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PubMed2005

Incidence, case-fatality rate and clinical pattern of firearm injuries in two cities where arm owning is forbidden.

OBJECTIVE: To review firearm injuries in five hospitals of Douala and Yaounde, both towns of Cameroon, a Sub-Saharan African country where ownership of firearm is forbidden. METHODS: This was a retrospective investigation carried out within the period January 1998 to December 2002. Records of the mortuaries, the emergency departments, the intensive care units, the operating rooms and the surgical units were all analysed to identify any injury caused by firearm. Our gold standard was any individual with a clear diagnosis of firearm injury, as determined by a medical doctor. RESULTS: 286 firearm injuries were found; 1.14 cases per 100,000 per year. 66% of cases were due to civilian assaults, 20% to armed forces, 8% to hunting accidents and 6% to accidental handling. There was no case of suicide or of shooting from a relative. The type of weapon was unknown in 31% of cases, it was a hand gun in 36%, a hunting type in 21% and an assault rifle in 12%. The mean age of victims was 33 years and the male:female ratio 5.5:1. The site of injury was unknown in 2%; the head in 6%, the chest in 12%, the abdomen in 31%, the extremities in 46%, the spine in 1% and multiple in 2%. The case fatality rate was 12.58%, and the victims were mainly criminals killed by armed forces assaults; the same ratio of survivors developed late complications. CONCLUSION: The incidence of firearm injuries in the two largest cities of Cameroon is five to fifty times lower than in many other towns, especially in Western countries. This may be due at least partially, to the current legislation on the ownership of firearm which is very restrictive in this country. Some efforts are however needed to reduce illegal access to weapons and to educate hunters on the safe handling of their gun.

Adolescent↗
PubMed2003

FiGHTS: a preliminary screening tool for adolescent firearms-carrying.

STUDY OBJECTIVE: Adolescent firearms-carrying is a risk factor for serious injury and death. Clinical screening tools for firearms-carrying have not yet been developed. We present the development of a preliminary screening test for adolescent firearms-carrying based on the growing body of knowledge of firearms-related risk factors. METHODS: A convenience sample of 15,000 high school students from the 1999 National Youth Risk Behavior Survey was analyzed for the purpose of model building. Known risk factors for firearms-carrying were candidates for 2 models predicting recent firearms-carrying. The "brief FiGHTS score" screening tool excluded terms related to sexual behavior, significant substance abuse, or criminal behavior (Fi=fighting, G=gender, H=hurt while fighting, T=threatened, S=smoker). An "extended FiGHTS score," which included 13 items, was developed for more precise estimates. RESULTS: The brief FiGHTS score had a sensitivity of 82%, a specificity of 71%, and an area under the receiver operating characteristic (ROC) curve of 0.84. The extended FiGHTS score had an area under the ROC curve of 0.90. Both models performed well in a validation data set of 55,000 students. CONCLUSION: The brief and extended FiGHTS scores have high sensitivity and specificity for predicting firearms-carrying and may be appropriate for clinical testing.

Adolescent↗
PubMed1998

Prevention of elderly suicide. Physicians' assessment of firearm availability.

INTRODUCTION: Physicians have a unique role to play in the prevention of elder suicide, yet they may not be sufficiently attentive to the prominence of firearms in the rising trend in suicide by elder persons. This study sought to examine the extent to which physicians inquired about firearms with their depressed and suicidal elderly patients and further identified factors associated with physicians' likelihood of asking about firearms. METHODS: A probability sample of 300 primary care physicians in Illinois was drawn from the American Medical Association Physician Masterfile. Physicians were chosen from the specialties most likely to be involved with elderly persons: internal medicine and family practice. A mailed questionnaire yielded a 63% response rate. RESULTS: Although they were treating depressed and suicidal older patients, a sizable proportion of the respondents (42%) reported that they did not ask such patients or their family members whether they had access to a firearm. Several factors distinguished physicians who assessed for firearms from those who did not. The most salient predictors were: continuing medical education training in suicide risk assessment, expertise in geriatric mental health, confidence in diagnosing depression, having a patient mention suicide in the past year, and indicating patient reluctance as a barrier to mental health treatment. DISCUSSION: Physicians working with depressed and suicidal elderly persons need to be informed about the prevalence of elder suicide and about the likelihood of elderly persons using firearms as a method of suicide. Effective suicide prevention will require physician training that directly addresses geriatric mental health and firearm suicide, in particular, at the student, residency, and continuing education levels.

Aged↗
PubMedDate not supplied

Parent's behaviors, knowledge, and beliefs related to unintentional firearm injuries among children and youth in the southwest.

INTRODUCTION: The purpose of this research study was to describe parents' behaviors, knowledge, and beliefs related to unintentional firearm injuries among children and youth. METHOD: A convenience sample of 80 parents whose children were attending one of six Kindercare Learning Centers in a Southwestern city was surveyed during the summer of 1995 to learn about their behaviors, knowledge and beliefs about unintentional firearm injuries among children and youth. Data on demographic characteristics, behaviors, knowledge, and beliefs, were collected with a questionnaire. RESULTS: Men and parents who had grown up with a gun in the house were more likely to be gun owners. Forty-eight percent of parents kept at least one gun in the home. Twenty-six percent of gun owners reported that the gun was loaded at all times, and 18% reported that a gun was kept within reach of a child. The most common reason given by parents for having a gun was for protection (61%). Only 8% of parents reported having discussed firearm safety with a health care worker. None of the parents had discussed firearm safety with a pediatrician. A test of knowledge about firearm injuries revealed some gaps in knowledge, with no significant differences between men and women or gun owners and non-gun owners. DISCUSSION: Results suggest that firearms in the home continue to pose a significant risk to children. Anticipatory guidance from NPs and pediatricians is needed to protect children from unintentional firearm injuries.

Adult↗
PubMed2006

Use of army weapons and private firearms for suicide and homicide in the region of Basel, Switzerland.

OBJECTIVES: Switzerland has one of the highest rates of firearm suicides in the world. International studies show a positive correlation between the rate of households with guns and femicides with guns. Because its defense system requires a militia to keep personal firearms at home, Switzerland has a high rate of households with a gun. METHODS: Records of suicides in the region of Basel between 1992 and 1996 were reviewed. Suicides with either army weapons or private firearms and suicides by other means were compared. Methods and types of homicides that occurred in the region at the same time were also analyzed. FINDINGS: Firearm suicides were clearly the most frequent means of suicide. They were also used in 30.0% of domestic homicides, although other means were used at similar rates. Firearms for suicide were mainly used by men, especially army weapons. These men were younger, professionally better qualified, and fewer had ever been treated in one of the local state psychiatric services. DISCUSSION: The use of firearms for suicide, rather than homicide, and particularly of army weapons by young, well-educated men, requires more attention in debates and informed policy regarding access to firearms and suicide prevention in Switzerland.

Adult↗
PubMed2004

Association of selected risk factors with variation in child and adolescent firearm mortality by state.

This study examined relationships between variation in child and adolescent firearm mortality by state and the following variables: childhood poverty rate, percent single parent families, percent population that is African American, percent population that is Hispanic, percent students carrying a gun, percent students carrying a weapon, percent students feeling unsafe, percent students feeling sad/hopeless, percent students academically at-risk, percent students involved infighting, percent students engaging in binge drinking behavior, violent crime rate for youths, individual gun laws in each state, prevalence of firearm ownership, and percent residing in urban area. Stepwise regression was calculated and one independent variable, prevalence of firearm ownership in the state, emerged as a significant predictor of child and adolescent firearm mortality. This variable predicted 47% of the variance from state to state in the child and adolescent firearm mortality. Schools need to address firearm safety and advocate for elimination of firearms accessible to youth.

Adolescent↗
PubMed2003

Review of evaluations of educational approaches to promote safe storage of firearms.

OBJECTIVE: To systematically review evaluation studies of educational interventions promoting safe firearm storage. METHODS: Medline, ERIC, PsycINFO, Criminal Justice Periodicals Index, Cumulative Index of Nursing and Allied Health Literature, and Sociofile were searched. The references from each potentially eligible study were checked, and experts in the field were contacted for additional reports. In addition, an internet search was performed to identify programs not published in the conventional literature. Sources relevant to safe firearm storage promotion were selected and evaluated. RESULTS: Seven studies met inclusion criteria: adult subjects, program description was included, and firearm storage outcomes were measured. One was a randomized controlled trial and the other six were one group pre-test and/or post-test. The studies were classified into the following categories based on the intervention strategies used: (1). counseling and firearm safety materials (n=3); (2). counseling/educational message (n=3); and (3). firearm safety materials distribution (n=1). The outcomes were safe firearms storage (firearms locked up and unloaded or removal from home) after intervention. Four studies, three using counseling and materials distribution, reported improved storage after the interventions. CONCLUSIONS: It is not yet clear what types of interventions, or which specific intervention components, prompt gun owners to securely store their weapons. Increased understanding of gun storage behaviors and stronger evaluation designs will aid further understanding of this important issue.

Adult↗
PubMed2001

Firearms risk management in psychiatric care.

OBJECTIVE: This study sought to assess the effectiveness of a firearms risk management program. METHODS: A firearms risk management program, which included multidisciplinary assessment, treatment, and discharge planning, was developed and implemented among 46 civilly committed psychiatric inpatients at the Twin Valley Psychiatric System, a behavioral health organization of the Ohio Department of Mental Health. RESULTS: The research sample comprised mainly men who had personality disorders and histories of substance abuse and who had expressed an intent to use a firearm to commit suicide. On discharge, none of the patients had access to a firearm. Of the 16 patients who were hospitalized during the next 24 months, only five were noted to have threatened to harm themselves or others with a firearm or to have access to a firearm. CONCLUSIONS: Multidisciplinary and focused assessment, treatment, and discharge planning can be effective in neutralizing the risk of firearms use among psychiatric patients.

Adolescent↗
PubMed2006

Firearms accidents in Northern India (1980-2000).

This paper investigates firearms accidents from the last two decades (1980-2000), with information received from the three North Indian states, Chandigarh, Delhi and Himachal Pradesh and from the military and paramilitary organisations working in the region. In this study 139 cases were analysed for evaluation of various parameters such as type of accident, type of firearm used, age, sex, occupation and caste of victim, day of the week and the season in which the accident occurred, place of incident and location of wound. Information was extracted from the case histories and First Information Reports (FIR), and also from autopsy and injury reports. The accidents were self-inflicted in nine cases while another person fired the weapon in 130 cases. Most accidents occurred during hunting or from mishandling the firearm. Gun cleaning accidents rarely occurred and few cases were due to technical defects of the firearm. Shotguns and rifles caused most of the accidents. Shotgun accidents occurred mostly in rural areas whereas the cases involving rifles and handguns were from urban areas. Victims were predominantly male with a mean age of 26 and 30 years for males and females respectively. Victims' occupations were principally agricultural followed by service class and housewives. The most aggressive community was the Kshatriya caste. Most of the accidents occurred during the winter season and on days between Sunday and Tuesday. Accident locations were most commonly the forest, the fields or the home. The chest and head were the most common anatomical sites of injury. All accidental cases were the result of only one firing. It is important to mention that, based on these findings, firearm accidents could be reduced significantly if firearm holders were better trained regarding the handling and safety aspects of their guns, particularly farmers to whom firearm licences are granted specifically for the protection of crops.

Accidents↗
PubMed1993

Policy research on firearms and violence.

The connection between firearms and violence has not received adequate research attention in the past. This paper proposes a research agenda that should explore (1) the effects of firearm use on the costs of violence; (2) the extent to which particular interventions can reduce the cost of violence by limiting use of firearms; and (3) the extent to which the benefits derived from firearm interventions are worth their public and private costs. The author identifies three priority research issues: the relationship between firearms and suicide; how to design interventions to reduce firearm use in violence; and how to evaluate the long-range costs and benefits of gun controls. Public health researchers can investigate many of the key issues in firearms and violence, but only if they expand their knowledge about guns and gun controls.

Firearms↗
PubMed2005

[Trends of homicide death in Brazil in the 90s: the role of firearms].

OBJECTIVE: To describe the growth of homicide death in Brazil and to investigate the contribution of firearms to homicide death growth in the 90s. METHODS: An ecological descriptive time series was carried out for the period 1991 to 2000. External cause mortality data were obtained according to place of residence for the overall population and by gender from the Ministry of Health Mortality Information System. Homicides were classified as firearm, non-firearm and unknown (weapon) deaths. Proportional mortality and mortality rates (by 100,000) were calculated. RESULTS: Homicides accounted for 33% of all external cause deaths in the 90s. Firearms were used in more than 50% of deaths in 1991 and in almost 70% in 2000. This growth was seen for both genders and in all state capitals. Homicide mortality rate grew 27.5% in the whole country, and firearm homicide mortality rate grew 72.5%. During the same period there was a drop in deaths classified as unknown weapon homicide, which could partially explain the growth seen in firearm homicide rates. CONCLUSIONS: Data suggest the magnitude of firearm contribution for the growing tendency of homicide deaths in Brazil in the 90s. Data quality regarding intentionality and type of weapon used has hindered data analysis.

Brazil↗
PubMedDate not supplied

Family practice patients' attitudes toward firearm safety as a preventive medicine issue: a HARNET Study. Harrisburg Area Research Network.

BACKGROUND: Firearm-related deaths are expected to outnumber motor-vehicle-related deaths within the next 5 years. The goal of this project was to document gun ownership and safety habits among patients of family physicians and to determine patients' attitudes toward physician counseling about firearm safety. METHODS: We conducted a cross-sectional survey of patients of 11 family practices affiliated with a research network. Patients (or parents of children) were asked to complete a 23-item questionnaire that asked about gun ownership, storage, sources of information about gun safety, and attitudes about gun safety, and the role of their physician. RESULTS: Of the 1359 questionnaires distributed, 1214 (89%) were returned. Gun ownership varied by location (urban, suburban, and rural) and ranged from 16% to 59%. Only 8% of respondents believed that their physician has a responsibility to discuss firearm safety. Most (91%) patients did not view their physician as a source of firearm safety information, and only 14% thought their physician was knowledgeable regarding gun safety. Most gun owners (71%) did not think they would follow their physicians' advice about gun storage. Most patients (5%) responded that gun safety should not be discussed during the office visit. CONCLUSION: With regard to firearm safety, family physicians lack credibility in the eyes of their patients. These patients do not appear to be receptive to information about firearm safety, and efforts to decrease firearm-related injury might be more effective if focused elsewhere.

Adult↗
PubMed1995

The impact of firearm control legislation on suicide in Queensland: preliminary findings.

OBJECTIVE: To examine the effect of specific firearm control legislation on firearm and overall suicide rates. DESIGN: Retrospective survey of data from the Register of the Suicide Research and Prevention Program, Queensland Department of Health. The hypothesis was tested that the legislation would reduce firearm and overall suicides more in metropolitan and provincial city areas than in rural areas, where firearm ownership is higher. SETTING: State of Queensland 1990-1993. OUTCOME MEASURES: Suicide rates by age, sex and method for metropolitan, provincial city and rural areas in the two years before (1990-1991) and after (1992-1993) legislation. RESULTS: Mean annual firearm suicide rates declined significantly (P < 0.05) in metropolitan and provincial city areas after legislation (from 3.6 to 2.3 per 100,000 and from 5.2 to 3.1 per 100,000, respectively), with significant declines among men and in the 15-29 years age group. Rates increased slightly in rural areas (from 7.2 to 8.2 per 100,000). Overall suicide rates declined in provincial areas only, with minimal change in metropolitan areas and a slight rise in rural areas. CONCLUSION: These results provide preliminary evidence that firearm control legislation, including a 28-day "cooling-off" period before firearm purchase, reduces suicide rates, especially among younger adult men.

Adolescent↗
PubMedDate not supplied

[Some issues concerning the use of firearms with Flobert cartridges].

The aim of the work is to analyze and evaluate legal, criminalistic and criminological problematic issues appearing in Lithuania due to circulation of firearms designed for the Flobert cartridge. The purpose of guns with the Flobert cartridge is shooting training in closed areas. Provided the kinetic energy of Flobert cartridge is not bigger that 7.5 J. the guns meant for those bullets have been classified to unlimited circulation of guns since 1999 in Lithuania. Now these firearms can be purchased by anyone over 18. Due to this reason the demand for these firearms has increased. The sale of these firearms amounts to several thousands (the population of Lithuania is more than 3.5 million). The analyses of the authors show that these firearms are not used in accordance with their purpose. Experimental practice and experimental research proved that these firearms can cause serious bodily injuries. The latter fact allowed the authors to formulate propositions regarding legal regulation of circulation of these firearms.

Evaluation Studies as Topic↗
PubMedDate not supplied

Firearm mortality among persons aged 1 to 34.

Firearms claim more than 30,000 lives each year in the United States. In 1988 more than half of these deaths were among ages 1-34, with firearms accounting for 15 percent of all deaths in this age group. Total firearm deaths, as well as firearm homicide rates, have been increasing since 1984, taking a disproportionate toll on America's minority youth. The firearm homicide rate among all adolescents aged 15-19 rose 67 percent between 1984 and 1988. Among blacks aged 15-24, the firearm homicide rate was 72.0 per 100,000 during 1986-88 versus 8.1 among white males of this age. Geographic differences also exist, with Texas, California and New York leading in firearm homicides among white males aged 15-24, and Michigan, D.C., and California leading among blacks of this age.

Adolescent↗
PubMed1988

Firearm availability and the incidence of suicide and homicide.

The present studied explored the validity of several indirect measures of firearm ownership in the states of the USA: the percentage of homicides and suicides committed with firearms, the accidental death rate from firearms, the strictness of state handgun control laws, and subscription rates to firearm magazines. These measures were then correlated with rates of suicide and homicide, and it was found that states with a greater availability of firearms had higher firearm suicide rates and higher firearm homicide rates.

Firearms↗
PubMedDate not supplied

Firearm deaths in Canadian adolescents and young adults.

This article describes the problem of firearm deaths among Canadians aged 15-24 years. It is based on data obtained from Statistics Canada, the Metropolitan Toronto Police Department, and the Canadian Department of Justice. Firearms are the third leading cause of death in this age group, accounting for 276 deaths in 1990, after motor vehicle accidents (997) and non-firearm suicides (358). Some 23% of Canadian homes contain a firearm; the average number of firearms per home is 2.67. Medical and public health professionals are urged to work toward prevention by educating patients and families about the risks of a firearm in the home and by supporting legislation to decrease the availability of firearms to young people.

Adolescent↗
PubMed1993

Firearm related deaths in New Zealand 1978-87.

AIMS: To identify the role of firearms as a public health issue in New Zealand and to consider this information in the context of international research on potentially effective interventions for the prevention of firearm deaths. METHODS: National data on firearm related mortality for the period 1978 to 1987 were abstracted to identify all firearm deaths categorised as unintentional, suicide, homicide and of undetermined intent. RESULTS: Over this 10 year period, there were an average of 91 firearm deaths annually, accounting for 0.3% of all deaths. Suicides accounted for 75.5% of these deaths, unintentional deaths for 11.6% and homicides for 10.6%. No significant temporal changes were observed. CONCLUSIONS: While deaths from firearms are not a major public health problem in New Zealand, there is still a need to identify strategies likely to lead to reductions in the current levels of firearm deaths. Appropriately targeted legislative and educational strategies may be effective in reducing such deaths.

Adolescent↗