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Roza TH, Marchionatti LE, Gosmann NP, do Canto GC, Machado PV, Massuda R, Passos IC, Kessler FHP, Magalhães PVDS, Telles LEDB. Characteristics of deaths by suicide in postmortem studies in Brazil: A systematic review and meta-analysis. Suicide Life Threat Behav 2023; 53:1086-1107. [PMID: 37864416 DOI: 10.1111/sltb.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Suicide is one of the leading causes of death, with a trend for its increase in Brazil in past decades. This study aimed to review the characteristics of suicides in Brazilian postmortem studies. METHODS Studies investigating suicide deaths in Brazil, and based on autopsy or psychological autopsy were included. Proportions were pooled across studies with the use of random and fixed effects models. RESULTS 6777 references were retrieved from six databases (searches up to January, 2023), and 45 studies included. In autopsy studies (k = 37, n = 16,231), substance use at toxicological analysis was found in 36.42% of cases (95% CI: 30.05-43.32), previous suicide attempts in 23.92% (95% CI: 6.73-57.78). In psychological autopsy studies (k = 8, n = 139), previous suicide attempts were reported in 28.09% (95% CI: 19.74-38.28), psychiatric conditions/symptoms in 90.67% (95% CI: 67.79-97.82), family history of suicidality in 21.33% (95% CI: 13.5-32.03). Most suicide deaths were reported in males and took place at the victim's home, hanging was the most frequent suicide method. Included studies presented significant limitations in quality assessment. CONCLUSION Future studies should present more robust methodology, including bigger samples, the use of controls, and validated methodology.
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Affiliation(s)
- Thiago Henrique Roza
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Lauro Estivalete Marchionatti
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Natan Pereira Gosmann
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Section of Negative Affect and Social Processes, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Anxiety Disorders Outpatient Program, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gustavo Cambraia do Canto
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Patrícia Vasconcelos Machado
- Seção de Perícias Psíquicas (Forensic Psychological and Psychiatric Examination Unit), Departamento-Médico Legal (Institute of Legal Medicine), Instituto-Geral de Perícias (General Crime Scene Investigation Institute), Porto Alegre, Brazil
| | - Raffael Massuda
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Ives Cavalcante Passos
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felix Henrique Paim Kessler
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lisieux Elaine de Borba Telles
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Amin D, Manhan AJ, Stern E, Smith RN, Abramowicz S. Socioeconomic Profile is Associated with the Type of Firearm Injuries to the Head and Neck. J Oral Maxillofac Surg 2023; 81:292-298. [PMID: 36481275 DOI: 10.1016/j.joms.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Socioeconomic status (SES) describes social standing of an individual or a group. SES has been directly associated with violence. The purpose of this study is to measure the association between SES profiles and firearm injuries (FIs) to the head and neck. METHODS This cross-sectional study reviewed patients at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to June 2021. The study included patients who sustained FIs to the head and neck. The primary predictor variable was Distressed Community Index as a surrogate for SES. The primary outcome variable was type of FI (assault-induced firearm injury [AFI] or self-inflicted firearm injury [SFI]). Covariates were patient characteristics, distribution, and severity of FI. Univariate and bivariate analyses were calculated. The χ2 test was used for categorical variables. Independent t test was used for continuous variables. Statistical significance was P < .05. RESULTS Six hundred ninety-four patients met inclusion criteria. AFIs were statistically more frequent in young (AFI = 32.2; SFI = 42.2; P ≤ .001) and/or Black patients (AFI: n = 483, 86.3%; SFI: n = 40, 29.9%; P ≤ .001). Patients who sustained AFIs were statistically more likely to live in areas associated with high Distressed Community Index score (AFI: 64.8, range = 3.7 to 99.7; SFI: 54.4, range = 2.8 to 98; P ≤ .001). A statistically significant number of SFI patients presented with lower Glasgow Coma Scale score (AFI: 10.7, range = 3 to 15; SFI: 5.5, range = 3 to 15; P ≤ .001), and/or required tracheostomy (AFI: n = 56, 10%; SFI: n = 27, 20.1%; P = .005). CONCLUSIONS Patients who lived in economically distressed areas were positively associated with AFIs to the head and neck. However, SFIs were statistically more sever. More studies on the impact of current gun prevention programs and how to be addressed to at-risk populations is needed.
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Affiliation(s)
- Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Texas A & M University, Dallas, TX.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Elinor Stern
- Medical Student, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Department of Surgery, Emory University School of Medicine; Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Shelly Abramowicz
- Professor in Oral and Maxillofacial Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Emory University, School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Tahmasebi E, Mohammadi M, Alam M, Abbasi K, Gharibian Bajestani S, Khanmohammad R, Haseli M, Yazdanian M, Esmaeili Fard Barzegar P, Tebyaniyan H. The current regenerative medicine approaches of craniofacial diseases: A narrative review. Front Cell Dev Biol 2023; 11:1112378. [PMID: 36926524 PMCID: PMC10011176 DOI: 10.3389/fcell.2023.1112378] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Craniofacial deformities (CFDs) develop following oncological resection, trauma, or congenital disorders. Trauma is one of the top five causes of death globally, with rates varying from country to country. They result in a non-healing composite tissue wound as they degenerate in soft or hard tissues. Approximately one-third of oral diseases are caused by gum disease. Due to the complexity of anatomical structures in the region and the variety of tissue-specific requirements, CFD treatments present many challenges. Many treatment methods for CFDs are available today, such as drugs, regenerative medicine (RM), surgery, and tissue engineering. Functional restoration of a tissue or an organ after trauma or other chronic diseases is the focus of this emerging field of science. The materials and methodologies used in craniofacial reconstruction have significantly improved in the last few years. A facial fracture requires bone preservation as much as possible, so tiny fragments are removed initially. It is possible to replace bone marrow stem cells with oral stem cells for CFDs due to their excellent potential for bone formation. This review article discusses regenerative approaches for different types of craniofacial diseases.
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Affiliation(s)
- Elahe Tahmasebi
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadi
- School of Dentistry, Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mostafa Alam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Abbasi
- Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Gharibian Bajestani
- Student Research Committee, Dentistry Research Center, Research Institute of Dental Sciences, Dental School, Shahid Behesti University of Medical Sciences, Tehran, Iran
| | - Rojin Khanmohammad
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohsen Haseli
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohsen Yazdanian
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Hamid Tebyaniyan
- Department of Science and Research, Islimic Azade University, Tehran, Iran
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Teixeira Costa S, Rodrigues Freire A, Ferreira-Pileggi BC, Daruge Júnior E, Bevilacqua Prado F, Rossi AC. Finite element analysis dynamic simulation of projectile impact caliber .40 S&W in temporal bone with neural tissue. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2149857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sárah Teixeira Costa
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Alexandre Rodrigues Freire
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Eduardo Daruge Júnior
- Department of Health Sciences and Pediatric Dentistry, Forensic Dentistry Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Felippe Bevilacqua Prado
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Ana Cláudia Rossi
- Department of Biosciences, Anatomy Division, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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Lee KC, Wu BW, Chuang SK. Are Facial Gunshot Wounds More Fatal When They Are Self-Inflicted or Other-Inflicted? Craniomaxillofac Trauma Reconstr 2022; 15:275-281. [PMID: 36387324 PMCID: PMC9647373 DOI: 10.1177/19433875211039919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Study Design This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample (NEDS). Objective Intraoral and submental projectile entry points may be less fatal than other facial entry points due to the indirect access to the intracranial structures and the protection offered by the intervening maxillofacial complex. Because intraoral and submental trajectories are almost always present in the setting of attempted suicide, this study sought to determine if intent (self-harm versus other-harm) influenced mortality in facial gunshot wound (GSW) patients. Methods All patients with a diagnosis of a facial fracture secondary to firearm injury were included in the study sample. The primary predictor was self-harm. Secondary predictors were derived from patient, injury, and hospitalization characteristics. The study outcome was death. Univariate time to event analyses were conducted for all study predictors. A multivariate regression model for mortality was created using all relevant predictors. Results The final sample included 668 facial GSW injuries, of which 19.3% were attributed to self-harm. Self-inflicted GSWs were more likely to involve the mandible (58.9 vs 46.0%, P < 0.01), ZMC/maxilla (47.3 vs 32.5%, P < 0.01), and intracranial cavity (48.1 vs 22.6%, P < 0.01). The overall mortality rate was 7.3%, and the mean time to death was 2.2 days. After controlling for pertinent covariates, the risk of mortality was independently decreased with mandibular injury (HR = 0.36, P = 0.03). However, mortality was increased by self-harm intent (HR = 3.94, P < 0.01) and intracranial involvement (HR = 11.24, P < 0.01). Conclusions Consistent with a pattern of intraoral and submental entry points, self-inflicted facial GSWs demonstrated higher rates of mandibular injury. Despite this finding, self-harm injuries still carried a higher incidence of intracranial injury and a greater independent risk of mortality. Our results refute any notion that the mechanism and trajectory of self-inflicted GSWs is less fatal.
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Affiliation(s)
- Kevin C. Lee
- Division of Oral and Maxillofacial
Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York,
NY, USA
| | - Brendan W. Wu
- Department of Oral and Maxillofacial
Surgery, New York University, Langone Medical Center and Bellevue Hospital Center,
New York, NY, USA
| | - Sung-Kiang Chuang
- Department of Oral and Maxillofacial
Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA,
USA
- Private Practice, Brockton Oral and
Maxillofacial Surgery Inc., Brockton, MA, USA
- Department of Oral and Maxillofacial
Surgery, Good Samaritan Medical Center, Brockton, MA, USA
- Department of Oral and Maxillofacial
Surgery, School of Dentistry, Kaohsiung Medical University, Kaohsiung
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Thomsen AH, Leth PM, Hougen HP, Villesen P. Gunshot homicides in Denmark 1992-2016. Int J Legal Med 2021; 135:1507-1514. [PMID: 33661341 DOI: 10.1007/s00414-021-02548-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
The majority of homicides in the world are caused by firearms and a good understanding of gunshot wounds is important for the forensic pathologist. We have analyzed all 315 homicides by gunshots in Denmark during 1992-2016 with focus on information relevant to forensic pathologists. Of the 1417 homicides in Denmark in 1992-2016, 315 (22.2%) had gunshot trauma as the primary homicide method. During 1992-2016, there has been a significant decrease in the number of gunshot homicides overall, of homicides committed with hunting weapons, and of domestic gunshot homicides. Most victims (70.5%) and offenders (93.7% of homicides with known offenders) were males. Male victims were significantly younger than female victims. Most victims were killed with handguns (43.8%) or shotguns (41.0%). Compared to all other weapons, the victims killed with shotguns had fewer entry wounds, a higher New Injury Severity Score (NISS), and a higher proportion of contact/close-range entry wounds. The head (58.1%) and thorax (46.7%) were often injured, with injuries to the head being more common in contact/close-range entry wounds. The results show that gunshot injuries in homicides are different from suicides and accidents and clearly are affected by the homicide type, the sex of the victim, and the weapon used and that these entities are intertwined. Our findings provide an evidence-based foundation for use in death investigations and for policy development in the area of interpersonal violence.
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Affiliation(s)
- Asser H Thomsen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensen Boulevard 99, 8200, Aarhus N, Denmark.
| | - Peter M Leth
- Department of Forensic Medicine, University of Southern Denmark, J. B. Winsloews Vej 17, DK-5000, Odense C, Denmark
| | - Hans Petter Hougen
- Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
| | - Palle Villesen
- Bioinformatics Research Centre, Aarhus University, CF Moellers Alle 8, 8000, Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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