Violence in Jamaica: an analysis of homicides 1998-2002

Peace and health: exploring the nexus in the Americas

The relationship between peace and health is complex, multifactorial and fraught with challenges of definitions, measurements and outcomes. This exploratory commentary on this nexus within a focus on the Americas posits this challenge clearly and calls for more scholarship and empirical work on this issue from an interdisciplinary perspective. The overall goal of this paper is to try and explore the elements that impact the relationship between peace and health with a focus on the Americas (defined as countries spanning from Canada to Argentina) in the post-Cold war period. Focusing on the 1990s and onwards, we seek to underscore why violence continues to permeate these societies despite a third and lasting wave of democratisation in the hemisphere. We hope this will allow a more robust dialogue on peace and health in the regional and global health literature.

Sexual homicide in Australia and New Zealand: a description of offenders, offences and victims

The field of sexual homicide research is relatively recent, with many existing studies limited by small sample sizes and sampling bias. In Australia and New Zealand specifically, only one study to date addresses this phenomenon but there is a lack of comprehensive descriptive data. This study aims to fill this research gap using a representative sample gathered from public legal databases. A total of 118 cases of sexual homicide offenders are described to create a portrait of this type of offender, their victims and their offence behaviour. Findings are similar to those found in other large samples from the UK, Canada and Germany. Because this crime is rare and practitioners tend to have limited experience of them, the findings of this research have the potential to inform investigative, criminal justice and clinical practice.

Sexual Homicides in China: Exploring the Offender, Victim, and Offense Characteristics

Nearly all information available on sexual homicides are limited to studies conducted in the West. Little is known about sexual homicides that occurred in China. The current study is arguably the first to explore the offender, victim, and offense characteristics of Chinese sexual homicides. Over a period of 23 years (1994 to 2016), the data of 59 cases collected from two data sources (i.e., published Chinese case reports and police data) are examined. Findings indicate that heterosexual assaults are far more prevalent in Chinese sexual homicides. Sexual murderers who averagely aged 32.44 years are mostly males (97%), single (67%), secondary school educated (68%), and with no prior overall (80%) and sexual (88%) convictions. The victims are mostly females (83%) with mean age of 35.35 years. The frequently observed offending patterns include strangers as victim choice (63%), con tactics as victim approach method (57%), sexual pleasure as primary motivation (49%), and personal weapons as murder weapon of choice (41%). Vaginal penetration is a commonly observed sexual assault (88%) and victim body mutilation is also not uncommon (47%). Three case examples are also presented to illustrate the diverse nature and offending patterns of Chinese sexual homicide offenders.

Assessing the cost-effectiveness of the Peace Management Initiative as an intervention to reduce the homicide rate in a community in Kingston, Jamaica

OBJECTIVES

Communities throughout the world are investigating various approaches to reduce violence, especially gun violence. The objective of this study is to determine the cost-effectiveness of the Peace Management Initiative as an intervention to reduce the homicide rate in volatile community in Kingston, Jamaica.

METHODS

A preliminary longitudinal study tracked the homicide rate in a selected volatile community in Kingston, Jamaica, over the 5-year period of PMI intervention in this community. The changes in the incidence of homicides were costed according to direct medical costs and productivity losses assuming that, without intervention, the number of homicides per year would have remained at the 2005 level. This was used to estimate the cost-effectiveness of the intervention.

RESULTS

The Peace Management Initiative approach reduced homicides by 96.9% over the 5-year intervention period. The cost/benefit ratio for the intervention has been estimated to be JMD $12.38 saved per dollar spent on intervention.

CONCLUSIONS

The Peace Management Initiative approach was seen to significantly reduce the murder rate over the 5-year intervention period and provides a promising cost-effective approach for violence prevention.

Understanding and Reducing Sexual Prejudice in Jamaica: Theoretical and Practical Insights From a Severely Anti-Gay Society

Jamaica has earned an international reputation for severe sexual prejudice-perhaps disproportionately so compared to other severely anti-LGBT (lesbian, gay, bisexual, and transgender) societies. Until recently, however, no quantitative empirical research had investigated Jamaica's sexual prejudice, leaving the prejudice poorly understood and methods of reducing it unclear. This article reviews empirical research on Jamaican anti-LGBT prejudice from the past 15 years. It situates Jamaica within the global context, explains the current understanding of the severity and nature of the problem, evaluates solutions currently being explored, and suggests promising strategies based on available evidence. Importantly, this article also reflects on lessons learned from Jamaica that are relevant for other severely anti-LGBT societies.

Profiling Pregnant Women at Risk for Domestic Violence in Jamaica: A Pilot Study

Background:

Domestic violence (DV) is recognized as a priority in maternity care. Data on the prevalence and profile of women experiencing DV during pregnancy are limited in Jamaica. This baseline study has identified the prevalence and provided a profile of pregnant women who are at risk for DV in Kingston, Jamaica.

Method:

A descriptive cross-sectional study was done in 2014. A total of 185 randomly selected pregnant women attending the antenatal clinic completed a self-administered questionnaire. The data were analyzed using SPSS. The study was approved by our local ethical boards and all ethical considerations were adhered to.

Results:

The study identified a prevalence rate of 41% (n= 75/182) which includes all types of DV during pregnancy. Those at risk were 23–29 years old, single (66.6%), employed (44%), had primary education (66.6%), and had unplanned pregnancies (65%). The majority of respondents (98%) were willing to disclose DV, but the clinic does not provide them the opportunity. Only 11% (8/75) reported that they sought professional help.

Conclusion:

This study adds to the body of knowledge on the prevalence of DV and notes that it is high among pregnant women attending the antenatal clinic. The findings can guide the development of a DV screening protocol to identify and treat pregnant women and train health practitioners in Jamaica.

Sharp Force Injuries at the University Hospital of the West Indies, Kingston, Jamaica: A Seventeen-year Autopsy Review

OBJECTIVES

This study aimed to ascertain the prevalence and patterns of fatal sharp force injuries, victims' demographics, cause of death and average survival time at the University Hospital of the West Indies (UHWI), Kingston, Jamaica.

METHODS

The autopsy records for 1990-2010 were searched for fatal cases of sharp force injuries. The records for 1998-2001 were not located. A 17-year retrospective analysis was therefore performed and findings for the two periods, 1990-1997 and 2002-2010 were compared. All data were obtained from the provisional anatomical diagnoses (PAD) autopsy reports.

RESULTS

During the 17-year period, 57/4264 autopsies were performed for sharp force injuries, yielding an overall autopsy prevalence rate of 1.34% (1.25%, 26/2086 (95% CI 0.77, 1.73) in Period 1 and 1.42%, 31/2178 (95% CI 0.92, 1.92) in Period 2). The majority were males (91.1%), in the age group 15-39 years (77%), mean age of 30.9 years (range = 17─65 years). Stab wounds predominated (91.3%) and the chest was the area most frequently stabbed (42.1%). In the 24 fatalities due to chest injuries only, eight (33.3%) had injuries to the heart alone. Forty-five patients (79.0%) died within 24 hours from exsanguination. Injury documentation at autopsy was deficient.

CONCLUSION

Stabbing was the most common sharp force injury, mainly involving the chest and young men were at greatest risk. Most patients died from exsanguination within 24 hours of admission. Introduction of synoptic-type reports for both clinical and autopsy examination may improve documentation.

Homicídios na região das Américas: magnitude, distribuição e tendências, 1999-2009

O objetivo do estudo foi descrever a magnitude e a distribuição da mortalidade por homicídios nas Américas e analisar suas tendências. Foram analisados óbitos por homicídios (X85 a Y09 e Y35) de 32 países das Américas, período 1999-2009, registrados no Sistema de Informações de Mortalidade/Organização Pan Americana da Saúde. Utilizou-se modelo binomial negativo para estudar as tendências. Cerca de 121.297 mortes por homicídios (89% homens e 11% mulheres) ocorreram anualmente nas Américas, predominando as idades de 15 a 24 e de 25 a 39 anos. Em 2009, a taxa padronizada de homicídios da região foi 15,5/100.000. Os países com taxas/100.000 baixas foram Canadá (1,8), Argentina (4,4), Cuba (4,8), Chile (5,2) e Estados Unidos (5,8); e com taxas/100.000 altas foram El Salvador (62,9), Guatemala (51,2), Colômbia (42,5), Venezuela (33,2) e Porto Rico (25,8). Entre 1999-2009 as taxas da região permaneceram estáveis; aumentaram em nove países, como Venezuela (p < 0,001), Panamá (p < 0,001), El Salvador (p < 0,001) e Porto Rico (p < 0,001); diminuíram em quatro países, especialmente na Colômbia (p < 0,001); e permaneceram estáveis no Brasil, Estados Unidos, Equador e Chile. O aumento no México ocorreu no período mais recente. Apesar dos esforços empreendidos, diversos países têm taxas altas de homicídios e crescimento nas mesmas.

Changing trends in the pattern and outcome of stab injuries at a North London hospital

OBJECTIVE

To study the incidence, pattern and outcome of stab injuries attending a North London Teaching Hospital over a 3-year (2006-2008) period.

MATERIALS AND METHODS

A retrospective review of collected data from the Hospital database was conducted. The database contains comprehensive medical records for all patients attended by the trauma team for deliberate stab injuries. It is updated by the surgical team after each admission. All patients with deliberate penetrating injury who were attended by the service between 1 January 2006 and 31 December 2008 were identified. Patients who died in the prehospital phase, those managed exclusively by the emergency department and limb injuries without vascular compromise were excluded from the study.

RESULTS

Six hundred and nineteen patients with stab injuries (following knife crime) from North London attended the Hospital in the above period. One hundred and thirty-seven paients required surgical admission. Two were cases of self-inflicted knife injuries. Over the 3-year period the percentage of victims below 20 years of age is increasing. Ninety-three percent of knife crime occured between 6 pm and 6 am; recently moving toward week days from weekend period.

CONCLUSIONS

The overall rate of penetrating injuries (stab injuries) is slowly declining. Timely cardiothoracic support facility is vital in saving lives with major cardiac stab injuries. Although alcohol drinking restriction has been lifted, most cases of stabbings are still occurring out-of-hours when surgical personnel are limited.

Complicated head trauma from machete wounds: the experience from a tertiary referral hospital in Jamaica

There have been limited reports on machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial injuries from machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated head injuries from machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow Coma Score < 8 at any point during admission; compound skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial bleeding; parenchymal contusions; lacerations and/or oedema. The data were analysed using the SPSS version 12.0. Of the 40 patients with complex injuries to the cranium, there was a 6:1 male preponderance with a mean age of 32.5 ± 13.7 years (Mean ± SD). The injuries included open skull fractures in all the 40 (100%) patients, depressed skull fractures in 20 (50%) patients, CSF leaks in 4 (10%) patients, protruding brain matter in 4 (10%) patients, cerebral contusions in 3 (7.5%) patients and extra cranial injuries in 16 (40%) patients. Tetanus prophylaxis and intravenous antibiotics were administered to all patients, and phenytoin was required in 16 (40%) cases. There were 37 (92%) patients requiring operative intervention at a mean of 10.4 h after presentation (SD ± 18.1; Median 6). The operative procedures included elevation of depressed fractures in 20 (54.1%) patients, dural repair in 10 (27.0%) patients and intra-cranial debridement in 7 (18.9%) patients. There were three deaths (7.5%), and seizures were recorded in 5 (12.5%) cases with no reports of infectious morbidity. Eighty percent of patients had a normal Glasgow outcome score on discharge. Complicated machete head trauma is uncommon at this health care facility in Jamaica. We achieved a satisfactory outcome with aggressive management consisting of prompt assessment of the extent of injury, appropriate antibiotics, anticonvulsants for those with seizures or cortical injury and early operation to decrease the risk of complications.

Diferenciais da mortalidade por violência contra adolescentes segundo estrato de condição de vida e raça/cor na cidade do Recife

Um estudo ecológico foi conduzido com o objetivo de analisar os diferenciais da mortalidade por violência contra adolescentes segundo estrato de condição de vida e raça/cor, no Recife, no período de 1998 a 2004. O coeficiente médio de mortalidade por violência para o período foi calculado para o município e para os estratos de condição de vida. Os dados relativos à violência foram obtidos do Sistema de Informação sobre Mortalidade. Para a raça/cor, foram calculadas proporções e considerado o período de 1999 a 2004. A taxa de mortalidade por mortes violentas contra adolescentes para o município foi de 88,24 por 100 mil adolescentes, sendo 46,93 no estrato I, de "melhor condição de vida", e 95,00 no estrato III, de "pior condição de vida". Dentre as mortes violentas, 92,45% acometeram adolescentes pretos e 7,55%, adolescentes brancos. Os resultados demonstram desigualdades na mortalidade por violência revelando um trágico panorama na trajetória de vida dos adolescentes.

Injury patterns of female homicide victims in South Africa

BACKGROUND

Injury patterns and interpretation of injuries in homicidal deaths are important components of medicolegal autopsies. The objective of this article is to describe the incidence of female homicides and their related injury patterns with reference to autopsy practices in South Africa.

METHODS

A national retrospective mortuary-based study of homicides in women of 14 years and older in 1999 was conducted. Data were gathered from medical legal laboratory records, autopsy reports, and police interviews from a stratified multistage sample of 25 mortuaries.

RESULTS

The most common cause of homicide was a gunshot wound injury, with a firearm mortality rate of 7.5/100,000 women, 14 years and older, in 1999, followed by sharp force injury (6.8/100,000) and blunt force injury (6.1/100,000). Gunshot victims were more likely to be African, and those killed by sharp force injury were more likely colored. Significantly, blunt force injury deaths occurred predominantly in intimate partner homicides. A full autopsy was performed only in 70% of cases. An assessment of postmortem reports revealed poor descriptions of the anatomic location of injuries and the specifications of wound dimensions.

CONCLUSIONS

South Africa has a high female homicide rate that exceeds reported rates with the cause of homicide varying by social group. Assessment of injury description suggests weaknesses in the documentation of injuries at autopsy. This weakens the forensic investigation and undermines the strength of evidence presented in court. Further measures are needed to strengthen forensic pathology services in South Africa.

Inter-hospital transfer of trauma patients in a developing country: a prospective descriptive study

There is no standardised protocol for the transfer of injured patients in Jamaica, a process that is well known to be potentially hazardous. We undertook this study to evaluate the inter-hospital transfer process of injured patients in this developing country.

MATERIALS AND METHODS

A prospective descriptive analytical study of all consecutive patients transferred to the University Hospital of the West Indies from other hospitals was conducted over six months. Data were collected on specially designed proformas and analysed using SPSS version 10.0.

RESULTS

Of 122 patients studied, 79.5% were male and the mean age was 27.8+/-20.7 years. Most injuries resulted from road traffic accidents (40.2%), falls (27.1%) and assaults (26.2%). Several problems with the transfer process were identified. There was poor documentation of clinical parameters at referring institutions, with records of pulse rates in 13.1% (16/122), blood pressure in 9.8% (12/122), respiratory rate in 9.8% (12/122), Glasgow Coma Score in 10.6% (13/122) and pupillary reaction in 4.9% (6/122) of cases. Transfer arrangements were made by junior medical officers in 93.4% (114/122) of cases while consultants requested only 3.3% (4/122) of transfers. Public hospital ambulances transported 91.8% (112/122) of patients and 7.4% (9/122) were transported by helicopter. These vehicles were equipped with facilities for oxygen administration in 99.2% (121/122) of cases and sphygmomanometers in 91% (111/122) of cases, but functional capacity for suction was only present in 50% of vehicles. These critically ill patients were accompanied by physicians in only 11.5% (14/122) of cases, while 68.9% (84/122) were accompanied only by nurses.

CONCLUSIONS

The transfer of injured patients is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardised protocol for the transfer of such patients in Jamaica.

Treating cocaine body packers: the unspoken personal risks

Cocaine trafficking is a significant problem that many Caribbean territories must face. "Body packing" is a common method of transport where the smugglers ingest several cocaine filled packages. Body packers may be taken to hospital when they are detained by law enforcement officers, but occasionally they present on their own or accompanied by persons other than the authorities. This scenario poses a difficult management dilemma in any jurisdiction. We describe our experience with one such case in Jamaica.