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Galante N, Blandino A, Disegna M, Franceschetti L, Casali MB. Intentional child and adolescent homicides in Milan (Italy): A 30-year interdisciplinary study. Leg Med (Tokyo) 2024; 68:102433. [PMID: 38467102 DOI: 10.1016/j.legalmed.2024.102433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
This study aims to discuss the forensic and criminological implications of child homicides in the territory of Milan, Italy. The authors present a retrospective study on all the cases of child and adolescent homicides, that were observed at the Institute of Legal Medicine of Milan (Italy) in the last 30 years (from January 1991 to December 2020). A total of 46 child homicides were collected, focusing on the sociological features, by highlighting peculiar cases, risk factors, potential changing social trends, and comparing our cases with the current literature. The analysis revealed a statistically significant relationship (p < 0.05) for male adolescents and indicated that adolescent homicides were more frequently perpetrated in extrafamilial contexts. In contrast, neonaticides and infanticides were mainly committed at home. Furthermore, the Fisher's Exact test revealed that child murders were mainly committed by immigrants in the Milan district after 2005 (p < 0.05). The two main causes of death were due to sharp and firearm injuries. While the relationship between homicide clusters and homicides committed by sharp objects was not significant, adolescent homicides were mainly committed using firearms (p < 0.05). The present study may help to identify risk factors for homicides against child and adolescent. Consequently, policies that identify, prevent, and minimize this extreme violence should be designed to interrupt the vicious circle of such dreadful murderous events. Child and adolescent homicides deserve additional focus and better education for healthcare professionals and further research should be carried out to develop therapeutic and caring strategies.
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Affiliation(s)
- Nicola Galante
- Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy.
| | | | - Marta Disegna
- Department of Management and Engineering (DTG), University of Padua, Via Stradella San Nicola 3, 36100 Vicenza, Italy
| | - Lorenzo Franceschetti
- Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy
| | - Michelangelo Bruno Casali
- Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy
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Tennakoon L, Ko A, Knight AW, Nassar AK, Wu R, Spain DA, Knowlton LM. Firearm-Related Injuries and the US Opioid and Other Substance Use Epidemic: A Nationwide Evaluation of Emergency Department Encounters. J Surg Res 2024; 298:128-136. [PMID: 38603943 DOI: 10.1016/j.jss.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION There has been a sharp climb in the Unites States' death rate among opioid and other substance abuse patients, as well as an increased prevalence in gun violence. We aimed to investigate the association between substance abuse and gun violence in a national sample of patients presenting to US emergency departments (EDs). METHODS We queried the 2018-2019 Nationwide Emergency Department Sample for patients ≥18 years with substance abuse disorders (opioid and other) using International Classification of Diseases, 10th Revision, Clinical Modification codes. Within this sample, we analyzed characteristics and outcomes of patients with firearm-related injuries. The primary outcome was mortality; secondary outcomes were ED charges and length of stay. RESULTS Among the 25.2 million substance use disorder (SUD) patients in our analysis, 35,306 (0.14%) had a firearm-related diagnosis. Compared to other SUD patients, firearm-SUD patients were younger (33.3 versus 44.7 years, P < 0.001), primarily male (88.6% versus 54.2%, P < 0.001), of lower-income status (0-25th percentile income: 56.4% versus 40.5%, P < 0.001), and more likely to be insured by Medicaid or self-pay (71.6% versus 53.2%, P < 0.001). Firearm-SUD patients had higher mortality (1.4% versus 0.4%, P < 0.001), longer lengths of stay (6.5 versus 4.9 days, P < 0.001), and higher ED charges ($9269 versus $5,164, P < 0.001). Firearm-SUD patients had a 60.3% rate of psychiatric diagnoses. Firearm-SUD patients had 5.5 times greater odds of mortality in adjusted analyses (adjusted odds ratio: 5.5, P < 0.001). CONCLUSIONS Opioid-substance abuse patients with firearm injuries have higher mortality rates and costs among these groups, with limited discharge to postacute care resources. All these factors together point to the urgent need for improved screening and treatment for this vulnerable group of patients.
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Affiliation(s)
- Lakshika Tennakoon
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, California
| | - Ara Ko
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, California
| | - Ariel W Knight
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, California
| | - Aussama K Nassar
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, California
| | - Ruoxue Wu
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, California
| | - David A Spain
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa M Knowlton
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, California.
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Joseph B, Hosseinpour H, Sakran J, Anand T, Colosimo C, Nelson A, Stewart C, Spencer AL, Zhang B, Magnotti LJ. Defining the Problem: 53 Years of Firearm Violence Afflicting America's Schools. J Am Coll Surg 2024; 238:671-678. [PMID: 38445669 DOI: 10.1097/xcs.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Firearm violence and school shootings remain a significant public health problem. This study aimed to examine how publicly available data from all 50 states might improve our understanding of the situation, firearm type, and demographics surrounding school shootings. STUDY DESIGN School shootings occurring in the US for 53 years ending in May 2022 were analyzed, using primary data files that were obtained from the Center for Homeland Defense and Security. Data analyzed included situation, injury, firearm type, and demographics of victims and shooters. We compared the ratio of fatalities per wounded after stratifying by type of weapon. Rates (among children) of school shooting victims, wounded, and fatalities per 1 million population were stratified by year and compared over time. RESULTS A total of 2,056 school shooting incidents involving 3,083 victims were analyzed: 2,033 children, 5 to 17 years, and 1,050 adults, 18 to 74 years. Most victims (77%) and shooters (96%) were male individuals with a mean age of 18 and 19 years, respectively. Of the weapons identified, handguns, rifles, and shotguns accounted for 84%, 7%, and 4%, respectively. Rifles had a higher fatality-to-wounded ratio (0.45) compared with shooters using multiple weapons (0.41), handguns (0.35), and shotguns (0.30). Linear regression analysis identified a significant increase in the rate of school shooting victims (β = 0.02, p = 0.0003), wounded (β = 0.01, p = 0.026), and fatalities (β = 0.01, p = 0.0003) among children over time. CONCLUSIONS Despite heightened public awareness, the incidence of school shooting victims, wounded, and fatalities among children has steadily and significantly increased over the past 53 years. Understanding the epidemic represents the first step in preventing continued firearm violence in our schools.
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Affiliation(s)
- Bellal Joseph
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Hamidreza Hosseinpour
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Joseph Sakran
- Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, MD (Sakran)
| | - Tanya Anand
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Christina Colosimo
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Adam Nelson
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Collin Stewart
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Audrey L Spencer
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Bo Zhang
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
| | - Louis J Magnotti
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ (Joseph, Hosseinpour, Anand, Colosimo, Nelson, Stewart, Spencer, Zhang, Magnotti)
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Douglas A, Rogers S. Survivor's remorse. J Trauma Acute Care Surg 2024; 96:e10-e12. [PMID: 37828663 DOI: 10.1097/ta.0000000000004175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
ABSTRACT In urban, large metropolitan trauma centers, we are accustomed to seeing the most gruesome morbidity and mortality in medicine. By far, the most devastating morbidity and mortality to observe are those inflicted on one human being to another. Gun violence is pervasive in this industrialized country, and it impacts us all. Staff, residents, and faculty in trauma centers bear the brunt of this trauma, second only to the families and communities that suffer the loss of loved ones. This burden is especially heavy for health care workers who share the same ethnic background of those who are disproportionately affected by interpersonal gun violence. Survivors of gun violence exist on a spectrum of chronic illness that ranges in physical and mental morbidity and social disruption in loss of wages and capabilities. This disease not only infects those wounded or killed but also transmits through communities and generations. Urban violence exists because of historic and systematic racism. It continues to persist because racism creates inequities in the quality of education, housing, and investment in urban environments, exacerbated by residential segregation. For two providers, a trainee and a faculty member of African descent, conscious of the determinants that create gun violence, it is overwhelming. We, as health care providers, must tell our stories and the stories of those whose voices are not empowered. We can hope that, by sharing these experiences, we stimulate action and change by raising the moral consciousness of those unaware of the tragedies we witness every day.
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Affiliation(s)
- Anthony Douglas
- From the Department of Surgery (A.D., S.R.), University of Chicago, Chicago, IL
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Kaufman EJ, Richmond TS, Hoskins K. Youth Firearm Injury: A Review for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:357-371. [PMID: 36898779 PMCID: PMC9662754 DOI: 10.1016/j.ccc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firearms are now the leading cause of death among youth in the United States, with rates of homicide and suicide rising even more steeply during the SARS-CoV-2 pandemic. These injuries and deaths have wide-ranging consequences for the physical and emotional health of youth and families. While pediatric critical care clinicians must treat the injured survivors, they can also play a role in prevention by understanding the risks and consequences of firearm injuries; taking a trauma-informed approach to the care of injured youth; counseling patients and families on firearm access; and advocating for youth safety policy and programming.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, MOB Suite 120, 51 North 39th Street, Philadelphia, PA 19104, USA
| | - Therese S Richmond
- University of Pennsylvania School of Nursing, Fagin Hall 330, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
| | - Katelin Hoskins
- University of Pennsylvania School of Nursing, Fagin Hall 312, 418 Curie Boulevard, Philadelphia, PA 19104, USA
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Newsome K, Sen-Crowe B, Autrey C, Alfaro S, Levy M, Bilski T, Ibrahim J, Elkbuli A. A Closer Look at the Rising Epidemic of Mass Shootings in the United States and Its Association With Gun Legislation, Laws, and Sales. J Surg Res 2022; 280:103-113. [PMID: 35969931 DOI: 10.1016/j.jss.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/13/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Mass shootings pose a considerable threat to public safety and significantly cost the United States in terms of lives and expenses. The following are the specific aims of this study: (1) to assess US mass shootings, firearm-related sales, laws, and regional differences from 2015 to 2021 and (2) to investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 pandemic. METHODS A retrospective review was conducted of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the United States from 2015 to 2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015 to 2021 were selected for further analysis. RESULTS Mass shootings correlated significantly with firearm sales from 2015 to 2021 nationwide (P < 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared to the years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. CONCLUSIONS Firearm sales correlated significantly with mass shootings from 2015 to 2021. Mass shootings and gun sales increased at greater rates during the Coronavirus Disease 2019 pandemic compared to the years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.
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Affiliation(s)
- Kevin Newsome
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Brendon Sen-Crowe
- NSU NOVA Southeastern University, Dr Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Cody Autrey
- NSU NOVA Southeastern University, Dr Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Sophie Alfaro
- A.T. Still University School of Osteopathic Medicine, Arizona
| | - Marc Levy
- Arnold Palmer Children's Hospital at Orlando Health, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Tracy Bilski
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida
| | - Joseph Ibrahim
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida
| | - Adel Elkbuli
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida.
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