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1.
Rev Bras Epidemiol ; 23 Suppl 1: e200002.SUPL.1, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32638986

RESUMO

OBJECTIVE: To describe the notifications of interpersonal and self-inflicted firearm violence in adolescents and to identify the factors associated with the notification of this event. METHODOLOGY: Cross-sectional study analyzing data from Sinan from 2011 to 2017, in adolescents aged 10-19 years, injured by firearms. The χ2 test was used to verify the gender ratio difference. Correlation analysis and multiple linear regression were performed between the logarithm of the firearm notification rate and each independent variable, in a sample of large municipalities. RESULTS: There were 30,103 reports of firearm violence in adolescents, of which (74.7%) were males aged 15-19 years (83.8%). Among girls, violence is more common at home, with a known perpetrator, and with physical and sexual violence combined. The death rate by firearms was higher in Fortaleza, Maceió, João Pessoa, Salvador and Natal, ranging from 105.88 to 71.73 per 100 thousand. Higher notification rates of firearm violence were associated with higher firearm death rates and greater coverage of health facilities. CONCLUSION: Firearm violence is a major public health problem in adolescents. Attacks on the disarmament statute and the loosening of gun possession and ownership directly confront the present and future of children and adolescents.


Assuntos
Violência com Arma de Fogo/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Cidades/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Adulto Jovem
3.
Rev Col Bras Cir ; 47: e20202506, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32555969

RESUMO

PURPOSE: Civil violence is responsible for 2.5% of deaths worldwide; it killed more people in the 21st century than the sum of all wars. This study describes violence victims treated at a trauma reference hospital in Salvador, Brazil and analyzes the impact of different types of interpersonal violence. METHODS: Interpersonal violence victims admitted between July 2015 and July 2017 were included. The 1,296 patients (mean age: 30.3 years; 90% male) were divided into three groups according to the mechanism of interpersonal violence: 1) beating, 2) firearm injury and 3) stab wound (STW) injury. The groups were compared for the following variables: age, gender, trauma mechanism, Revised Trauma Score (RTS) at admission, need for intensive care unit (ICU) attention, length of hospital stay, need for transfusion of blood products and death. RESULTS: Gunshot wounds (GSW) were the primary mechanism of injury (59%), followed by beating (24%) and STW (17%). Gunshot wound victims had a lower mean RTS upon admission, increased need for blood products and more Intensive Care Unit (ICU) admissions. Beating victims had the longest mean hospital stay (11.6 ± 19.6 days). The GSW group accounted for 77.4% of all deaths. The in-hospital mortality rate was significantly higher in the GSW group (12.7%) than in the beating group (5.4%) and in the STW group (4.9%). CONCLUSIONS: Gunshot wound victims are more critical: they require longer ICU stays, more transfusions of blood products and exhibit increased mortality compared with STW and beating victims.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Violência/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
4.
J Forensic Sci ; 65(4): 1386-1387, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32510615
5.
Rev Col Bras Cir ; 47: e20202523, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32520133

RESUMO

The nonoperative treatment of anterior abdominal gunshot wounds remains controversial. This article presents a narrative review of the literature after the selection of studies in electronic databases (PubMed, Cochrane Library and Lilacs), with the intention of evaluating the clinical and diagnostic tools that should be part of conservative selective approach of these lesions. It was observed that a nonoperative selective treatment can be effectively and safely used, when performed by a trained interdisciplinary team, working in adequate trauma centers. The selective nonoperative treatment is associated with a decrease in negative and nontherapeutic laparotomies, reducing the incidence of complications. It also contributes to the reduction of hospital costs.


Assuntos
Traumatismos Abdominais/terapia , Tratamento Conservador , Ferimentos por Arma de Fogo/terapia , Abdome , Traumatismos Abdominais/diagnóstico , Humanos , Escala de Gravidade do Ferimento , Laparotomia , Ferimentos por Arma de Fogo/diagnóstico
7.
JMIR Public Health Surveill ; 6(2): e19369, 2020 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-32437329

RESUMO

BACKGROUND: In the past, national emergencies in the United States have resulted in increased gun preparation (ie, purchasing new guns or removing guns from storage); in turn, these gun actions have effected increases in firearm injuries and deaths. OBJECTIVE: The aim of this paper was to assess the extent to which interest in gun preparation has increased amid the coronavirus disease (COVID-19) pandemic using data from Google searches related to purchasing and cleaning guns. METHODS: We fit an Autoregressive Integrated Moving Average (ARIMA) model over Google search data from January 2004 up to the week that US President Donald Trump declared COVID-19 a national emergency. We used this model to forecast Google search volumes, creating a counterfactual of the number of gun preparation searches we would expect if the COVID-19 pandemic had not occurred, and reported observed deviations from this counterfactual. RESULTS: Google searches related to preparing guns have surged to unprecedented levels, approximately 40% higher than previously reported spikes following the Sandy Hook, CT and Parkland, FL shootings and 158% (95% CI 73-270) greater than would be expected if the COVID-19 pandemic had not occurred. In absolute terms, approximately 2.1 million searches related to gun preparation were performed over just 34 days. States severely affected by COVID-19 appear to have some of the greatest increases in the number of searches. CONCLUSIONS: Our results corroborate media reports that gun purchases are increasing amid the COVID-19 pandemic and provide more precise geographic and temporal trends. Policy makers should invest in disseminating evidence-based educational tools about gun risks and safety procedures to avert a collateral public health crisis.


Assuntos
Infecções por Coronavirus/epidemiologia , Armas de Fogo/estatística & dados numéricos , Internet/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Ferramenta de Busca/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Humanos , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
8.
9.
Ann R Coll Surg Engl ; 102(5): 375-382, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233854

RESUMO

INTRODUCTION: Selective non-operative management (SNOM) for penetrating abdominal injury (PAI) is accepted in trauma centres in South Africa and the US. Owing to the low incidence of gunshot wounds (GSWs) in Western Europe, few are inclined to practise SNOM for such injuries although it is considered for stab wounds (SWs). This study evaluated the outcome of patients admitted to a Dutch level 1 trauma centre with PAI. METHODS: A retrospective study was undertaken of all PAI patients treated over 15 years. In order to prevent bias, patients admitted six months prior to and six months following implementation of a treatment algorithm were excluded. Data concerning type of injury, injury severity score and treatment were compared. RESULTS: A total of 393 patients were included in the study: 278 (71%) with SWs and 115 (29%) with GSWs. Of the 178 SW patients in the SNOM group, 111 were treated before and 59 after introduction of the protocol. The SNOM success rates were 90% and 88% respectively (p=0.794). There were 43 patients with GSWs in the SNOM cohort. Of these, 32 were treated before and 11 after implementation of the algorithm, with respective success rates of 94% and 100% (p=0.304).The protocol did not bring about any significant change in the rate of non-therapeutic laparotomies for SWs or GSWs. However, the rate of admission for observation for SWs increased from 83% to 100% (p<0.001). There was a decrease in ultrasonography for SWs (from 84% to 32%, p<0.001) as well as for GSWs (from 87% to 43%, p<0.001). X-ray was also used less for GSWs after the protocol was introduced (44% vs 11%, p=0.001). CONCLUSIONS: SNOM for PAI resulting from either SWs or GSWs can be safely practised in Western European trauma centres. Results are comparable with those in trauma centres that treat high volumes of PAI cases.


Assuntos
Traumatismos Abdominais/terapia , Tratamento Conservador/métodos , Ferimentos por Arma de Fogo/terapia , Ferimentos Perfurantes/terapia , Traumatismos Abdominais/diagnóstico , Adulto , Protocolos Clínicos , Tratamento Conservador/efeitos adversos , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Países Baixos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos Perfurantes/diagnóstico , Adulto Jovem
10.
Vasc Endovascular Surg ; 54(5): 441-444, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32292134

RESUMO

This article describes a deep femoral arteriovenous fistula (AVF) diagnosed over a decade after a small caliber gunshot injury to the groin. The fistula persisted following 2 previous attempts at endovascular exclusion and was referred to our institution for further care. We describe the successful exclusion of the AVF via a combination of endovascular techniques. Postoperatively, obliteration was noted to be durable for 4 additional years of follow-up.


Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Artéria Femoral/lesões , Veia Femoral/lesões , Lesões do Sistema Vascular/terapia , Ferimentos por Arma de Fogo/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Circulação Colateral , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia
11.
World Neurosurg ; 138: 408-410, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32247791

RESUMO

Civilian gunshot wounds to the brain are associated with high overall mortality; however, outcomes can vary significantly depending on bullet trajectory. This report details the outcome of a patient who sustained a bifrontal gunshot wound with multiple associated calvarial and frontal sinus fractures. Although surgery for penetrating brain injury is most frequently employed for relief of mass effect and decompression of vital structures, this case report describes a more comprehensive technique involving duroplasty, obliteration of the frontal sinus, and cranial vault reconstruction with the aim of decreasing the rate of cerebrospinal fluid leak, infection, reoperation, and readmission.


Assuntos
Encéfalo/cirurgia , Craniotomia/métodos , Traumatismos Cranianos Penetrantes/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ferimentos por Arma de Fogo/cirurgia , Encéfalo/patologia , Drenagem , Feminino , Traumatismos Cranianos Penetrantes/etiologia , Traumatismos Cranianos Penetrantes/patologia , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Pessoa de Meia-Idade , Crânio/patologia , Crânio/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/patologia
13.
Am Surg ; 86(3): 208-212, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223799

RESUMO

Gun-related injuries are a hotly debated sociopolitical topic in the United States. Annually, more than 33 million Americans seek heathcare services for mental health issues. These conditions are the leading cause of combined disability and death among women and the second highest among men. Our study's main objective was to identify cases of self-inflicted penetrating firearm injuries with reported pre-existing psychiatric conditions as defined in the 2013-2016 National Trauma Data Standard. The 2013-2016 Research Data Sets (RDSs) were reviewed. Cases were identified using the ICD-9 external cause codes 955-955.4, and ICD 10th Edition Clinical Modification external cause codes X72-X74. Odds ratios were calculated, and categorical data were analyzed by using the chi-squared test, with significance defined as P < 0.05. The 2013-2016 Research Data Set consists of 3,577,168 reported cases, with 15,535 observations of self-inflicted penetrating firearms injuries. Of those patients, 18.4 per cent had major psychiatric illnesses, 7.5 per cent had alcohol use disorder, 6.4 per cent had drug use disorder, and 0.6 per cent had dementia. An upward trend in the proportion of patients with major psychiatric illnesses was observed, from 15.5 per cent in 2013 to 18.6 per cent in 2016, peaking in 2015 at 20.9 per cent. Nearly one in three self-inflicted penetrating firearm injuries in the United States is associated with pre-existing behavioral health conditions. Advances in understanding the behavioral and social determinants leading to these conditions, and strategies to improve the diagnosis of mental illness and access to mental health care are required.


Assuntos
Violência com Arma de Fogo/psicologia , Violência com Arma de Fogo/estatística & dados numéricos , Cobertura de Condição Pré-Existente/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Adulto , Idoso , Alcoolismo/epidemiologia , Bases de Dados Factuais , Demência/epidemiologia , Feminino , Armas de Fogo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Comportamento Autodestrutivo/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
14.
PLoS One ; 15(3): e0230135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155211

RESUMO

BACKGROUND/OBJECTIVE: Male veterans ages 55-74 comprise a disproportionate number of suicide deaths among United States veterans, for whom a majority of suicides are firearm-related. Little is known about the firearm-related experiences and beliefs of veterans, which could be informative for firearm-related lethal means safety interventions. The aim of this qualitative study was to identify themes relevant to developing such interventions among older male veterans. METHODS: We conducted semi-structured qualitative interviews with seventeen United States male veterans, ages 50-70, who were eligible to receive Veterans Health Administration services, and were current or former firearm owners or users. Transcripts were analyzed via thematic analysis using an inductive approach. RESULTS: Six themes were identified: 1) Firearm experiences were usually facilitated by male family members and occurred at an early age; 2) Safety lessons during early firearm encounters focused on preventing unintentional injuries through safe firearm handling and using "common sense;" 3) Firearms serve an important social function across veterans' lifespans (e.g., hunting with friends); 4) Veterans perceive firearms as useful for protection; 5) Veterans believe that not everyone should have access to firearms, and some described scenarios in which they acted to limit others' access during unsafe situations; and 6) Veterans have preferences for who is involved in firearm safety discussions. CONCLUSIONS: We identified themes relevant to developing firearm-specific lethal means safety interventions among older male veterans. Findings suggest potential obstacles (e.g., sociocultural value of firearms) to affecting changes in firearm behaviors, and factors that could potentially facilitate interventions (e.g., family involvement). Consideration of these findings may be important for developing personalized, effective interventions for this population.


Assuntos
Armas de Fogo/ética , Suicídio/psicologia , Veteranos/psicologia , Idoso , Atitude , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Segurança , Suicídio/prevenção & controle , Estados Unidos , Ferimentos por Arma de Fogo/prevenção & controle , Ferimentos por Arma de Fogo/psicologia
15.
Bull World Health Organ ; 98(3): 170-176, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32132751

RESUMO

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.


Assuntos
Armas de Fogo/legislação & jurisprudência , Homicídio/estatística & dados numéricos , Mortalidade , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Colômbia , Feminino , Humanos , Masculino , Propriedade
18.
Can Assoc Radiol J ; 71(3): 335-343, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32103684

RESUMO

Here in Canada, we often think of gun violence as confined to conflict zones, terrorism, and more of a problem for our southern neighbor. However, in recent years, it has also become a Canadian problem with increased gun violence related to criminal activity presenting in daily practice. Radiologists play a critical role in the evaluation of ballistic trauma and must therefore be familiar with both the common and uncommon patterns of ballistic injury. In this article, we review the mechanisms of ballistic trauma as well as their resultant injury patterns in order to guide image interpretation.


Assuntos
Tomografia Computadorizada por Raios X/métodos , Ferimentos por Arma de Fogo/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética/métodos , Física , Ultrassonografia/métodos
19.
World Neurosurg ; 137: 94-97, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32006734

RESUMO

BACKGROUND: Elevation of bone for the treatment of depressed skull fractures overlying venous sinuses is rarely required or performed. The neurosurgical literature only describes a handful of cases of surgical intervention in which the posterior two-thirds of the superior sagittal sinus was involved. Clinical course is variable, signs and symptoms suggest increased intracranial pressure, and all conservative measures should be exhausted before proceeding with the surgical route. CASE DESCRIPTION: A 27-year-old man presented with a self-inflicted gunshot wound to posterior head. On presentation, there were no neurologic complaints. On imaging, the bullet fragment was associated with a comminuted anteriorly displaced fracture over the torcula. Vessel imaging showed tapering of the superior sagittal sinus and transverse sinuses near the torcula, suggesting narrowing due to mass effect. The patient did not respond to initial conservative management and developed worsening diplopia and papilledema concerning for increased intracranial pressure. Occipital/suboccipital craniectomy was performed with elevation of depressed skull fracture, decompression of dural venous sinus, removal of bullet, and mesh cranioplasty. Repeat ophthalmology examination postoperatively showed improvement in optic disc edema and diplopia. CONSLUSIONS: This case confirms that the approach of surgical management of superior sagittal venous sinus injuries associated with skull fractures described in the literature also can be used successfully for injuries over the torcula if conservative management does not help alleviate the symptoms and results in good outcome. It was felt that delayed surgery also plays an important role, as it gives time for scar tissue to form, which may help to protect the sinus from injury during surgery.


Assuntos
Cavidades Cranianas/cirurgia , Hipertensão Intracraniana/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Cavidades Cranianas/lesões , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Masculino , Papiledema/diagnóstico , Papiledema/cirurgia , Fraturas Cranianas/complicações , Fraturas Cranianas/cirurgia , Seio Sagital Superior/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico
20.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32098787

RESUMO

Behavioral economics applies key principles from psychology and economics to address obstacles to behavior change. The important topic of pediatric firearm injuries has not yet been explored through a behavioral economic lens. Pediatric firearm-related injuries are a significant public health problem in the United States. Despite American Academy of Pediatrics guidelines advising that firearms be stored unloaded, in a locked box or with a locking device, and separate from ammunition, estimates suggest that ∼4.6 million children live in homes with at least 1 loaded and unlocked firearm. In this article, we use behavioral economic theory to identify specific cognitive biases (ie, present bias; in-group, out-group bias; and the availability heuristic) that may influence parental decision-making around firearm storage. We illustrate situations in which these biases may occur and highlight implementation prompts, in-group messengers, and increased salience as behaviorally informed strategies that may counter these biases and subsequently enhance safe firearm storage. We also describe other opportunities to leverage the behavioral economic tool kit. By better understanding the individual behavioral levers that may impact decision-making around firearm storage, behavioral scientists, pediatric providers, and public health practitioners can partner to design and test tailored interventions aimed at decreasing pediatric firearm injuries. Further empirical study is warranted to identify the presence of specific biases and heuristics and determine the most effective behavior change strategies for different subpopulations.


Assuntos
Economia Comportamental , Armas de Fogo , Propriedade , Segurança , Acidentes Domésticos/prevenção & controle , Humanos , Ferimentos por Arma de Fogo/prevenção & controle
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