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1.
Bull World Health Organ ; 98(3): 170-176, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32132751

RESUMEN

Objective: To assess the effect of a permanent gun-carrying restriction on gun-related mortality in Colombia between 2008 and 2014, and determine differences in the effect of the restriction by place of death and sex. Methods: In 2012, Bogotá and Medellín introduced a permanent gun-carrying restriction. We compared gun-related mortality rates in these cities (intervention cities) with the rates in all other Colombian cities with more than 500 000 inhabitants (control cities). We used data from the Colombian National Department of Statistics to calculate monthly gun-related mortality rates between 2008 and 2014 for intervention and control cities. We used a differences-in-differences method with fixed effects to assess differences in gun-related mortality in intervention and control cities before and after the introduction of the gun-carrying restriction. We stratified effects by place of death (public area or residence) and sex. We made robustness checks to test the assumptions of the models. Findings: Gun-related deaths in the control and intervention cities decreased between 2008 and 2014; however, the decrease was greater in the intervention cities (from 20.29 to 14.93 per 100 000 population; 26.4%) than in the control cities (from 37.88 to 34.56 per 100 000 population; 8.8%). The restriction led to a 22.3% reduction in the monthly gun-related mortality rate in Bogotá and Medellín. The reduction was greater in public areas and for males. Robustness checks supported the assumptions of the models. Conclusion: The permanent restriction on carrying guns reduced gun-related deaths. This policy could be used to reduce gun-related injuries in urban centres of other countries with large numbers of gun-related deaths.


Asunto(s)
Armas de Fuego/legislación & jurisprudencia , Homicidio/estadística & datos numéricos , Mortalidad , Suicidio/estadística & datos numéricos , Heridas por Arma de Fuego/mortalidad , Colombia , Femenino , Humanos , Masculino , Propiedad
3.
Am J Public Health ; 110(2): 230-236, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31855477

RESUMEN

Objectives. To test whether year-over-year strengthening of state-level firearm laws is associated with decreases in workplace homicide rates.Methods. In this time-series ecological study of working people in all 50 US states, we used federal data on workplace homicides by state and year from 2011 to 2017, linked to an index of state-year firearm laws, to characterize the regulatory environment (overall and within legislative categories). We used generalized linear regression to model associations between changes in firearm laws and changes in workplace homicide rates the following year.Results. From 2011 to 2017, more than 3000 people died as a result of workplace homicides; over that period, 23 states strengthened firearm regulations and 23 weakened them. We modeled the impact of states strengthening laws within the interquartile range (IQR; equivalent to adding 20.5 firearm laws). This change was associated with a 3.7% reduction in the workplace homicide rate (95% confidence interval [CI] = -3.86, -3.51). Positive IQR changes in specific categories of firearm laws-concealed carry permitting (-5.79%; 95% CI = -6.09, -3.51), domestic violence-related restrictions (-5.31%; 95% CI = -5.57, -5.05), and background checks (-5.07%; 95% CI = -5.32, -4.82)-were also associated with significant reductions.Conclusions. Strengthening state-level firearm laws may reduce the population-level mortality and morbidity burden posed by workplace homicides.


Asunto(s)
Armas de Fuego/legislación & jurisprudencia , Homicidio/estadística & datos numéricos , Lugar de Trabajo/estadística & datos numéricos , Heridas por Arma de Fuego/mortalidad , Estudios Transversales , Armas de Fuego/estadística & datos numéricos , Homicidio/tendencias , Humanos , Estados Unidos
5.
Pediatrics ; 144(6)2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31767715

RESUMEN

OBJECTIVES: To investigate nonpowder firearm injuries treated in US emergency departments among children <18 years old. METHODS: National Electronic Injury Surveillance System data from 1990 through 2016 were analyzed. RESULTS: An estimated 364 133 (95% confidence interval 314 540-413 727) children <18 years old were treated in US emergency departments for injuries related to nonpowder firearms from 1990 to 2016, averaging 13 486 children annually. From 1990 to 2016, the number and rate of nonpowder firearm injuries decreased by 47.8% (P < .001) and 54.5% (P < .001), respectively. Most injuries occurred among 6- to 12-year-olds (47.4%) and 13- to 17-year-olds (47.0%). Boys accounted for 87.1% of injured children, the most common diagnosis was foreign body (46.3%), and 7.1% of children were admitted. BB guns accounted for 80.8% of injuries, followed by pellet guns (15.5%), paintball guns (3.0%), and airsoft guns (0.6%). The rate of eye injuries increased by 30.3% during the study period. Eye injuries accounted for 14.8% of all injuries and the most common diagnoses were corneal abrasion (35.1%), hyphema (12.5%), globe rupture (10.4%), and foreign body (8.6%). CONCLUSIONS: Although the number and rate of nonpowder firearm injuries declined during the study period, nonpowder firearms remain a frequent and important source of preventable and often serious injury to children. The severity and increasing rate of eye injuries related to nonpowder firearms is especially concerning. Increased prevention efforts are needed in the form of stricter and more consistent safety legislation at the state level, as well as child and parental education regarding proper supervision, firearm handling, and use of protective eyewear.


Asunto(s)
Servicio de Urgencia en Hospital , Heridas por Arma de Fuego/epidemiología , Adolescente , Niño , Preescolar , Contusiones/epidemiología , Lesiones Oculares/epidemiología , Femenino , Armas de Fuego/legislación & jurisprudencia , Cuerpos Extraños/epidemiología , Fracturas Óseas/epidemiología , Humanos , Laceraciones/epidemiología , Masculino , Estudios Retrospectivos , Estados Unidos/epidemiología , Heridas por Arma de Fuego/prevención & control , Heridas por Arma de Fuego/terapia
6.
South Med J ; 112(11): 581-585, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31682739

RESUMEN

OBJECTIVES: The number of deaths from gun violence continues to increase in the United States. Despite multiple studies demonstrating that counseling patients leads to safer gun storage, it is not routinely practiced by physicians. There are multiple barriers to discussing firearms with patients. A barrier in Florida, until recently, was a law preventing physicians from asking patients about firearms. The law was overturned in 2017; however, it is unclear whether physicians are aware of this decision. We undertook a survey to study University of Florida faculty physicians' knowledge, attitudes, and practices related to discussing firearms safety. METHODS: The survey consisted of 15 questions related to firearms and counseling. Invitations to participate were e-mailed in 2018 to faculty in general internal medicine, emergency medicine, and surgery within our institution. RESULTS: The response rate was 50% (n = 71/142). The majority of faculty surveyed did not own a gun (56%). Ninety-one percent of faculty surveyed agreed that "gun violence is a public health issue" and 93% agreed that gun safety discussion with patients at risk for suicidal or violent behavior is important. More than half of the respondents (62%) believed they could effectively discuss firearms safety with patients; 73% strongly agreed or agreed that they would discuss gun safety with at-risk patients, whereas 27% were either neutral or disagreed. Fewer still (55%) feel comfortable initiating conversations, and only 5% of participants always talk to at-risk patients about gun safety. Twenty-four percent discussed gun safety most of the time, 30% discussed it sometimes, 32% rarely discussed it, and 9% never discussed it; 76% were aware of the 2017 court decision overturning the physician gag law in Florida. The most-often cited barriers to discussions included lack of time (36%), worry about negative reaction from patient (30%), worry about lack of support from administration (13%), and lack of knowledge (20%). Gun owners and nonowners differed significantly on only two survey items: having taken a firearms safety course (gun owners more likely, relative risk 1.63, 95% confidence interval 1.16-2.29, P = 0.001) and agreeing with gun violence being a public health issue (gun owners being less likely, relative risk 1.24, 95% confidence interval 1.03-1.49, P = 0.006). CONCLUSIONS: Faculty miss opportunities to prevent gun violence despite acknowledging that it is important to do so. More than 40% of the physicians who were surveyed do not counsel at-risk patients about gun safety, citing a lack of knowledge, a persisting belief that asking patients about guns in Florida is illegal, worry about negative patient reactions, and time limitations. Inaction persists despite increased awareness and activism by physicians regarding gun violence. A wider availability of continuing medical education opportunities to learn about firearms counseling should be considered.


Asunto(s)
Actitud del Personal de Salud , Armas de Fuego , Propiedad , Médicos/estadística & datos numéricos , Consejo , Armas de Fuego/legislación & jurisprudencia , Florida , Humanos , Relaciones Médico-Paciente , Encuestas y Cuestionarios
9.
West J Emerg Med ; 20(5): 818-821, 2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31539340

RESUMEN

INTRODUCTION: Suicide is the 10th leading cause of death in the United States. An estimated 50% of these deaths are due to firearms. Suicidal ideation (SI) is a common complaint presenting to the emergency department (ED). Despite these facts, provider documentation on access to lethal means is lacking. Our primary aim was to quantify documentation of access to firearms in patients presenting to the ED with a chief complaint of SI. METHODS: This was a cross-sectional study of consecutive patients, nearly all of whom presented to an academic, urban ED with SI during July 2014. We collected data from all provider documentation in the electronic health record. Primary outcome assessed was whether the emergency physician (EP) team documented access to firearms. Secondary outcomes included demographic information, preexisting psychiatric diagnoses, and disposition. RESULTS: We reviewed 100 patient charts. The median age of patients was 38 years. The majority of patients had a psychiatric condition. EPs documented access to firearms in only 3% of patient charts. CONCLUSION: EPs do not adequately document access to firearms in patients with SI. There is a clear need for educational initiatives regarding risk-factor assessment and counseling against lethal means in this patient cohort.


Asunto(s)
Documentación , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Armas de Fuego/legislación & jurisprudencia , Médicos/estadística & datos numéricos , Ideación Suicida , Suicidio/prevención & control , Adulto , Anciano , Consejo , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suicidio/legislación & jurisprudencia , Estados Unidos , Adulto Joven
11.
Pediatrics ; 144(2)2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31308258

RESUMEN

BACKGROUND: Firearms are the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, 3 state laws were associated with a reduction in overall deaths from firearms: universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirement for firearms. We sought to determine if stricter firearm legislation at the state level is associated with lower pediatric firearm-related mortality. METHODS: This was a cross-sectional study in which we used 2011-2015 Web-based Injury Statistics Query and Reporting System and Census data. We measured the association of the (1) strictness of firearm legislation (gun law score) and (2) presence of the 3 aforementioned gun laws with pediatric firearm-related mortality. We performed negative binomial regression accounting for differences in state-level characteristics (population-based race and ethnicity, education, income, and gun ownership) to derive mortality rate ratios associated with a 10-point change in each predictor and predicted mortality rates. RESULTS: A total of 21 241 children died of firearm-related injuries during the 5-year period. States with stricter gun laws had lower rates of firearm-related pediatric mortality (adjusted incident rate ratio 0.96 [0.93-0.99]). States with laws requiring universal background checks for firearm purchase in effect for ≥5 years had lower pediatric firearm-related mortality rates (adjusted incident rate ratio 0.65 [0.46-0.90]). CONCLUSIONS: In this 5-year analysis, states with stricter gun laws and laws requiring universal background checks for firearm purchase had lower firearm-related pediatric mortality rates. These findings support the need for further investigation to understand the impact of firearm legislation on pediatric mortality.


Asunto(s)
Armas de Fuego/legislación & jurisprudencia , Heridas por Arma de Fuego/mortalidad , Adolescente , Niño , Estudios Transversales , Femenino , Homicidio/legislación & jurisprudencia , Homicidio/tendencias , Humanos , Masculino , Mortalidad/tendencias , Suicidio/legislación & jurisprudencia , Suicidio/tendencias , Estados Unidos/epidemiología , Heridas por Arma de Fuego/diagnóstico , Adulto Joven
12.
Am J Med ; 132(8): 992-994, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31164193

RESUMEN

BACKGROUND: Mortality from firearms among US schoolchildren is an increasingly major clinical and public health crisis. We explored temporal trends in mortality from firearms among US schoolchildren from 1999 to 2017 by age and race. METHODS: We used the Multiple Cause of Death Files of the United States National Center for Health Statistics; PubMed searches, and joinpoint regressions for trend analyses and calculated mortality rates and 95% confidence limits. RESULTS: From 1999 to 2017, the 38,942 deaths due to firearms in school-age children ranged from 340 per year at ages 5-14 to 2050 at 15-18 years. One epidemic among 5- to 14-year-olds began in 2009 and another among 15- to 18-year-olds began in 2014. The listed intents were 61% assault, 32% suicide, 5% accidental, and 2% undetermined. Blacks accounted for 41% of overall deaths, but only 17% of the school-age deaths. 86% of all deaths were boys. CONCLUSIONS: Mortality from firearms in US schoolchildren is increasing at alarming rates, especially among blacks and those aged 15-18 years. To the best of our knowledge, this is the first report to quantify these recent epidemics. Although federal laws prohibited them until recently, analytic studies designed a priori to do so are necessary to test the hypotheses generated by these descriptive data. We believe that combatting the epidemic of mortality from firearms among US schoolchildren without addressing firearms is analogous to combatting the epidemic of mortality from lung cancer from cigarettes without addressing cigarettes.


Asunto(s)
Armas de Fuego/estadística & datos numéricos , Heridas por Arma de Fuego/mortalidad , Adolescente , Causas de Muerte/tendencias , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Femenino , Armas de Fuego/legislación & jurisprudencia , Humanos , Masculino , Estados Unidos/epidemiología , Heridas por Arma de Fuego/epidemiología
13.
Pediatrics ; 144(1)2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31235607

RESUMEN

Firearm injuries are the second most common cause of death in children who come to a trauma center, and pediatric surgeons provide crucial care for these patients. The American Pediatric Surgical Association (APSA) is committed to comprehensive pediatric trauma readiness, including firearm injury prevention. The APSA supports a public health approach to firearm injury, and it supports availability of quality mental health services. The APSA endorses policies for universal background checks, restrictions on assault weapons and high-capacity magazines, strong child access protection laws, and a minimum purchase age of 21 years. The APSA opposes efforts to keep physicians from counseling children and families about firearms. The APSA promotes research to address this problem, including increased federal research support and research into the second victim phenomenon. The ASPA supports school safety and readiness, including bleeding control training. Although it may be daunting to try to reduce firearm deaths in children, the United States has seen success in reducing motor vehicle deaths through a multidimensional approach: prevention, design, policy, behavior, and trauma care. The ASPA believes that a similar public health approach can succeed in saving children from death and injury from firearms. The ASPA is committed to building partnerships to accomplish this.


Asunto(s)
Armas de Fuego/legislación & jurisprudencia , Heridas por Arma de Fuego/prevención & control , Niño , Consejo , Primeros Auxilios , Homicidio/prevención & control , Homicidio/estadística & datos numéricos , Humanos , Incidentes con Víctimas en Masa/prevención & control , Incidentes con Víctimas en Masa/estadística & datos numéricos , Servicios de Salud Mental , Pediatría , Rol del Médico , Instituciones Académicas , Sociedades Médicas , Especialidades Quirúrgicas , Trastornos por Estrés Postraumático , Suicidio/prevención & control , Suicidio/estadística & datos numéricos , Estados Unidos/epidemiología , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/terapia
15.
Behav Sci Law ; 37(3): 270-280, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31087580

RESUMEN

Firearm legislation is associated with statewide suicide rates; however, prior research has often relied upon older data and categorical legislative grades while also failing to consider the nuanced role of firearm ownership. Therefore, the robust literature base on legislation and suicide has not directly examined regarding the extent to which the value of legislation hinges upon the rate of firearm ownership in a given state. The current study examined 2015 US statewide firearm legislation strength scores from Giffords Law Center to Prevent Gun Violence and 2016 statewide suicide rates from the Centers for Disease Control and Prevention. Firearm legislation strength was inversely associated with statewide overall and firearm suicide rates, but not with non-firearm suicide rates. Firearm ownership rates moderated the association between firearm legislation strength and statewide overall suicide rates. Specifically, firearm legislation strength was inversely associated with statewide overall suicide rates at mean and high levels of firearm ownership. Findings support the potential utility of firearm legislation as part of a national effort to decrease US suicide deaths, particularly in areas with higher firearm ownership rates.


Asunto(s)
Armas de Fuego/legislación & jurisprudencia , Armas de Fuego/estadística & datos numéricos , Propiedad/legislación & jurisprudencia , Propiedad/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Correlación de Datos , Estudios Transversales , Violencia con Armas/legislación & jurisprudencia , Violencia con Armas/estadística & datos numéricos , Humanos , Masculino , Estados Unidos
16.
J Pediatr Surg ; 54(7): 1269-1276, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31079862

RESUMEN

Firearm injuries are the second most common cause of death in children who come to a trauma center, and pediatric surgeons provide crucial care for these patients. The American Pediatric Surgical Association (APSA) is committed to comprehensive pediatric trauma readiness, including firearm injury prevention. APSA supports a public health approach to firearm injury, and it supports availability of quality mental health services. APSA endorses policies for universal background checks, restrictions on assault weapons and high capacity magazines, strong child access protection laws, and a minimum purchase age of 21 years. APSA opposes efforts to keep physicians from counseling children and families about firearms. APSA promotes research to address this problem, including increased federal research support and research into the second victim phenomenon. APSA supports school safety and readiness, including bleeding control training. While it may be daunting to try to reduce firearm deaths in children, the U.S. has seen success in reducing motor vehicle deaths through a multidimensional approach - prevention, design, policy, behavior, trauma care. APSA believes that a similar public health approach can succeed to save children from death and injury from firearms. APSA is committed to building partnerships to accomplish this. TYPE OF STUDY: APSA Position Statement. LEVEL OF EVIDENCE: Level V, Expert Opinion.


Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Armas de Fuego , Servicios de Salud Mental/organización & administración , Instituciones Académicas/organización & administración , Sociedades Médicas/legislación & jurisprudencia , Heridas por Arma de Fuego/prevención & control , Niño , Armas de Fuego/legislación & jurisprudencia , Humanos , Política Pública , Centros Traumatológicos , Estados Unidos/epidemiología , Heridas por Arma de Fuego/epidemiología
18.
Epidemiology ; 30(3): 371-379, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30969945

RESUMEN

In the comparative interrupted time series design (also called the method of difference-in-differences), the change in outcome in a group exposed to treatment in the periods before and after the exposure is compared with the change in outcome in a control group not exposed to treatment in either period. The standard difference-in-difference estimator for a comparative interrupted time series design will be biased for estimating the causal effect of the treatment if there is an interaction between history in the after period and the groups; for example, there is a historical event besides the start of the treatment in the after period that benefits the treated group more than the control group. We present a bracketing method for bounding the effect of an interaction between history and the groups that arises from a time-invariant unmeasured confounder having a different effect in the after period than the before period. The method is applied to a study of the effect of the repeal of Missouri's permit-to-purchase handgun law on its firearm homicide rate. We estimate that the effect of the permit-to-purchase repeal on Missouri's firearm homicide rate is bracketed between 0.9 and 1.3 homicides per 100,000 people, corresponding to a percentage increase of 17% to 27% (95% confidence interval: 0.6, 1.7 or 11%, 35%). A placebo study provides additional support for the hypothesis that the repeal has a causal effect of increasing the rate of state-wide firearm homicides.


Asunto(s)
Métodos Epidemiológicos , Armas de Fuego/legislación & jurisprudencia , Homicidio/estadística & datos numéricos , Humanos , Missouri/epidemiología
19.
JAMA Netw Open ; 2(4): e191736, 2019 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-30951161

RESUMEN

Importance: Increased understanding of public response to mass shootings could guide public health planning regarding firearms. Objectives: To test the hypothesis that mass shootings are associated with gun purchasing in the United States and to determine factors associated with gun purchasing changes. Design and Setting: In a cross-sectional study, monthly data on US background checks for all firearm purchases, handgun permits, and long gun permits between November 1, 1998, and April 30, 2016, were obtained from the National Instant Criminal Background Check System. All mass shootings resulting in 5 or more individuals injured or killed during the study period were also identified. Interrupted autoregressive integrated moving average time-series modeling was used to identify events associated with changes in gun purchase volume. Then, logistic regression was used to identify event characteristics associated with changes in gun purchases. Analyses were performed between June 6, 2016, and February 5, 2019. Exposures: For the time-series analysis, each mass shooting was modeled as an exposure. In the logistic regression, examined factors were the shooter's race/ethnicity, the region in the United States in which a shooting occurred, whether a shooting was school related, fatalities, handgun use, long gun use, automatic or semiautomatic gun use, media coverage level, and state political affiliation. Main Outcomes and Measures: Identification of major mass shootings significantly associated with changes in gun purchases, and the identification of event-specific factors associated with changes in gun purchases. Results: Between November 1998 and April 2016, 124 major mass shootings and 233 996 385 total background checks occurred. A total of 26 shootings (21.0%) were associated with increases in gun purchases and 22 shootings (17.7%) were associated with decreases in gun purchasing. Shootings receiving extensive media coverage were associated with handgun purchase increases (odds ratio, 5.28; 95% CI, 1.30-21.41; P = .02). Higher-fatality shootings had an inverse association with handgun purchase decreases (odds ratio, 0.73; 95% CI, 0.53-1.00; P = .049). Conclusions and Relevance: The findings of this study suggest an association between mass shootings and changes in gun purchases, observed on a comprehensive timescale. Identification of media coverage and fatalities as significant factors underlying this association invites further study into the mechanisms driving gun purchase changes, holding implications for public health response to future gun violence.


Asunto(s)
Armas de Fuego/economía , Análisis de Series de Tiempo Interrumpido/métodos , Incidentes con Víctimas en Masa/estadística & datos numéricos , Heridas por Arma de Fuego/epidemiología , Estudios Transversales , Grupos Étnicos , Armas de Fuego/legislación & jurisprudencia , Armas de Fuego/estadística & datos numéricos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Incidentes con Víctimas en Masa/historia , Incidentes con Víctimas en Masa/mortalidad , Proyectos de Investigación , Estados Unidos/epidemiología , Heridas por Arma de Fuego/etnología , Heridas por Arma de Fuego/mortalidad
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