Pediatric Firearm Injuries, Kansas City, 1992: A Population-Based Study

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 867-873 ◽  
Author(s):  
M. Denise Dowd ◽  
Jane F. Knapp ◽  
Laura S. Fitzmaurice
Keyword(s):  
Kansas City ◽  
Population Based ◽  
Case Definition ◽  
Medical Examiner ◽  
Care Providers ◽  
Unintentional Injuries ◽  
Permanent Disability ◽  
Census Tracts ◽  
Firearm Injury ◽  
Firearm Injuries

Objective. To determine the morbidity, mortality, and epidemiologic features of pediatric powder-firearm injuries in a defined urban population. Design and setting. A population-based, descriptive epidemiologic study was conducted of firearm injuries to children in a mid-size urban community (total population: 435 178) in 1992. The population was 56% white and 39% black. Data from prehospital care providers, all city and adjacent community hospitals, and medical examiner and police records were searched for cases of firearm injury. The 1990 United States census provided denominator data. Case definition. Subjects were all 0- to 16-year-old residents of Kansas City, Missouri who sought medical treatment at a hospital for a powder-firearm injury or who presented to the medical examiner with a fatal firearm injury in calendar year 1992. Results. Seventy-two children met the case definition, for an incidence of 70 per 100 000 persons per year. There were 12 (16.7%) fatalities, for a mortality rate of 11.7 per 100 000 persons per year. Almost 10% of the patients sustained permanent disability. Mean and median ages of the patients were 14.9 years and 15.8 years, respectively; 79% were male and 82% were black. The majority of the children (63%) lived in census tracts with a high proportion of families in poverty. Black males had the highest rates of firearm injury, with a 1-year incidence of 233 per 100 000 persons per year. At younger than 12 years, the rates were equal among the races; however, for those 12 years and older, black adolescents had 13 times the risk of white adolescents (541 compared to 42 per 100 000 persons per year). The majority (71%) of injuries were due to assaults, with drive-by shootings the most frequent circumstance. The majority of unintentional injuries occurred to adolescents as the result of an unplanned discharge of a handgun as it was being placed in or removed from concealment. Among the patients, 39% were admitted to the hospital and 26% required surgery. Conclusions. 1) Black male adolescents had the highest risk of firearm injury or fatality. 2) The majority of victims lived in census tracts characterized by poverty. 3) Injuries were alarmingly severe. 4) Interpersonal violence was the leading contributor to fatal and nonfatal injuries. 5) Unintentional injuries characteristically occurred during the process of weapon concealment. 6) The leading contributor to injury and death was the interaction of adolescents and guns, particularly handguns. The main implication for firearm-injury prevention in this population is the limiting of access to guns by adolescents. In addition, measures aimed at preventing violent behavior, such as education in nonviolent methods of conflict resolution, should be explored.

scholarly journals Firearm injury epidemiology in children and youth in Ontario, Canada: a population-based study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053859
Author(s):  
Natasha Ruth Saunders ◽  
Charlotte Moore Hepburn ◽  
Anjie Huang ◽  
Claire de Oliveira ◽  
Rachel Strauss ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Population Based ◽  
Children And Youth ◽  
Unintentional Injuries ◽  
Cross Sectional ◽  
Firearm Injury ◽  
Firearm Injuries ◽  
Injury Epidemiology ◽  
Self Injury ◽  
Increased Risk

Background and objectiveDespite firearms contributing to significant morbidity and mortality globally, firearm injury epidemiology is seldom described outside of the USA. We examined firearm injuries among youth in Canada, including weapon type, and intent.DesignPopulation-based, pooled cross-sectional study using linked health administrative and demographic databases.SettingOntario, Canada.ParticipantsAll children and youth from birth to 24 years, residing in Ontario from 1 April 2003 to 31 March 2018.ExposureFirearm injury intent and weapon type using the International Classification of Disease-10 CM codes with Canadian enhancements. Secondary exposures were sociodemographics including age, sex, rurality and income.Main outcomesAny hospital or death record of a firearm injury with counts and rates of firearm injuries described overall and stratified by weapon type and injury intent. Multivariable Poisson regression stratified by injury intent was used to calculate rate ratios of firearm injuries by weapon type.ResultsOf 5486 children and youth with a firearm injury (annual rate: 8.8/100 000 population), 90.7% survived. Most injuries occurred in males (90.1%, 15.5/100 000 population). 62.3% (3416) of injuries were unintentional (5.5/100 000 population) of which 1.9% were deaths, whereas 26.5% (1452) were assault related (2.3/100 00 population) of which 18.7% were deaths. Self-injury accounted for 3.7% (204) of cases of which 72.0% were deaths. Across all intents, adjusted regression models showed males were at an increased risk of injury. Non-powdered firearms accounted for half (48.6%, 3.9/100 000 population) of all injuries. Compared with handguns, non-powdered firearms had a higher risk of causing unintentional injuries (adjusted rate ratio (aRR) 14.75, 95% CI 12.01 to 18.12) but not assault (aRR 0.84, 95% CI 0.70 to 1.00).ConclusionsFirearm injuries are a preventable public health problem among youth in Ontario, Canada. Unintentional injuries and those caused by non-powdered firearms were most common and assault and self-injury contributed to substantial firearm-related deaths and should be a focus of prevention efforts.

scholarly journals Urban-Rural Differences in Indiana Pediatric Firearm Trauma

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Cory Wuerch ◽  
Jodi Raymond, MPH, CSTR, CAISS ◽  
Joseph O'Neil, MD, MPF, FAAP ◽  
Matthew P. Landman, MD, MPH, FAAP, FACS
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Statistical Significance ◽  
Population Data ◽  
Population Based ◽  
Vital Statistics ◽  
Injury Death ◽  
Firearm Injury ◽  
Firearm Injuries ◽  
Rural Counties

Background and Hypothesis: Several studies have evaluated differences in firearm injuries among children and adolescents based on population. However, many of these studies exclude patients who die before arriving at a trauma center. We therefore hypothesize that important population-based differences in pediatric firearm injuries may be uncovered with inclusion of both pre-hospital firearm mortalities and patients treated at a tertiary children’s hospital. Methods: Patients less than 15 years of age who sustained a firearms-related injury/death between the years 2012 and 2018 were identified in: (1) death certificates from the Office of Vital Statistics State of Indiana and (2) Riley Hospital for Children Trauma Registry. Counties were classified as either urban, midsized, or rural based on the National Center for Health Statistic’s population data. Bivariate analyses were used to analyze important variables with statistical significance set at p<0.05. Results: A total of 222 patients were identified (77% male, mean age = 11.3 ± 4.2 years). The median age of firearm injury survivors was 13 (IQR 7-14), while the median age of nonsurvivors was 14 (IQR 11-15). The county population was associated with injury intent, where the frequency of assaults/homicides was higher than expected in urban counties compared to midsized and rural counties (p<0.05 and p<0.001, respectively). Suicide frequency was higher than expected in rural counties (p<0.001). Race was associated with injury intent (p<0.001). Rural and midsized counties had higher than expected mortalities compared to urban counties (p<0.001 and p<0.05, respectively). Attempted suicides in rural areas were more likely to be associated with mortality than attempts in urban areas (p<0.001). Conclusion and Potential Impact: Important differences exist between firearm injuries based on where they occur. The findings presented here will inform public health initiatives aimed at reducing firearm injury and death in Indiana.

scholarly journals Neighborhood disadvantage and firearm injury: does shooting location matter?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Kimberly Dalve ◽  
Emma Gause ◽  
Brianna Mills ◽  
Anthony S. Floyd ◽  
Frederick P. Rivara ◽  
...  
Keyword(s):  
Census Tract ◽  
Social Deprivation ◽  
Public Health Problem ◽  
Credible Interval ◽  
Neighborhood Disadvantage ◽  
Future Research ◽  
Census Tracts ◽  
Firearm Injury ◽  
Firearm Injuries ◽  
Census Tract Level

Abstract Background Firearm violence is a public health problem that disparately impacts areas of economic and social deprivation. Despite a growing literature on neighborhood characteristics and injury, few studies have examined the association between neighborhood disadvantage and fatal and nonfatal firearm assault using data on injury location. We conducted an ecological Bayesian spatial analysis examining neighborhood disadvantage as a social determinant of firearm injury in Seattle, Washington. Methods Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index. The index includes proportion of female-headed households with children, proportion of households with public assistance income, proportion of people with income below poverty in the past 12 months, and proportion of the civilian labor force aged 16 and older that are unemployed at the census tract level. Firearm injury counts included individuals with a documented assault-related gunshot wound identified from medical records and supplemented with the Gun Violence Archive between March 20, 2016 and December 31, 2018. Available addresses were geocoded to identify their point locations and then aggregated to the census tract level. Besag-York-Mollie (BYM2) Bayesian Poisson models were fit to the data to estimate the association between the index of neighborhood disadvantage and firearm injury count with a population offset within each census tract. Results Neighborhood disadvantage was significantly associated with the count of firearm injury in both non-spatial and spatial models. For two census tracts that differed by 1 decile of neighborhood disadvantage, the number of firearm injuries was higher by 21.0% (95% credible interval: 10.5, 32.8%) in the group with higher neighborhood disadvantage. After accounting for spatial structure, there was still considerable residual spatial dependence with 53.3% (95% credible interval: 17.0, 87.3%) of the model variance being spatial. Additionally, we observed census tracts with higher disadvantage and lower count of firearm injury in communities with proximity to employment opportunities and targeted redevelopment, suggesting other contextual protective factors. Conclusions Even after adjusting for socioeconomic factors, firearm injury research should investigate spatial clustering as independence cannot be able to be assumed. Future research should continue to examine potential contextual and environmental neighborhood determinants that could impact firearm injuries in urban communities.

scholarly journals Estimating the asymptomatic proportion of SARS-CoV-2 infection in the general population: Analysis of nationwide serosurvey data in the Netherlands

2021 ◽  
Author(s):  
Scott A. McDonald ◽  
Fuminari Miura ◽  
Eric R. A. Vos ◽  
Michiel van Boven ◽  
Hester E. de Melker ◽  
...  
Keyword(s):  
The Netherlands ◽  
Population Analysis ◽  
Large Population ◽  
Population Based ◽  
Attributable Risk ◽  
Case Definition ◽  
Aggregated Data ◽  
Age Dependent ◽  
Additive Regression ◽  
June July

Abstract Background The proportion of SARS-CoV-2 positive persons who are asymptomatic—and whether this proportion is age-dependent—are still open research questions. Because an unknown proportion of reported symptoms among SARS-CoV-2 positives will be attributable to another infection or affliction, the observed, or 'crude' proportion without symptoms may underestimate the proportion of persons without symptoms that are caused by SARS-CoV-2 infection. Methods Based on two rounds of a large population-based serological study comprising test results on seropositivity and self-reported symptom history conducted in April/May and June/July 2020 in the Netherlands (n = 7517), we estimated the proportion of reported symptoms among those persons infected with SARS-CoV-2 that is attributable to this infection, where the set of relevant symptoms fulfills the ECDC case definition of COVID-19, using inferential methods for the attributable risk (AR). Generalised additive regression modelling was used to estimate the age-dependent relative risk (RR) of reported symptoms, and the AR and asymptomatic proportion (AP) were calculated from the fitted RR. Results Using age-aggregated data, the 'crude' AP was 37% but the model-estimated AP was 65% (95% CI 63–68%). The estimated AP varied with age, from 74% (95% CI 65–90%) for < 20 years, to 61% (95% CI 57–65%) for the 50–59 years age-group. Conclusion Whereas the 'crude' AP represents a lower bound for the proportion of persons infected with SARS-CoV-2 without COVID-19 symptoms, the AP as estimated via an attributable risk approach represents an upper bound. Age-specific AP estimates can inform the implementation of public health actions such as targetted virological testing and therefore enhance containment strategies.

scholarly journals The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 666
Author(s):  
Fahimeh Ramezani Tehrani ◽  
Marzieh Saei Ghare Naz ◽  
Razieh Bidhendi Yarandi ◽  
Samira Behboudi-Gandevani
Keyword(s):  
Systematic Review ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Diagnostic Criteria ◽  
Meta Analysis ◽  
Population Based ◽  
Maternal Outcomes ◽  
Care Providers ◽  
Iadpsg Criteria ◽  
The Impact

This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.

scholarly journals Five regions, five retinopathy screening programmes: a systematic review of how Portugal addresses the challenge

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andreia Marisa Penso Pereira ◽  
Raul Manuel da Silva Laureano ◽  
Fernando Buarque de Lima Neto
Keyword(s):  
Diabetic Retinopathy ◽  
Web Sites ◽  
National Health System ◽  
Health Department ◽  
Population Based ◽  
Care Providers ◽  
Levels Of Care ◽  
Diabetic Retinopathy Screening ◽  
Relevant Role ◽  
Retinopathy Screening

Abstract Background The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes, and difficulties. However, factors such as the existence of regional programmes, specificities of each country’s health systems, organisational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects. Methods Web of Science and PubMed platforms were searched using appropriate key words. The review process resulted in 423 articles adherent to the search criteria, 28 of which were accepted and analysed. Web sites of all Portuguese governmental and non-governmental organisations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed. Results Since 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading, and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening. Conclusion Access to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes, especially if each other highlights are considered. The findings of this research could be very useful for the other countries with similar socio-political characteristics. Trial registration PROSPERO registration ID CRD42020200115.

scholarly journals Unintentional injuries in children and youth from immigrant families in Ontario, Canada: a population-based cross-sectional study

CMAJ Open ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. E90-E96 ◽  
Author(s):  
Natasha Ruth Saunders ◽  
Alison Macpherson ◽  
Jun Guan ◽  
Lisa Sheng ◽  
Astrid Guttmann
Keyword(s):  
Immigrant Families ◽  
Population Based ◽  
Cross Sectional Study ◽  
Children And Youth ◽  
Sectional Study ◽  
Unintentional Injuries ◽  
Cross Sectional

Symptom patterns in childhood arterial ischemic stroke: Analysis of a population-based study in Germany

2018 ◽  
Vol 230 (06) ◽  
pp. 319-325
Author(s):  
Lucia Gerstl ◽  
Raphael Weinberger ◽  
Rüdiger von Kries ◽  
Florian Heinen ◽  
Andreas Sebastian Schroeder ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Symptoms ◽  
Population Based ◽  
Case Definition ◽  
Childhood Stroke ◽  
Older Children ◽  
Arterial Ischemic Stroke ◽  
Focal Neurological Deficit ◽  
Symptom Patterns ◽  
Specific Symptoms

Hintergrund Die zeitliche Verzögerung zwischen Symptombeginn und Diagnose ist eine Herausforderung in der Behandlung von Kindern mit arteriell ischämischem Schlaganfall. Frühere Studien zur klinischen Präsentation beschäftigten sich v. a. mit kumulativen Symptomen. Zielsetzung Ziel dieser Studie ist es, mögliche Symptommuster aufzuzeigen. Methoden In einer aktiven Beobachtungsstudie zwischen 01/2015 und 12/2016 (ESPED-Studie) wurden Kinder mit Erstdiagnose eines arteriell ischämischen Schlaganfalls eingeschlossen. Isoliert auftretende Erstsymptome wurden verschiedenen Symptomkombinationen gegenübergestellt. Zudem wurde untersucht, inwieweit ein als „akut“ oder „progredient“ klassifiziertes Auftreten der Symptome Rückschlüsse auf die zugrundeliegende Ätiologie erlaubt. Ergebnisse Es wurden 99 Kinder in die Studie eingeschlossen. Unabhängig vom Alter traten überwiegend fokale Symptome auf (86%). Krampfanfälle als Initialsymptom wurden insbesondere bei Säuglingen beschrieben (67%), wohin-gegen diffuse, unspezifische Symptome vor allem bei Vorschulkindern (38%) und älteren Kindern (59%) auftraten. Isoliert traten fokale Symptome bei 37 Kindern auf, 48 Kinder zeigten zusätzlich unspezifische Symptome, darunter auch 9 Kinder mit Krampfanfällen. Isolierte unspezifische Symptome zeigten sich lediglich bei 7 Kindern, 2 Kinder wurden nur mit Krampfanfällen symptomatisch. Die Akuität des Symptombeginns wurde bei 53/78 als „akut“ und bei “25/78 Fällen als „progredient“ klassifiziert, lieferte jedoch keinen Hinweis auf die zugrundeliegende Ätiologie. Schlussfolgerung Jedes neue fokal neurologische Defizit sollte unabhängig vom Auftreten (isoliert oder kombiniert, akut oder progredient) an einen kindlichen Schlaganfall denken lassen. Background Time delay between onset of clinical symptoms and diagnosis is a challenge in childhood arterial ischemic stroke. Most previous studies reported cumulative symptoms. Objective We attempted to identify typical symptom patterns and assessed their emergence in childhood stroke. Methods Prospective active surveillance in ESPED, a hospital based Pediatric Surveillance Unit for rare diseases in Germany, between January 2015 and December 2016. Case definition: first diagnosis of a radiologically confirmed arterial ischemic stroke. Symptom patterns were identified as occurring in isolation or in combination. We distinguished acute vs. progressive onset. We ascertained risk factors to identify the possible etiology. Results 99 children with childhood arterial ischemic stroke were reported. Focal symptoms were the predominant presenting feature (86%), independent of age. Seizures were more often seen in infants < 1 year (67%), whereas diffuse symptoms were more present in pre-school children (38%) and older children (59%). 37 children had focal features alone and 48 additional non-specific features, including 9 with seizures. Isolated non-specific features accounted for 7 cases, and 2 children had (focal) seizures as the only symptom. In 77% of all cases at least one risk factor was identified. The emergence of symptoms was acute in 53/78 cases and progressive in 25/78 cases. The pattern of emergence was unrelated to the underlying etiology. Conclusions Any new focal neurological deficit in isolation, or associated with seizures or further non-specific symptoms should alert to childhood stroke.

Healthcare Resource Utilization in Bipolar Depression Compared with Unipolar Depression: Results of a United States Population-Based Study

CNS Spectrums ◽  
2006 ◽  
Vol 11 (9) ◽  
pp. 704-710 ◽  
Author(s):  
Mark A. Frye ◽  
Joseph R. Calabrese ◽  
Michael L. Reed ◽  
Robert M.A. Hirschfeld
Keyword(s):  
United States ◽  
Social Services ◽  
Psychiatric Hospitalization ◽  
Bipolar Depression ◽  
Unipolar Depression ◽  
Population Based ◽  
Healthcare Resource Utilization ◽  
Care Providers ◽  
The Past ◽  
United States Population

ABSTRACTIntroduction:This study examined healthcare utilization in the past year by subjects who screened positive for bipolar versus unipolar depression.Method:A self-administered survey was completed in 2002 by a United States population-based sample. Respondents were categorized into one of three subgroups: bipolar depressed screen positive (BP DEP+, n=394); unipolar depressed screen positive (UP DEP+, n=794); and control subjects (n=1,612).Results:For depressive symptoms in the past year, BP DEP+ respondents were significantly more likely than UP DEP+ respondents to report a healthcare visit to a number of diverse care providers. In analyses controlled for demographics and depression severity, the differences in psychiatric hospitalization, psychologist/counselor outpatient visit, substance abuse/social services visit, and number of emergency room visits remained significant between BP DEP+ and UP DEP+ respondents.Conclusion:Subjects with self-reported bipolar depression sought care more often from a number of diverse healthcare resources than subjects with self-reported unipolar depression. These findings underscore the morbidity associated with bipolar depression.

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