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1.
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
3.
J Forensic Leg Med ; 69: 101888, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32056805

RESUMO

Firearms injuries have a legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. A retrospective study was carried out on the autopsy records produced in the first semester of 2015, in five Institutes of Legal Medicine in Porto Velho, situated in the cities of João Pessoa, Vitória, Porto Alegre and Brasília. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death (homicide, suicide or accident). Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent (97.0%). It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close-range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions (p < 0.0001). The data obtained are useful for guiding research that takes into account craniofacial trauma caused by firearm projectiles, makes it possible to compare this data with those of other countries and can base investigative conclusions based on the analyzes discussed in the present work.


Assuntos
Traumatismos Faciais/mortalidade , Traumatismos Cranianos Penetrantes/mortalidade , Ferimentos por Arma de Fogo/mortalidade , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Criança , Grupos de Populações Continentais/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio Consumado/estatística & dados numéricos , Adulto Jovem
4.
J Forensic Leg Med ; 69: 101889, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32056806

RESUMO

Studies on firearm fatalities in some parts of Ghana have been reported. However, the incidence and pattern of firearm fatalities in the Northern sector of Ghana have fled the spotlight. This study aimed at reporting the incidence and pattern of gunshot fatalities autopsied within 2008 and 2013 year. There were 82(91.1%) male and 8(8.9%) female victims of gunshot deaths during the study period with an average of 15 cases annually. Where 60(66.7%) of the victims aged within 21-40; years resembling the pattern observed in several parts of the world. A significant number 28(31.1%) of the victims died of multiple shots or dispersed pellets affecting several parts of the body, followed by a single shot to the chest 18(20.0%), abdomen 17(18.9%), head 14(15.6%). Collectively, entry sites like the neck and upper limb among others accounted for 13(14.4%). Robbery accounted for 44(48.9%) followed by homicides 14(15.6%) cases. Recovered pellets, nature and legal status of firearm involved were also examined, and like in several developing countries, country-made guns played a substantial role in the firearm fatalities with calls to strengthen laws governing gun acquisition and use in the country.


Assuntos
Ferimentos por Arma de Fogo/mortalidade , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Crime/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Feminino , Gana/epidemiologia , Homicídio/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
5.
Am J Forensic Med Pathol ; 41(1): 18-26, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000223

RESUMO

The suicide rate in the United States has been increasing steadily over the previous 10 years. In DC, these results are not mirrored. The suicide rate has a tendency to be lower than the rest of the country. During this retrospective review of suicides in DC, factors such as medical history and toxicology results were examined.In this study performed over 8 years (2009-2016), 394 suicides occurred. It was found that decedents committed suicide mostly by hanging (31.2%), firearms (20.3%), or drug intoxication (15.7%). The average age was 44.5 years. Similar to national statistics, male individuals committed suicide at a higher rate (77.9%) than did female individuals (22.1%). The toxicology data showed that ethanol (26.4%), antidepressants (20.1%), opioids (14.9%), and benzodiazepines (12.9%) were the drugs most frequently involved, although the finding of no drugs was most common (33.7%). Ethanol was present in 5 methods of suicide that include death by hanging, drowning, firearm, suffocation, and poisoning.This research provides information that may be useful for public health officials when confronting the issue of suicide. It is hoped that it will encourage other medical examiner offices to perform toxicological analysis and autopsy of all suicide cases.


Assuntos
Suicídio Consumado/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Depressores do Sistema Nervoso Central/análise , Criança , Grupos de Populações Continentais/estatística & dados numéricos , District of Columbia/epidemiologia , Afogamento/mortalidade , Etanol/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Preparações Farmacêuticas/análise , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
9.
J Trauma Acute Care Surg ; 88(2): 310-313, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31389914

RESUMO

BACKGROUND: There are no reports comparing wounding pattern in urban and public mass shooting events (CPMS). Because CPMS receive greater media coverage, there is a connation that the nature of wounding is more grave than daily urban gun violence. We hypothesize that the mechanism of death following urban gunshot wounds (GSWs) is the same as has been reported following CPMS. METHODS: Autopsy reports of all firearm-related deaths in Washington, DC were reviewed from January 1, 2016, to December 31, 2017. Demographic data, firearm type, number and anatomic location of GSWs, and organ(s) injured were abstracted. The organ injury resulting in death was noted. The results were compared with a previously published study of 19 CPMS events involving 213 victims. RESULTS: One hundred eighty-six urban autopsy reports were reviewed. There were 171 (92%) homicides and 13 (7%) suicides. Handguns were implicated in 180 (97%) events. One hundred eight (59%) gunshots were to the chest/upper back, 85 (46%) to the head, 77 (42%) to an extremity, and 71 (38%) to the abdomen/lower back. The leading mechanisms of death in both urban firearm violence and CPMS were injury to the brain, lung parenchyma, and heart. Fatal brain injury was more common in CPMS events as compared with urban events involving a handgun. CONCLUSION: There is little difference in wounding pattern between urban and CPMS firearm events. Based on the organs injured, rapid point of wounding care and transport to a trauma center remain the best options for mitigating death following all GSW events. LEVEL OF EVIDENCE: Epidemiological, level IV.


Assuntos
Lesões Encefálicas/mortalidade , Traumatismos Cardíacos/mortalidade , Lesão Pulmonar/mortalidade , Incidentes com Feridos em Massa/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/etiologia , Lesões Encefálicas/terapia , Causas de Morte , District of Columbia/epidemiologia , Feminino , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/terapia , Humanos , Lesão Pulmonar/etiologia , Lesão Pulmonar/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos por Arma de Fogo/etiologia , Ferimentos por Arma de Fogo/terapia , Adulto Jovem
10.
J Forensic Sci ; 65(1): 193-195, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31433492

RESUMO

The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.


Assuntos
Lesões Encefálicas/mortalidade , Base do Crânio/lesões , Fraturas Cranianas/epidemiologia , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Abuso Físico/estatística & dados numéricos , Distribuição por Sexo , Base do Crânio/patologia , Fraturas Cranianas/patologia , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
11.
Am J Public Health ; 110(2): 230-236, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31855477

RESUMO

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.


Assuntos
Armas de Fogo/legislação & jurisprudência , Homicídio/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Estudos Transversais , Armas de Fogo/estatística & dados numéricos , Homicídio/tendências , Humanos , Estados Unidos
12.
Public Health Rep ; 135(1): 40-46, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31835013

RESUMO

OBJECTIVES: Violence due to firearms is a substantial public health problem. Death data from medical examiner and vital records were linked to evaluate the use of medical examiner data to augment routine surveillance and determine any differences in sex, age, manner of death, or race and ethnicity between the 2 data systems. MATERIALS AND METHODS: Medical examiner data were searched for keywords of interest, and vital records data were obtained and linked for deaths occurring in Multnomah County, Oregon, from January 1, 2010, through December 31, 2016. Both data sets were compared for the number and proportion of firearm-related deaths by sex, age, manner of death, and race/ethnicity. Sensitivity and positive predictive values were calculated for variables that had discordant results. RESULTS: A total of 568 firearm-related deaths were identified in the medical examiner data. After matching with manual review, the 2 data systems had 100% case agreement. A reverse match showed that most cases not found in medical examiner data were due to transfer of case jurisdiction. The 2 systems matched nearly perfectly in sex, age, and manner of death but differed in characterization of race and ethnicity. Sensitivity was 62% for Hispanic ethnicity but 93% for white and black race. PRACTICE IMPLICATIONS: Using medical examiner data was a useful way to augment routine surveillance of firearm-related deaths in our jurisdiction in close to real time. However, caution is needed when analyzing data by subgroups because of discordant classifications of race between the data systems.


Assuntos
Médicos Legistas/estatística & dados numéricos , Coleta de Dados/métodos , Registros/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adulto , Distribuição por Idade , Idoso , Grupos de Populações Continentais , Coleta de Dados/normas , Grupos Étnicos , Feminino , Armas de Fogo , Humanos , Masculino , Pessoa de Meia-Idade , Oregon , Vigilância da População , Reprodutibilidade dos Testes , Distribuição por Sexo , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/etnologia , Adulto Jovem
13.
Forensic Sci Int ; 307: 110117, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31881372

RESUMO

The ability to conduct accurate retrospective homicide comparative research is reliant on the publishing of robust studies that assess the specifics of homicides in a standardised manner. To address these matters at the Institute of Forensic Medicine (IFM) in Pristina, Kosovo, the IFM homicide data of the years 2006-2015 was retrospectively studied. In general, there was a year on year downward trend in the number of homicide deaths in Kosovo per 100,000 people, however it was noted that a standardisation method to record homicides in Kosovo has not been developed and as such, the data may not be complete. In addition, the analysis of the IFM data demonstrated that firearms were consistently used in 73.76 % of all homicides committed between 2006-2015 but the examination of, and the specific documentation of the types of firearms used was not recorded. This is important to provide evidence to enforce legislation to reduce the availability of these weapons and ultimately the number of homicides. Consequently, this study aimed to compare global homicide trends relative to the retrospective homicide data from Kosovo, to inform and address the need for prevention programmes and to establish standardised recording of homicides in Kosovo.


Assuntos
Homicídio/tendências , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Vítimas de Crime/estatística & dados numéricos , Feminino , Armas de Fogo/estatística & dados numéricos , Medicina Legal , Homicídio/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Kosovo/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
14.
Ann Vasc Surg ; 62: 98-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31344461

RESUMO

BACKGROUND: The incidence of wartime upper-extremity vascular injury (UEVI) has been stable for the past century. The objective of this study is to provide a contemporary review of wartime UEVI, including epidemiologic characterization and description of early limb loss. METHODS: The Department of Defense Trauma Registry (DoDTR) was queried to identify US service members who sustained a battle-related UEVI in Afghanistan between January 2009 and December 2015. Anatomic distribution of injury, mechanism of injury (MOI), associated injuries, early management, and early limb loss were analyzed. RESULTS: Analysis identified 247 casualties who sustained 308 UEVIs. The most common injury was to the vessels distal to the brachial bifurcation (63.3%, n = 195), followed by the brachial vessels (27.3%, n = 84) and the axillary vessels (9.4%, n = 29). The predominant MOIs were penetrating explosive fragments (74.1%, n = 183) and gunshot wounds (25.9%, n = 64). Associated fractures were identified in 151 (61.1%) casualties and nerve injuries in 133 (53.8%). Angiography was performed in 91 (36.8%) casualties, and endovascular treatment was performed 10 (4%) times. Temporary vascular shunts were placed in 39 (15.8%) casualties. Data on surgical management were available for 171 injuries and included repair (48%, n = 82) and ligation (52%, n = 89). The early limb loss rate was 12.1% (n = 30). For all casualties sustaining early limb loss, the MOI was penetrating fragments from an explosion; the average injury severity score (ISS) was 32.3, and the mortality was 6.7% (n = 2). In those without amputation, the ISS and mortality were low at 20 and 4.6% (n = 10), respectively. Overall mortality was 4.9% (n = 12). CONCLUSIONS: The early limb loss rate was increased compared with initial descriptions from Operation Iraqi Freedom. Amputations are associated with a higher ISS. Improved data capture and fidelity, or differing MOIs, may account for this trend. Proficiency with open and endovascular therapy remains a critical focus for combat casualty care.


Assuntos
Traumatismos por Explosões/epidemiologia , Procedimentos Endovasculares , Extremidade Superior/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Campanha Afegã de 2001- , Amputação , Traumatismos por Explosões/diagnóstico por imagem , Traumatismos por Explosões/mortalidade , Traumatismos por Explosões/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Humanos , Incidência , Salvamento de Membro , Medicina Militar , Militares , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/terapia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/terapia
15.
Am Surg ; 85(11): 1205-1208, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775959

RESUMO

Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as "historical" (1973-1975 and 1988-1990) and "modern" (2005-2007 and 2015-2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.


Assuntos
Traumatismos Torácicos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Emergências , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/cirurgia , Humanos , Kentucky/epidemiologia , Pulmão/cirurgia , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/mortalidade , Toracostomia/métodos , Toracotomia/estatística & dados numéricos , Toracotomia/tendências , Fatores de Tempo , Tempo para o Tratamento , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
16.
Am Surg ; 85(10): 1166-1170, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657317

RESUMO

Youth and young adult interpersonal violence (IPV) is a unique clinical challenge which merits study. This study defined the demographics and clinical outcomes of youth and young adult victims of IPV presenting to our hospital while examining violent injury recidivism. We reviewed patients aged 10 to 30 years admitted to our trauma bay as a victim of gunshot wound (GSW), stabbing wound, or blunt assault from 1998 to 2015 (n = 12,549). Logistic regression analysis was conducted to compare patient mortality across demographic characteristics, and Cox proportional hazards regression was used to determine risk factors for recidivism. Male (92%) and Hispanic patients (75%) constituted the majority of admissions. We observed differences in the mortality rate by gender (9% in males vs 5% in females, P < 0.001), race/ethnicity (5% non-Hispanic white vs 9% Hispanic, P = 0.001), insurance status (3% insured vs 10% uninsured, P < 0.001), and mechanism of injury (13% GSW, 2% stabbing wound, and 0.3% blunt assault, P < 0.001). Male gender, younger age, GSW, and amphetamine placed patients at higher risk for IPV recidivism (P < 0.05). This study demonstrates the need to better understand how demographics and economics are associated with youth and young adult IPV. In addition, future IPV prevention and intervention initiatives can be tailored to suit the unique needs of our population.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Reincidência/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Ferimentos não Penetrantes/mortalidade , Ferimentos Perfurantes/mortalidade , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Criança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Violência com Arma de Fogo/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Razão de Chances , Reincidência/etnologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/etnologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/etnologia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/etnologia , Adulto Jovem
17.
Work ; 64(1): 77-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31561404

RESUMO

BACKGROUND: Healthcare workers experience a disproportionately high frequency of workplace assaults. Incidents involving firearms are of particular concern. OBJECTIVE: To provide detailed characterizations of recent hospital shootings to better inform prevention and mitigation strategies. METHODS: Quantitative content analysis of reports involving hospital shootings resulting in casualties derived from web searches for each year from 2012-2016. Data were abstracted independently by two investigators, with differences resolved by consensus. Data were compared between subgroups by chi-square test, Fisher's exact test, or Kruskal-Wallis test, as appropriate. RESULTS: Eighty-eight shootings occurred in 86 hospitals resulting in 121 firearms-related casualties, including 54 victims and 67 perpetrators. Case fatality rates were 55.6% (n = 30) and 70.1% (n = 47), respectively. The most frequent sites involved were the emergency department, (n = 27, 30.3%), patient room (n = 19, 21.3%), and parking lot (n = 13, 14.6%). Grudge (n = 17, 19.3%), suicide (n = 14, 15.9%), and mental instability (n = 13, 14.8%) were the most common explanations for these shootings. Four inadvertent discharges occurred and were more likely to involve a female perpetrator (p = 0.03). Shootings were most frequent during summer (p = 0.03) and winter (p = 0.04). CONCLUSIONS: Out study findings on location and seasonal patterns can guide the development or improvement of prevention and mitigations strategies for hospital shootings.


Assuntos
Hospitais/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Armas de Fogo , Humanos , Masculino , Transtornos Mentais , Pessoa de Meia-Idade , Traumatismos Ocupacionais/epidemiologia , Quartos de Pacientes/estatística & dados numéricos , Estações do Ano , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
18.
J Spec Oper Med ; 19(3): 90-93, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539440

RESUMO

INTRODUCTION: The military working dog (MWD) has been essential in military operations such as Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). MWDs sustain traumatic injuries that require point of injury and en route clinical interventions. The objective of this study was to describe the injuries and treatment military working dogs received on the battlefield and report their final disposition. METHODS: This was a convenience sample of 11 injury and treatment reports of US MWDs from February 2008 to December 2014. We obtained clinical data regarding battlefield treatment from the 160th Special Operations Aviation Regiment (SOAR) database and supplemental operational sources. A single individual collected the data and maintained the dataset. The data collected included mechanism of injury, clinical interventions, and outcomes. We reported findings as frequencies. RESULTS: Of the 11 MWD casualties identified in this dataset, 10 reports had documented injuries secondary to trauma. Eighty percent of the cases sustained gunshot wounds. The hindlegs were the most common site of injury (50%); however, 80% sustained injuries at more than one anatomical location. Seventy percent of cases received at least one clinical intervention before arrival at their first treatment facility. The most common interventions included trauma dressing (30%), gauze (30%), chest seal (30%), and pain medication (30%). The survival rate was 50%. CONCLUSION: The majority of the MWD cases in this dataset sustained traumatic injuries, with gunshot being the most common mechanism of injury. Most MWDs received at least one clinical intervention. Fifty percent did not survive their traumatic injuries.


Assuntos
Serviços Médicos de Emergência , Serviço Veterinário Militar , Lesões Relacionadas à Guerra/terapia , Lesões Relacionadas à Guerra/veterinária , Campanha Afegã de 2001- , Animais , Cães , Guerra do Iraque 2003-2011 , Análise de Sobrevida , Resultado do Tratamento , Lesões Relacionadas à Guerra/mortalidade , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/terapia , Ferimentos por Arma de Fogo/veterinária
20.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31308258

RESUMO

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.


Assuntos
Armas de Fogo/legislação & jurisprudência , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Criança , Estudos Transversais , Feminino , Homicídio/legislação & jurisprudência , Homicídio/tendências , Humanos , Masculino , Mortalidade/tendências , Suicídio/legislação & jurisprudência , Suicídio/tendências , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/diagnóstico , Adulto Jovem
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