The Hazard of Sharp Force Injuries: Factors Influencing Outcome

Highlights

• This study is original since sharp force injury is rather uncommon in Norway.
• The overall mortality rate of sharp force injury in this study was 29%.
• Penetrating chest injury was more deadly than penetrating abdominal injury.
• Isolated heart injury had a lethal outcome in 80% of the cases.
• Still the outcome of sharp force injury is often random and unpredictable.

Abstract

The risk of dying from sharp force injury is difficult to ascertain. To the best of our knowledge, no study has been performed in Norway regarding mortality due to sharp force injury or factors that impact survival. Thus, the objective of the present study was to investigate and assess mortality in subjects with sharp force injury. 

This retrospective study comprises data on 136 subjects (34 female, 102 male) with suspected severe sharp force injury (self-inflicted or inflicted by others) admitted to Haukeland University Hospital between 2001 and 2010. The majority of subjects were intoxicated, and the injury was most often inflicted by a knife. The incidence of sharp force injury in Western Norway is similar to the incidence in other European countries. Almost half of the subjects with self-inflicted injury died. In cases with injury inflicted by another individual, one in five died. Mortality rates were higher in those with penetrating chest injuries than those with penetrating abdominal injuries and higher in cases with cardiac injury compared to pleural or lung injury. Sharp force injury can be fatal, but the overall mortality rate in this study was 29%. 

Factors influencing mortality rate were the number of injuries, the topographic regions of the body injured, the anatomical organs/structures inflicted, and emergency measures performed.

Below:  Ethanol and/or drugs in subjects with sharp force injury

Below:  Number of sharp force injuries, related to outcome

Below:  Distribution of sharp force injury in surviving and deceased subjects, related to anatomical regions (both penetrating and non-penetrating injuries)

Below:  Number of surviving and deceased subjects with penetrating sharp force injury

Full article at:   http://goo.gl/q2OIUT

By:  Kristoffersen S1, Normann SA2, Morild I3, Lilleng PK3, Heltne JK4.

• 1Department of Pathology, The Gade Institute, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Medicine, Gade Laboratory of Pathology, University of Bergen and Haukeland University Hospital, 5021 Bergen, Norway. Electronic address: stine.kristoffersen@helse-bergen.no.
• 2Cand.Med.-Degree Programme, Faculty of Medicine and Dentistry, University of Bergen, Norway.
• 3Department of Pathology, The Gade Institute, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Medicine, Gade Laboratory of Pathology, University of Bergen and Haukeland University Hospital, 5021 Bergen, Norway.
• 4Department of Anaesthesia and Intensive Care, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. 

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Ecologic Factors Relating to Firearm Injuries and Gun Violence in Chicago

Highlights

• Ecologic variables related to firearm-related injuries and crime were explored.
• The Illinois Trauma Registry and the Chicago Police Department's CLEAR were analyzed.
• Weekday, daily temperature, and rain are associated with firearm injuries and crime.
• Snow was not found to be associated with either firearm-related injuries or crime.

Background

Firearm violence is a major burden on Chicago with greater than 1500 gunshot injuries occurring annually. Identifying ecologic variables related to the incidence of firearm-related injuries and crime could prove useful for developing new strategies for reducing gun-related injuries.

Methods

The Illinois Trauma Registry (ITSR) and the Chicago Police Department's CLEAR (Citizen Law Enforcement Analysis and Reporting) dataset were retrospectively analyzed to investigate group-level factors potentially related to the incidence of gun-related injuries and crime in Chicago from 1999 through 2012. Multivariate linear regression was used to evaluate the effects of day of the week, daily maximum temperature, precipitation, and snow on the incidence of firearm-related injuries and crime.

Results

A total of 18,655 gunshot wounds occurred during the study period (ITSR, 1999–2009). There were 156,866 acts of gun violence identified in the CLEAR dataset (2002–2012). Day of the week, daily maximum temperature, and precipitation were associated with differential risks of gun injury and violence. Rain decreased firearm-related injuries by 9.80% [RR: 0.902, 95% CI: 0.854–0.950] and crime by 7.00% [RR: 0.930, 95% CI: 0.910–0.950]. Gunshot wounds were 33% [RR: 1.33, 95% CI: 1.29–1.37] more frequent on Fridays and Saturdays and gun crime was 18% [RR: 1.18, 95% CI: 1.16–1.20] more common on these days. Snow was not associated with firearm-related injuries or crime.

Conclusions

Day of the week, daily maximum temperature, and rain are associated with the incidence of firearm-related injuries and crime. Understanding the effects of these variables may allow for the development of predictive models and for risk-adjusting injury and crime data.

Purchase full article at:   http://goo.gl/WgFPpj

By:  Kieltyka J1, Kucybala K2, Crandall M3.

• 1Department of Emergency Medicine, Northwestern University, United States. Electronic address: j-kieltyka@northwestern.edu.
• 2Northwestern University, Feinberg School of Medicine, United States.
• 3Department of Surgery, University of Florida - Jacksonville, United States. 
• J Forensic Leg Med. 2016 Jan;37:87-90. doi: 10.1016/j.jflm.2015.11.003. Epub 2015 Nov 29.

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Heterogeneous Effects of Housing Vouchers on the Mental Health of US Adolescents

OBJECTIVES:

To assess the mental health effects on adolescents of low-income families residing in high-poverty public housing who received housing vouchers to assist relocation.

METHODS:

We defined treatment effects to compare 2829 adolescents aged 12 to 19 years in families offered housing vouchers versus those living in public housing in the Moving to Opportunity experiment (1994-1997; Boston, MA; Baltimore, MD; Chicago, IL; Los Angeles, CA; New York, NY). We employed model-based recursive partitioning to identify subgroups with heterogeneous treatment effects on psychological distress and behavior problems measured in 2002. We tested 35 potential baseline treatment modifiers.

RESULTS:

For psychological distress, Chicago participants experienced null treatment effects. Outside Chicago, boys experienced detrimental effects, whereas girls experienced beneficial effects. Behavior problems effects were null for adolescents who were aged 10 years or younger at baseline. For adolescents who were older than 10 years at baseline, violent crime victimization, unmarried parents, and unsafe neighborhoods increased adverse treatment effects. Adolescents who were older than 10 years at baseline without learning problems or violent crime victimization, and whose parents moved for better schools, experienced beneficial effects.

CONCLUSIONS:

Health effects of housing vouchers varied across subgroups. Supplemental services may be necessary for vulnerable subgroups for whom housing vouchers alone may not be beneficial

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By:  Nguyen QC1, Rehkopf DH1, Schmidt NM1, Osypuk TL1.

• 1Quynh C. Nguyen is with the Department of Health Promotion and Education, College of Health, University of Utah, Salt Lake City. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA. Theresa L. Osypuk and Nicole M. Schmidt are with the Minnesota Population Center, University of Minnesota, Minneapolis. Theresa L. Osypuk is also with the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis. 

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Killing the Mother of One's Child: Psychiatric Risk Factors among Male Perpetrators & Offspring Health Consequences

OBJECTIVE:

To study possible psychiatric and criminological risk factors of intimate partner femicide (IPF) as well as the bereaved offspring's psychiatric morbidity and premature death.

METHOD:

We conducted a nested case-control study, based on Swedish national registries, including all perpetrators of IPF. We computed risk estimates relative to matched population controls, which were compared to those of non-IPF homicide offenders. Exposed children were matched to population controls and followed longitudinally up to 37 years. Offspring outcomes were psychiatric and substance use disorders (according to ICD) self-harm; violent crime; suicide; and premature, all-cause death.

RESULTS:

We identified 261 male IPF perpetrators and 494 bereaved children from 1973 through 2009. Multivariable logistic regression suggested that major mental disorder  and violent crime convictions were independent risk factors of IPF, but substance use disorders were not. Children exposed to IPF before age 18 years had elevated risks of major mental disorder, substance use disorders and self-harm. Offspring 18 years or older at the IPF had an increased risk of completed suicide.

CONCLUSIONS:

Previous major mental disorder and violent behavior were strong independent risk factors for IPF. Bereavement caused by IPF had significant associations with the offspring's future life, especially for those below 18 years of age at exposure. Our findings demonstrate the need of direct support to the exposed offspring by health care providers and social services.

Full article at:   http://goo.gl/hHEDrZ

By:  Lysell H1, Dahlin M, Långström N, Lichtenstein P, Runeson B.

• 1Karolinska Institutet, Department of Clinical Neuroscience/Stockholm County Council, Centre for Psychiatry Research, St Göran's Hospital, SE-112 81 Stockholm, Sweden henrik.lysell@ki.se. 
• J Clin Psychiatry. 2016 Jan 5. 

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Household Factors Associated with Self-Harm in Johannesburg, South African Urban-Poor Households

Introduction

Low and middle income countries bear the majority burden of self-harm, yet there is a paucity of evidence detailing risk-factors for self-harm in these populations. This study aims to identify environmental, socio-economic and demographic household-level risk factors for self-harm in five impoverished urban communities in Johannesburg, South Africa.

Methods

Annual serial cross-sectional surveys were undertaken in five impoverished urban communities in Johannesburg for the Health, Environment and Development (HEAD) study. Logistic regression analysis using the HEAD study data (2006–2011) was conducted to identify household-level risk factors associated with self-harm (defined as a self-reported case of a fatal or non-fatal suicide attempt) within the household during the preceding year. Stepwise multivariate logistic regression analysis was employed to identify factors associated with self-harm.

Results

A total of 2 795 household interviews were conducted from 2006 to 2011. There was no significant trend in self-harm over time. Results from the final model showed that self-harm was significantly associated with households exposed to a violent crime during the past year (Adjusted Odds Ratio (AOR) 5.72; 95% CI 1.64–19.97); that have a member suffering from a chronic medical condition (AOR 8.95; 95% 2.39–33.56) and households exposed to indoor smoking (AOR 4.39; CI 95% 1.14–16.47).

Conclusion

This study provides evidence on household risk factors of self-harm in settings of urban poverty and has highlighted the potential for a more cost-effective approach to identifying those at risk of self-harm based on household level factors.

Below:  Factors associated with self-harm by stepwise multiple logistic regression: Johannesburg, South Africa (2006–2011)

Full article at:   http://goo.gl/nUKAyF

By:  

Nisha Naicker, Angela Mathee

Environment & Health Research Unit, South African Medical Research Council, Johannesburg, South Africa

Nisha Naicker, Pieter de Jager, Shan Naidoo, Angela Mathee

Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

Pieter de Jager

Epidemiology and Surveillance Unit, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa

Angela Mathee

Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa

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Children's Cognitive Performance and Selective Attention Following Recent Community Violence

Research has shown robust relationships between community violence and psychopathology, yet relatively little is known about the ways in which community violence may affect cognitive performance and attention. 

The present study estimates the effects of police-reported community violence on 359 urban children's performance on a computerized neuropsychological task using a quasi-experimental fixed-effects design. Living in close proximity to a recent violent crime predicted faster but marginally less accurate task performance for the full sample, evolutionarily adaptive patterns of “vigilant” attention (i.e., less attention toward positive stimuli, more attention toward negative stimuli) for children reporting low trait anxiety, and potentially maladaptive patterns of “avoidant” attention for highly anxious children. These results suggest that community violence can directly affect children's cognitive performance while also having different (and potentially orthogonal) impacts on attention deployment depending on children's levels of biobehavioral risk. 

Implications for mental health and sociological research are discussed.

...Specifically, we find that children whose cognitive performance was assessed within one week after a violent event occurred within a half mile of their home were faster and marginally less accurate in locating the position of a dot on a computer screen than their peers who came from the same community but who were assessed either before or well after a violent crime took place. These results suggest that the physiological and mental demands of dealing with an environmental stressor may reduce children's cognitive capacity to focus on a simple task and instead lead to more automatic (i.e., faster but error-prone) task performance. Such impulsive response patterns are in line with clinical research showing short-term impairments in information processing, effortful control, and other aspects of higher-order self-regulation following trauma (Brandes et al. 2002; Nader and Fairbanks 1994) and may help to explain previously observed reductions in children's academic performance and regulatory capacity following exposure to homicide (Sharkey 2010; Sharkey et al. 2012). Future research that includes longitudinal data on psychological and behavioral functioning is needed to understand the degree to which the short-term effects of violent crime on cognitive performance may lead to more stable deficits in mental/behavioral health over time.

Importantly, the observed relationship between community violence and average response time was driven primarily by children reporting low trait anxiety (a proxy for low levels of biobehavioral arousal), whereas highly anxious children maintained relatively consistent response time regardless of violence. Differential response patterns for children characterized by varying levels of anxiety were also observed when testing children's selective attention outcomes. Children with low levels of trait anxiety who were assessed immediately after a nearby violent event showed vigilant response patterns, including increased attention toward negative images and decreased attention toward positive images compared to their peers who were assessed before or well after a crime took place. Highly anxious children, on the other hand, exhibited response patterns more associated with avoidance, including decreased attention toward negative images and increased attention toward positive images following a crime. Consistent across analyses, the magnitude of the impact of violence on child outcomes was largest when the violent crime took place within a short distance from children's homes and within a short time period prior to assessment...

Below:  Approximate Locationa of Participant Homes and Total Violent Crimes by 2000 Census Tract.

aAlthough precise address location was used for actual analyses, dots in Figure 1 represent a random location in children's residential census tract to maintain confidentiality.

Full article at:  http://goo.gl/qemlj0

By:  Dana Charles McCoy,1,2 C. Cybele Raver,1 and Patrick Sharkey1

¹New York University, New York, NY, USA

²Harvard University, Cambridge, MA, USA

Corresponding Author: Dana McCoy, Harvard University, Center on the Developing Child, 50 Church St., Rm 415, Cambridge, MA 02138, USA. Email: ude.dravrah.esg@yoccm_anad

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Psychiatric & Neurological Disorders in Late Adolescence & Risk of Convictions for Violent Crime in Men

Background

The relationship between mental illness and violent crime is complex because of the involvement of many other confounding risk factors. In the present study, we analysed psychiatric and neurological disorders in relation to the risk of convictions for violent crime, taking into account early behavioural and socio-economic risk factors.

Methods

The study population consisted of 49,398 Swedish men, who were thoroughly assessed at conscription for compulsory military service during the years 1969–1970 and followed in national crime registers up to 2006. Five diagnostic groups were analysed: anxiety-depression/neuroses, personality disorders, substance-related disorders, mental retardation and neurological conditions. In addition, eight confounders measured at conscription and based on the literature on violence risk assessment, were added to the analyses. The relative risks of convictions for violent crime during 35 years after conscription were examined in relation to psychiatric diagnoses and other risk factors at conscription, as measured by odds ratios (ORs) and confidence intervals (CIs) from bivariate and multivariate logistic regression analyses.

Results

In the bivariate analyses there was a significant association between receiving a psychiatric diagnosis at conscription and a future conviction for violent crime (OR = 3.83, 95 % CI = 3.47–4.22), whereas no significant association between neurological conditions and future violent crime (OR = 1.03, 95 % CI = 0.48–2.21) was found. In the fully adjusted multivariate logistic regression model, mental retardation had the strongest association with future violent crime (OR = 3.60, 95 % CI = 2.73–4.75), followed by substance-related disorders (OR = 2.81, 95 % CI = 2.18–3.62), personality disorders (OR = 2.66, 95 % CI = 2.21–3.19) and anxiety-depression (OR = 1.29, 95 % CI = 1.07–1.55). Among the other risk factors, early behavioural problem had the strongest association with convictions for violent crime.

Conclusions

Mental retardation, substance-related disorders, personality disorders and early behavioural problems are important predictors of convictions for violent crime in men.

Table 1

Adolescent risk factors for future convictions for violent crime

Variables	Violent crime
	OR (95 % CI)
Poor economic conditions in family (very or rather poor vs. average, rather or very good)	1.42 (1.24–1.64)
Divorced parents (yes vs. no)	2.87 (2.60–3.18)
Corporal punishment in upbringing (often or sometimes vs. seldom or never)	1.96 (1.76–2.18)
Easily angry (often vs. sometimes, seldom or never)	3.13 (2.80–3.51)
Sleep disturbance (often vs. sometimes, seldom or never)	1.76 (1.52–2.04)
Lowered marks due to misconduct at school (several times or once vs. never)	3.92 (3.61–4.27)
Contact with the police or child welfare committee (several times or sometimes vs. never)	5.32 (4.87–5.82)
Arrested by police for drunkenness (several times, twice or once vs. never)	5.91 (5.36–6.50)

Table 2

Multivariate analyses for future convictions for violent crime in Models I–IV

	Model I	Model II	Model III	Model IV
	OR (95 % CI)	OR (95 % CI)	OR (95 % CI)	OR (95 % CI)
Anxiety-depression (yes vs. no)	1.99 (1.69–2.34)	1.79 (1.51–2.12)	1.63 (1.37–1.94)	1.29 (1.07–1.55)
Personality disorder (yes vs. no)	5.36 (4.60–6.25)	4.90 (4.16–5.76)	4.29 (3.62–5.08)	2.66 (2.21–3.19)
Substance-related disorder (yes vs. no)	10.08 (8.18–12.42)	8.18 (6.53–10.26)	7.55 (5.98–9.54)	2.81 (2.18–3.62)
Mental retardation (yes vs. no)	5.65 (4.50–7.09)	4.95 (3.87–6.33)	4.39 (3.40–5.67)	3.60 (2.73–4.75)
Poor economic conditions in family		1.00 (0.86–1.17)	0.98 (0.84–1.15)	1.00 (0.85–1.18)
(very or rather poor vs. average, rather or very good)
Divorced parents		2.32 (2.08–2.59)	2.30 (2.06–2.58)	1.68 (1.49–1.90)
(yes vs. no)
Corporal punishment in upbringing		1.61 (1.43–1.80)	1.52 (1.35–1.71)	1.29 (1.14–1.46)
(often or sometimes vs. seldom or never)
Easily angry (often vs. sometimes, seldom or never)			2.15 (1.89–2.45)	1.72 (1.50–1.98)
Sleep disturbance (often vs. sometimes, seldom or never)			0.93 (0.78–1.11)	0.84 (0.70–1.01)
Lowered marks due to misconduct at school (several times or once vs. never)				2.11 (1.91–2.34)
Contact with the police or child welfare committee (several times or sometimes vs. never)				2.67 (2.38–2.99)
Arrested by police for drunkenness (several times, twice or once vs. never)				2.06 (1.82–2.32)

Model 1. Model fit: Chi-square = 798.98, DF = 4, p < 0.0001; p-values of all included predictors < 0.0001

Model 2. Model fit: Chi-square =1032.38, DF = 7, p < 0.0001; p-values of all included predictors except poor economic conditions in family (p = 1.00) were significant, p < 0.0001

Model 3. Model fit: Chi-square = 1128.36, DF = 9, p < 0.0001; p-values of all included predictors except poor economic conditions in family (p = 0.80) and sleep disturbance (p = 0.44) were significant, p < 0.0001

Model 4. Model fit: Chi-square = 2231.10, DF = 12, p < 0.0001; p-values of all included predictors except poor economic conditions in family (p = 0.98) and sleep disturbance (p = 0.058) were significant: Anxiety-depression, p = 0.0074, all other p values < 0.0001

Full article at:  http://goo.gl/y7AOGu

By:  Tomas Moberg, Marlene Stenbacka, Anders Tengström, Erik G. Jönsson, Peter Nordström, and Jussi Jokinen

Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Sweden

NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden

Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital/Solna, SE-171 76 Stockholm, Sweden

Tomas Moberg, Phone: +46-73-6822558, Email: es.ik@grebom.samot.

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Young People at Risk of Transitioning to Injecting Drug Use in Sydney, Australia: Social Disadvantage & Other Correlates of Higher Levels of Exposure to Injecting

While numerous studies have examined characteristics of young people who have recently initiated injecting, little attention has focused on young people who may be at high risk of transitioning to injecting. This study sought to examine the extent that socially disadvantaged young people were exposed to injecting, determine their level of hepatitis C (HCV) knowledge and identify correlates of higher injecting exposure. 

A cross-sectional survey was administered to 210 young people in 2010-2011 who were exposed to injecting drug use, but had not transitioned to injecting. Respondents were primarily recruited from youth services in metropolitan Sydney. Exposure to injecting in the previous 12 months was assessed with four items that examined whether close friends, romantic/sexual partners or family members/acquaintances injected drugs, and whether they were offered an injection. 

Most respondents had at least a few close friends who injected drugs (65%) and almost half had been offered drugs to inject in the previous 12 months (48%). It was less common for respondents to report having a partner who injects (11%). Correlates of higher injecting exposure were examined with multivariate ordinal regression. In the multivariate model, higher exposure to injecting was independently associated with the experience of abuse or violent crime and reporting more favourable attitudes towards injecting. Higher exposure to injecting was not independently associated with patterns or history of drug use. HCV knowledge was low to moderate and was not associated with higher exposure to injecting. That drug use was not independently associated with higher injecting exposure may suggest that exposure is shaped more by social disadvantage than by drug use patterns. 

Additional research is required to investigate this, using an improved measure of exposure to injecting.

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By: Lea T1, Bryant J, Ellard J, Howard J, Treloar C.

• 1Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia.  

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