Digital mammography, sestamibi breast scintigraphy, and positron emission tomography breast imaging.

Digital mammography allows for the separate optimization of image acquisition and display. Through this technology, and the application of image processing and computer aided diagnosis, breast cancer detection and breast lesion diagnosis might be improved. Besides the obvious data storage, retrieval, and transmission advantages that digital mammography will allow, additional advances such as tomosynthesis, dual energy mammography and digital subtraction mammography are in development. The possible future utility of Sestamibi breast scintigraphy and breast imaging with positron emission tomography is also discussed.

Mortality among recent purchasers of handguns.

BACKGROUND: There continues to be considerable controversy over whether ownership of a handgun increases or decreases the risk of violent death. METHODS: We conducted a population-based cohort study to compare mortality among 238,292 persons who purchased a handgun in California in 1991 with that in the general adult population of the state. The observation period began with the date of handgun purchase (15 days after the purchase application) and ended on December 31, 1996. The standardized mortality ratio (the ratio of the number of deaths among handgun purchasers to the number expected on the basis of age- and sex-specific rates among adults in California) was the principal outcome measure. RESULTS: In the first year after the purchase of a handgun, suicide was the leading cause of death among handgun purchasers, accounting for 24.5 percent of all deaths and 51.9 percent of deaths among women 21 to 44 years old. The increased risk of suicide by any method among handgun purchasers (standardized mortality ratio, 4.31) was attributable entirely to an excess risk of suicide with a firearm (standardized mortality ratio, 7.12). In the first week after the purchase of a handgun, the rate of suicide by means of firearms among purchasers (644 per 100,000 person-years) was 57 times as high as the adjusted rate in the general population. Mortality from all causes during the first year after the purchase of a handgun was greater than expected for women (standardized mortality ratio, 1.09), and the entire increase was attributable to the excess number of suicides by means of a firearm. As compared with the general population, handgun purchasers remained at increased risk for suicide by firearm over the study period of up to six years, and the excess risk among women in this cohort (standardized mortality ratio, 15.50) remained greater than that among men (standardized mortality ratio, 3.23). The risk of death by homicide with a firearm was elevated among women (standardized mortality ratio at one year, 2.20; at six years, 2.01) but low among men (standardized mortality ratio at one year, 0.84; at six years, 0.79). CONCLUSIONS: The purchase of a handgun is associated with a substantial increase in the risk of suicide by firearm and by any method; the increase in the risk of suicide by firearm is apparent within a week after the purchase of a handgun. The magnitude of the increase and the relation between handgun purchase and the risk of death by homicide differ between men and women.

Weapons of choice: previous criminal history, later criminal activity, and firearm preference among legally authorized young adult purchasers of handguns.

OBJECTIVE: To determine whether there is an association between criminal activity and preference for a particular class of handgun among young adults who purchase handguns legally. DESIGN: Historical cohort study. MATERIALS AND METHODS: Subjects were 5,360 authorized purchasers of handguns in California in 1988 who were 21 to 25 years of age, divided into two groups: all eligible purchasers with a previous criminal history (n = 2,765), and a random sample of purchasers with no such history (n = 2,595). Handguns were classified as small and inexpensive or larger and expensive. Associations were assessed by relative risks adjusted for gender and race or ethnicity. MEASUREMENTS AND MAIN RESULTS: Handgun purchasers with a previous criminal history were more likely than those without such a history to purchase a small, inexpensive handgun (relative risk (RR) = 1.28; 95% confidence interval (CI), 1.16-1.42). Among handgun purchasers with no previous criminal history, those who purchased a small, inexpensive handgun were more likely than purchasers of other handguns to be charged with new crimes after handgun purchase (RR = 1.73; 95% CI, 1.34-2.24) and were nearly twice as likely to charged with new crimes involving firearms or violence (RR = 1.93; 95% CI, 1.38-2.69). CONCLUSION: In this population, criminal activity both before and after handgun purchase was associated with a preference for small, inexpensive handguns.

Prior misdemeanor convictions as a risk factor for later violent and firearm-related criminal activity among authorized purchasers of handguns.

CONTEXT: Under current federal law, many persons with prior convictions for misdemeanor offenses pass criminal records background checks and legally purchase handguns. OBJECTIVE: To determine whether authorized handgun purchasers with prior misdemeanor convictions are more likely than those with no criminal history to be charged with new crimes, particularly offenses involving firearms and violence. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: A total of 5923 authorized purchasers of handguns in California in 1977 who were younger than 50 years, identified by random sample. MAIN OUTCOME MEASURES: Incidence and relative risk (RR) of first charges for new criminal offenses after handgun purchase. RESULTS: Of the 5923 authorized purchasers, 3128 had at least 1 conviction for a misdemeanor offense prior to handgun purchase, and 2795 had no prior criminal history. Follow-up to the end of the 15-year observation period or to death was available for 77.8% of study subjects and for a median 8.9 years for another 9.6%. Handgun purchasers with at least 1 prior misdemeanor conviction were more than 7 times as likely as those with no prior criminal history to be charged with a new offense after handgun purchase (RR, 7.5; 95% confidence interval [CI], 6.6-8.7). Among men, those with 2 or more prior convictions for misdemeanor violence were at greatest risk for nonviolent firearm-related offenses such as weapon carrying (RR, 11.7; 95% CI, 6.8-20.0), violent offenses generally (RR, 10.4; 95% CI, 6.9-15.8), and Violent Crime Index offenses (murder or non-negligent manslaughter, forcible rape, robbery, or aggravated assault) (RR, 15.1; 95% CI, 9.4-24.3). However, even handgun purchasers with only 1 prior misdemeanor conviction and no convictions for offenses involving firearms or violence were nearly 5 times as likely as those with no prior criminal history to be charged with new offenses involving firearms or violence. CONCLUSIONS: Handgun purchasers with prior misdemeanor convictions are at increased risk for future criminal activity, including violent and firearm-related crimes.

Criminal activity and assault-type handguns: a study of young adults.

STUDY OBJECTIVE: We studied a population of young adults who legally purchased handguns to determine whether an association exists between the purchase of an assault-type handgun and prior or subsequent criminal activity. METHODS: We conducted a longitudinal study of 5,360 legally authorized purchasers of handguns in California in 1988 who were younger than 25 years at the time of purchase. Our main outcome measures were (1) adjusted relative risk (RR) for the purchase of an assault-type handgun for subjects with a criminal history compared with subjects without such a history and (2) adjusted RR for new criminal activity during the 3 years after handgun purchase for purchasers of assault-type handguns compared with purchasers of other handguns. RRs were adjusted for sex and race/ethnicity. RESULTS: Handgun purchasers with a criminal history were more likely than those with no criminal history to purchase assault-type handguns (4.6% and 2.0%, respectively; RR = 2.0; 95% confidence interval [CI] 1.5 to 2.8). Among handgun purchasers who had a criminal history, purchasers of assault-type handguns were more likely than purchasers of other handguns to be charged with new offenses (RR = 1.5; 95% CI, 1.3 to 1.9), including offenses involving firearms of violence (RR = 1.7; 95% CI, 1.3 to 2.20. Among those who had previously been charged with Violent Crime Index offenses (murder, rape, robbery, aggravated assault), those who purchased assault-type handguns were more than twice as likely as purchasers of other handguns to be charged with a new offense (RR = 2.3; 95% CI, 1.5 to 3.4) and three times as likely to be charged with a new offense involving firearms or violence (RR = 3.0, 95% CI, 1.9 to 4.6). CONCLUSION: In this population, the purchase of an assault-type handgun was associated with both prior and subsequent criminal activity.