette use (a more neutral topic) published in top U.S. newspapers between January 2015 and July 2020 using bivariate analysis and logistic regression to compare disclosure of university affiliation among experts in each topic area. RESULTS: We included 41 abortion, 102 gun control, and 130 smoking articles, which consisted of 304 distinct media mentions of university-affiliated faculty. Articles with smoking and gun control faculty experts had statistically more affiliations mentioned (90%, n = 195 and 88%, n = 159, respectively) than abortion faculty experts (77%, n = 54) (p = 0.02). The probability of faculty disclosing university affiliation was similar between smoking and gun control (p = 0.73), but between smoking and abortion was significantly less (Ave Marginal Effects - 0.13, p = 0.02). CONCLUSIONS: Fewer faculty members disclose their university affiliation in top U.S. newspapers when discussing abortion. Lack of academic disclosure may paradoxically make these faculty appear less 'legitimate.' This leads to misinformation, branding abortion as a 'choice,' suggesting it is an unessential medical service. With the recent U.S. Supreme Court landmark decision, Dobbs v. Jackson Women's Health Organization, and subsequent banning of abortion in many U.S. states, faculty will probably be even less likely to disclose their university affiliation in the media than in the past.

Militarização da vida e avanço da violência de estado / Militarization of life and advancement of state violence

Procura-se neste artigo compreender as marcas da militarização como elemento estruturante do Estado na América Latina e, em especial, no Brasil. Toma-se como ponto de partida o protagonismo dos movimentos sociais nas lutas contra a violência de Estado e na elaboração do conhecimento sobre o que seriam essas formas de militarização. Busca-se problematizar tanto a permanência de processos de militarização quanto a sua intensificação em determinados momentos, e a percepção do atual avanço destas políticas e práticas que produzem também subjetividades que naturalizam e legitimam a violência de Estado.

Disfiguring Firearm Injuries in Children in the United States.

Firearms are a leading cause of injury and death among children in the United States. Most gun violence studies highlight mortality, but few have examined the morbidity in disfiguring injuries suffered by children. Using National Trauma Data Bank 2007-2015, children who suffered gunshot injuries and underwent procedures with lasting physical disfigurement formed the cohort of this study. We identified 28 593 children as victims of firearm injuries. Most were aged 13-18 (84%). There was a preponderance of male gender (86%) and black race/ethnicity (57%). Total mortality was 3774 (13%), and 1500 (5.4%) were identified with one or more disfigurements: 220 amputations, 191 craniectomy, 100 enucleation, 533 ileostomy/colostomy, and 557 tracheostomies. This report highlights the large toll firearm injuries take on American children, specifically in non-concealable disfigurements. These injuries are very impactful to their education and overall socialization and therefore must be a part of the discussion of gun violence in the United States.

Presença de risco de transtorno do estresse pós-traumático em policiais militares feridos por arma de fogo / Presence of risk of posttraumatic stress disorder in military police officers wounded by firearms / Presencia de riesgo de trastorno de estrés postraumático en policías militares heridos por armamiento de fuego

Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)

This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)

Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)

Physical violence in children and adolescents: a retrospective study of injuries to the head and neck region

Aim: This study aimed to investigate the prevalence of physical violence and head and neck injuries among children and adolescents who suffered physical aggression, firearm aggression, and white gun aggression referred to the Legal Medical Department in a southern city in Brazil. Methods: This study was performed at Legal Medical Department in the city of Pelotas, RS, Brazil, from January 2011 to December of 2015. Data were collected from medical reports of children and adolescents (0-19 years old). Demographic information such as sex, age, and skin color was collected. Data were submitted to Chi-square test and multivariate Poisson regression analysis. Results: In this study, 2,716 physical examination reports were analyzed, with a total of 2,171 exams resulting from violence; lesions that had physical aggression as their etiology (1,951) had a higher prevalence. The analysis of the exams revealed that the majority were adolescents (90,05%), white (84.09%), and female (50.21%). The head and neck regions were affected in most cases of violence (57.90%). In the adjusted model, the occurrence of injuries in the head and neck region was higher in males (PR 1.16, CI 95% 1.08 - 1.25), among adolescents (PR 1.28, CI 95% 1.10 - 1.48) and in victims of physical aggression compared to victims of the firearm (2.81, CI 95% 1.79 - 4.40). Conclusion: The results revealed a high prevalence of head and face injuries in victims of violence and that there was a greater prevalence of physical violence among adolescents compared to children and males

Tiros na escola: algumas referências para a psicologia na assistência à comunidade escolar / School shotting: some references for psychology in school comunity support / Tíros em la escuela: algunas referencias para la psicología em la asistencia à comunidad escolar

A atuação em situações de emergências e desastres apresentam-se como um dos grandes desafios na atuação dos profissionais da Psicologia, demandando intervenções singulares, desde o primeiro contato com as vítimas e o com entorno afetado pelo ocorrido, passando pelo trabalho interdisciplinar e interinstitucional junto aos órgãos públicos de segurança, justiça, assistência e saúde. O presente artigo tem como objetivo apresentar, por meio da experiência na assistência às vítimas na Escola Estadual Raul Brasil, as particularidades e adversidades enfrentadas durante o primeiro semestre de intervenções emergenciais que antecederam a contratação de psicólogos por parte do poder público municipal para continuidade das ações. Por meio de relatos de experiência em intervenções psicológicas, obtidos em diferentes instituições para a assistência às vítimas, este trabalho também visa apresentar alternativas que possam servir de referências para a intervenção do psicólogo e da psicóloga em situações de emergências e desastres, especialmente ocorridas na comunidade escolar. Observou-se que a realização do trabalho interdisciplinar e interinstitucional somado à participação da direção da escola no planejamento das ações e a realização de plantões psicológicos e rodas de conversa junto à comunidade escolar foram fundamentais para a assistência às vítimas do ocorrido.(AU)

Timely response to emergency and disaster situations is a major challenge for Psychology professionals and require particular interventions, from initial contact with the victims and the affected environment to interdisciplinary and interinstitutional collaboration with public security, justice, assistance and health agencies. Based on the experience of providing assistance to the victims of the State School Raul Brasil, this paper presents the adversities and specificities faced during the first semester of emergency interventions implemented before psychologists were hired by municipal officials for the continuity of care. By analyzing experience reports on psychological interventions obtained from different institutions for victim assistance, this paper proposes alternatives to be used as reference for psychological intervention in emergency and disaster situations, especially those experienced by the school community. Interdisciplinary and interinstitutional collaboration with the school board for planning actions and offering psychological services and conversation circles for the school community was fundamental to assist the victims.(AU)

La actuación en situaciones de emergencias es uno de los grandes desafíos a los profesionales de la psicología, pues demanda intervenciones singulares desde el primer contacto con las víctimas y con el contexto afectado por lo ocurrido, pasando por la interdisciplinaridad e interinstitucionalidad junto a los organismos públicos de seguridad, justicia, asistencia y salud. Este artículo tiene como objetivo presentar, por medio de la experiencia de la asistencia a las víctimas del colegio estadual Raul Brasil (en São Paulo, Brasil), las particularidades y adversidades enfrentadas durante el primer semestre de las intervenciones de emergencia que antecedieron la contratación de psicólogos por parte del municipio para continuidad de las acciones. Por medio de reportes de experiencia en intervenciones psicológicas, obtenidos en diferentes instituciones para la asistencia a las víctimas, este estudio también pretende presentar alternativas que puedan servir de referencia en la intervención de psicólogos y psicólogas en situaciones de emergencia y desastres, especialmente ocurridas en la comunidad escolar. Se verificó que la realización del trabajo interdisciplinar e interinstitucional, la participación de la dirección del colegio en la implementación de acciones y la realización de guardias psicológicas y círculos de conversación con la comunidad escolar fueron fundamentales para una asistencia a las víctimas.(AU)

A new pandemic and an old epidemic: The impact of COVID-19 and gun violence as measured by years of potential life lost in a US city.

BACKGROUND: The COVID-19 pandemic has altered daily life on a global scale and has resulted in significant mortality with >985,000 lives lost in the United States alone. Superimposed on the COVID-19 pandemic has been a concurrent worsening of longstanding urban gun violence. We sought to evaluate the impact attributable to these 2 major public health issues on the greater Louisville region as determined by years of potential life lost. METHODS: Using the Collaborative Jefferson County Firearm Injury Database, all firearm injuries from January 1, 2011 to December 31, 2021 were examined. The COVID-19 data was compiled from the Louisville Metro Department of Public Health and Wellness. Pre-COVID (March 1, 2019-February 29, 2020) and COVID (March 1, 2020-February 28, 2021) time intervals were examined. The demographics, outcomes data, and years of potential life lost were determined for the groups, and injury locations were geocoded. RESULTS: From 2011 to 2021, there were 6,043 firearm injuries in Jefferson County, Kentucky. During the COVID time interval, there were 4,574 years of potential life lost due to the SARS-CoV-2 virus and 9,722 years of potential life lost due to all-cause gun violence. In the pre-COVID time interval, there were 5,723 years of potential life lost due to all-cause gun violence. CONCLUSION: In Louisville, greater years of potential life lost were attributable to firearm fatalities than the SARS-CoV-2 virus. Given the impact of COVID-19, the robust response has been proportionate and appropriate. The lack of response to firearm injury and fatality is striking in comparison. Additional resources to combat the sequelae of gun violence are needed.

Prevalência de exposição às situações de violência vividas por estudantes adolescentes brasileiros / Prevalencia de la exposición a situaciones de violencia entre los estudiantes adolescentes brasileños / Prevalence of the exposure to situations of violence experienced by brazilian in-school adolescents

RESUMO Objetivo: descrever e comparar os indicadores de exposição a situações de violência vividas por estudantes adolescentes, de acordo com sexo, tipo de escola e unidades federadas nos anos de 2015 e 2019. Métodos: estudo transversal, descritivo com dados da Pesquisa Nacional de Saúde do Escolar (PeNSE). Foram descritas e comparadas as prevalências e seus respectivos intervalos de confiança de 95% (IC95%) dos indicadores de exposição às situações de violência envolvendo adolescentes. Resultados: apontaram que: faltaram à escola por insegurança no trajeto 11,6% (IC95%:11,1;12,1); faltaram à escola por insegurança na escola 10,8% (IC95%:10,3;11,2); maiores prevalências de violência foram nas meninas e em estudantes de escolas públicas. Dentre os indicadores do estudo, constatou-se a que a prevalência de escolares que estiveram envolvidos em briga com luta física foi de 10,6% (IC95%:10,2;11,0), em briga com utilização de arma de fogo 2,9% (IC95%:2,7;3,1) e uso de arma branca foi de 4,8% (IC95%:4,5;5,1), dos quais a maioria eram meninos que estudavam em escolas públicas. Relataram ter sofrido acidente ou agressão no último ano 18,2% (IC95%:17,7;18,7) e 21,0% (IC95%:20,5;21,6), tendo sido agredidos pela mãe/pai/responsável e a maioria oriunda de escolas particulares. Ocorreu melhorias nos seguintes indicadores entre 2015 e 2019: envolver-se em briga com arma de fogo, de 6,4% (IC95%: 5,6;7,2) em (2015) para 2,9% (IC95%:2,7;3,1) (2019); e envolver-se em briga com arma branca, de 7,9% (IC95%:7,0;8,8) (2015) para 4,8% (IC95%:4,5;5,1) em (2019). Conclusão: os adolescentes estão expostos a violências no âmbito escolar ou comunitária, além de sofrerem violências no ambiente intrafamiliar/doméstico. Essas instituições deveriam ser capazes de garantir a proteção e o desenvolvimento saudável e seguro do adolescente.

RESUMEN Objetivo: describir y comparar los indicadores de exposición a situaciones de violencia de los estudiantes adolescentes según género, tipo de escuela y unidades federadas, en 2015 y 2019. Métodos: estudio transversal, descriptivo con datos de la Encuesta Nacional de Salud Escolar. Se describieron y compararon la prevalencia y los respectivos intervalos de confianza del 95% (IC95%) de los indicadores de exposición a situaciones de violencia que afectan a los adolescentes. Resultados: se registraron ausencias escolares: por inseguridad en el camino a la escuela 11,6% (IC95%:11,1;12,1); por inseguridad en la escuela 10,8% (IC95%:10,3;11,2); la mayor prevalencia fue entre las niñas y los estudiantes de escuelas públicas. Entre los indicadores del estudio: la prevalencia de alumnos implicados en peleas con lucha física fue del 10,6% (IC95%:10,2;11,0), en peleas con armas de fuego del 2,9% (IC95%:2,7;3,1); uso de arma blanca del 4,8% (IC95%:4,5;5,1), la mayoría de ellos eran varones, que estudiaban en escuelas públicas. El 18,2% (IC95%:17,7;18,7) declaró haber sufrido un accidente o una agresión en el último año, el 21,0% (IC95%:20,5;21,6) fue agredido por su madre/padre/cuidador y la mayoría procedía de colegios privados. Se produjeron mejoras en los siguientes indicadores entre 2015 y 2019: involucrarse en una pelea con un arma de fuego, del 6,4% (IC 95%:5,6;7,2) en (2015) al 2,9% (IC 95%:2,7;3,1) (2019); involucrarse en una pelea con un cuchillo: del 7,9% (IC 95%:7,0;8,8) (2015) al 4,8% (IC 95%:4,5;5,1) en (2019). Conclusión: los adolescentes están expuestos a la violencia en el ámbito escolar o comunitario, además de sufrirla en el entorno intrafamiliar/doméstico. Estas instituciones deben ser capaces de garantizar la protección y el desarrollo sano y seguro del adolescente.

ABSTRACT Objective: to describe and compare the indicators corresponding to exposure to situations of violence experienced by in-school adolescents according to gender, type of school and Federation Units in 2015 and 2019. Methods: A cross-sectional and descriptive study conducted with data from the National School Health Survey (Pesquisa Nacional de Saúde do Escolar, PeNSE). The prevalence values and their respective 95% confidence intervals (85% CIs) of the indicators corresponding to exposure to situations of violence involving adolescents were described and compared. Results: They pointed out that: 11.6% missed classes due to insecurity on the way (95% CI: 11.1-12.1); 10.8% missed classes due to insecurity at school (95% CI: 10.3-11.2); and the highest prevalence values of violence were recorded among girls and public school students. Among the study indicators, it was found that the prevalence of students who were involved in physical fights was 10.6% (95% CI: 10.2-11.0), in fights with firearm use, 2.9% (95% CI: 2.7-3.1), and in fights with melee weapon use, 4.8% (95% CI: 4.5-5.1), most of them boys who attended public schools. 18.2% (95% CI: 17.7-18.7) reported having suffered an accident or aggression in the last year and 21.0% (95% CI: 20.5-21.6) stated having been assaulted by their mother/father/guardian, most of them from private schools. There were improvements in the following indicators between 2015 and 2019: engaging in a fight involving a firearm, from 6.4% (95% CI: 5.6-7.2) in 2015 to 2.9% (95% CI: 2.7-3.1) in 2019; and engaging in a fight involving a melee weapon, from 7.9% (95% CI: 7.0-8.8) in 2015 to 4.8% (95% CI: 4.5-5.1) in 2019. Conclusion: Adolescents are exposed to several types of violence in the school or community settings, in addition to experiencing violence in the family/domestic environment. These institutions should be capable of ensuring protection and healthy and safe development to adolescents.

Development and Implementation of a Novel Case-Based Gun Violence Prevention Training Program for First-Year Residents.

PROBLEM: Gun violence results in approximately 40,000 deaths in the United States each year, yet physicians rarely discuss gun access and firearm safety with patients. Lack of education about how to have these conversations is an important barrier, particularly among trainees. APPROACH: A 2-part training curriculum was developed for first-year residents. It included (1) a didactic presentation outlining a framework to understand types of firearm-related violence, describing institutional resources, and reviewing strategies for approaching discussions about firearms with patients, and (2) interactive case scenarios, adjusted for clinical disciplines, with standardized patients. Before and after the training, participants completed surveys on the training's relevance, efficacy, and benefit. Standardized patients provided real-time feedback to participants and completed assessments based on prespecified learning objectives. OUTCOMES: In June-August 2019, 148 first-year residents in internal medicine (n = 74), general surgery (n = 12), emergency medicine (n = 15), pediatrics (n = 22), psychiatry (n = 16), and OB/GYN (n = 9) completed the training. Most (70%, n = 104) reported having no prior exposure to gun violence prevention education. Knowledge about available resources increased among participants from 3% (n = 5) pretraining to 97% (n = 143) post-training. Awareness about relevant laws, such as Extreme Risk Protection Orders, and their appropriate use increased from 3% (n = 4) pretraining to 98% (n = 145) post-training. Comfort discussing access to guns and gun safety with patients increased from a median of 5 pretraining to 8 post-training (on a scale of 1-10, with higher scores indicating more comfort). NEXT STEPS: Delivery of a case-based gun violence prevention training program was effective and feasible in a single institution. Next steps include expanding the training to other learners (across undergraduate and graduate medical education) and institutions and assessing how the program changes practice over time.

The association between food insecurity and gun violence in a major metropolitan city.

BACKGROUND: Food insecurity (FI) is an important social determinant of health that is associated with many forms of violence. We hypothesized that FI would be associated with gun violence. METHODS: Firearm injury data was collected from 2016 to 2020 (n = 3115) at a single institution that serves as the only Level I trauma center in a major southern US city. The data were linked with Map the Meal Gap data, a publicly available data set, which estimates rates of county-level FI based on state-level FI and social determinants, including unemployment, poverty, disability, and other factors. Regression analysis was utilized to examine the relationship between FI with rates of overall gun trauma and odds of gun-related violence. Food insecurity by county of patient residence was categorized by rates less than the national average of 11.5% (low), between the national and state average (16.5%) (moderate), and greater than the state average (high). Out of state residents were excluded from the analyses. RESULTS: Of the 3,115 patients with firearm injuries identified, 138 (4.4%) resided in counties with low FI rates, 1048 (33.6%) in moderate FI, and 1929 (62.0%) in counties with high FI. Patients in regions of high FI were more likely to be a Level I trauma activation, a victim of assault, and have Medicaid or be self-pay. There was no significant difference in mortality by levels of FI. Food insecurity was significantly associated with firearm injury, with each percent increase in FI being related to approximately 56 additional gun-related injuries per 100,000 people (95% confidence interval, 54-59) and increased odds of the injury classified as assault (odds ratio, 1.13; 95% confidence interval, 1.07-1.19). CONCLUSION: Violence prevention initiatives targeting food insecure communities may help alleviate the US gun violence epidemic. Further, trauma center screening for household FI and in-hospital interventions addressing FI may help reduce gun violence recidivism. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.

States should use Medicaid to support violence intervention efforts.

ABSTRACT: In recent years, calls to address gun violence through public health approaches have increased. However, securing funding for health-based community violence intervention models has remained a challenge. New actions suggest that this may be shifting. Upon taking office, the Biden administration announced a series of funding opportunities for these programs, which ranged from competitive grant programs to a proposed 8-year, $5 billion plan. Less publicized, but just as important, is the administration's announcement that Medicaid can be used to reimburse this work, specifically noting the eligibility of hospital-based violence intervention and prevention programs. For these programs, this creates a predictable and reliable funding source that has not existed to date. This integration of violence prevention programming in the traditional health care and financing systems represents a critical inflection point in the United States' shifting response to community violence. However, the decision to use this optional benefit lies with each state. States should strongly consider harnessing Medicaid as a wise investment to address the United States' gun violence epidemic. LEVEL OF EVIDENCE: Economic and value-based evaluation, level IV.

An analysis of American physician professional statements about gun violence against children.

BACKGROUND: We examine the content of physician professional association statements and assess the extent to which these statements kept gun violence-especially against children-on policymakers' agendas. METHODS: After constructing a list of U.S. physician professional associations, we located position statements by consulting association websites, conducting a PubMed search, and reviewing the citations of identified statements. Once unique statements were identified (N = 32), two reviewers independently coded content such as major events, pediatric focus, firearm type, and policy recommendations. RESULTS: Recent statements appear to be timed following mass casualty events such as the Sandy Hook and Parkland school shootings. Associations have increasingly adopted public health framing over time. Nine statements focused on the pediatric population, while an additional 13 made reference to the pediatric population. The most common recommendations include increased gun violence research or research funding (84%), freedom of physician counseling (75%), mandatory background checks (72%), and safe storage (72%). CONCLUSION: Based on this analysis, recent statement volume appears to be tied to current events rather than keeping daily gun violence against children continuously on the agenda. Mentions of "gun control" have receded over time and have been replaced by public health framing that places advocacy for firearm injury prevention in the physician's domain. LEVEL OF EVIDENCE: III/IV.