Injury Prevention最新文献

Background: The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) conducts inspections of Federal Firearms Licensees (FFLs) to ensure compliance with federal laws in an effort to keep the public safe from firearm violence. However, the criteria for which FFLs are inspected lacks transparency, potentially signalling inefficiencies or biases.

Methods: We extracted data on FFL inspections and violations (2016-2017) requiring remedial action from the Gun Store Transparency Project database and the ATF's FFLs listings. Using a generalised linear mixed model with a random effect for states and robust SE, we estimated the census tract and state level predictors of 1) the likelihood of the ATF inspecting an FFL and 2) among those inspected, the likelihood of a violation.

Results: Of the 93,420 FFLs, 22 921 were inspected and 2392 had violations requiring remedial action. Increased likelihood of inspection was statistically significantly associated with higher levels of poverty, lower median income, greater non-White population percentages, and older census tract median ages. The sole predictor of an FFL receiving a violation requiring remedial action was the state's firearm law permissiveness.

Discussion: ATF inspections disproportionately targeted communities with higher poverty, lower median income, larger non-White populations, and older demographics. This indicates potential racial and socioeconomic biases, diverting attention from jurisdictions with more lenient firearm laws where violations were more likely to occur.

Conclusion: The ATF needs to reassess the influence of potential biases on its strategies for selecting FFLs for inspections and instead focus on risk-based assessments in order to promote public safety.

Background: Veterans have higher suicide rates than matched non-veterans, with firearm suicides being especially prevalent among veterans. We examined whether state firearm laws and state firearm ownership rates are important risk factors for suicide among veterans.

Methods: US veteran's and demographically matched non-veteran's suicide rates, 2002-2019, are modelled at the state level as a function of veteran status, lethal means, state firearm law restrictiveness, household firearm ownership rates and other covariates.

Results: Marginal effects on expected suicide rates per 100 000 population were contrasted by setting household firearm ownership to its 75th versus 25th percentile values of 52.3% and 35.3%. Ownership was positively associated with suicide rates for both veterans (4.35; 95% credible interval (CrI): 1.90, 7.14) and matched non-veterans (3.31; 95% CrI: 1.11, 5.77). This association was due to ownership's strong positive association with firearms suicide, despite a weak negative association with non-firearm suicide. An IQR difference in firearm laws corresponding to three additional restrictive laws was negatively associated with suicide rates for both veterans (-2.49; 95% CrI: -4.64 to -0.21) and matched non-veterans (-3.19; 95% CrI: -5.22 to -1.16). Again, these differences were primarily due to associations with firearm suicide rates. Few differences between veterans and matched non-veterans were found in the associations of state firearm characteristics with suicide rates.

Discussion: Veterans' and matched non-veterans' suicide risk, and specifically their firearm suicide risk, was strongly associated with state firearm characteristics.

Conclusions: These results suggest that changes to state firearm policies might be an effective primary prevention strategy for reducing suicide rates among veterans and non-veterans.

Background: Every year, thousands of people from Latin America and the Caribbean are migrating to the USA. Policy-makers have argued that US firearms are fuelling violence in these countries and are contributing to migration. The objective of this article is to examine the proportion of immigrants from Latin America and the Caribbean arriving at the US border who have previously been threatened with a firearm. This article further explores sociodemographic factors associated with the likelihood of previous firearm-related threats, whether those threats are associated with post-traumatic stress disorder, as well as the reasons behind those threats.

Methods: Data were obtained from a survey of migrants recruited at the southern US border from March 2022 to August 2023. To be selected, respondents had to be 18 years of age or older, had to speak English or Spanish and come from a Latin American or Caribbean country. We used descriptive statistics and a logistic regression.

Results: We analysed 321 cases. Roughly, 48% of respondents reported previous firearm-related threats. Males and respondents coming from Honduras, Venezuela and El Salvador were more likely to report previous firearm-related threats. There was a strong association between previous firearm-related threats and signs of post-traumatic stress disorder. Most threats occurred during robberies or extortions, but other threats were perpetrated by authorities, to prevent crime reporting, or by intimate partners.

Conclusion: Understanding the violence, particularly firearm-related violence, experienced by those migrating to the USA from Latin America and the Caribbean could help guide policy discussion and actions.

Background: A US survey of surgeons found that 32% store firearms unlocked and loaded. This study explored conditions and contexts impacting personal firearm storage methods among surgeons.

Methods: We conducted semi-structured interviews with English-speaking fellows of the American College of Surgeons who treated patients injured by firearms and who owned or lived in homes with firearms. Participants were recruited through email and subsequent snowball sampling from April 2022 to August 2022. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was applied to transcripts to identify codes. A mixed deductive and inductive approach was used for data reduction and sorting.

Results: A total of 32 surgeons were interviewed; most were male and white. Dominant themes for firearm storage practices were based on (1) attitudes; (2) perceived norms; (3) personal agency; and (4) intention of firearm use. Personal agency often conflicted with attitudes and perceived norms for surgeons owning firearms for self-defence.

Conclusions: Storage practices in this sample of firearm-owning surgeons were driven by intent for firearm use, coupled with attitudes, perceived norms and personal agency. Personal agency often conflicted with attitudes and perceived norms, especially for surgeons who owned their firearm for self-defence.

Background: Road traffic injuries are the leading cause of death in children. Parents' health literacy (HL) is closely related to child safety, especially for the young children. This study aimed to develop an intervention-oriented parent HL scale: Parents' Health Literacy Scale on Preventing Road Traffic Injuries (PHLS-PRTIs).

Methods: We developed the scale including four parts: (1) definition and conceptualisation of PHLS-PRTIs; (2) domain and item development; (3) instrument construction; and (4) psychometric property validation. 685 parents participated in process of development (n=333) and validation (n=352). Cronbach's α and test-retest correlation were used to assess reliability. Content validity and construct validity were used to assess validity.

Results: The scale consisted of five domains (access, understand, belief, communication and use) and 16 subdomains. The Cronbach's α for each domain and the whole scale was 0.85, 0.70, 0.87, 0.80, 0.79 and 0.85, respectively. The test-retest reliability was acceptable (intraclass correlations >0.70). Content validity was good (item-level content validity index >0.79, average of the scale-level content validity index >0.80, kappa >0.74). For construct validity for domain understand, χ²/df=1.723, p=0.009, standardised root mean square residual (SRMR)=0.0404, root mean square error of approximation (RMSEA)=0.045, Comparative Fit Index (CFI)=0.942, Tucker-Lewis Index (TLI)=0.910; and for the other four domains, χ²/df=1.840, p<0.001, SRMR=0.043, RMSEA=0.049, CFI=0.958, TLI=0.952.

Conclusions: PHLS-PRTIs was developed and validated by a rigorous process, providing a tool for community doctors to measure parents' HL on child road traffic safety and develop targeted health education interventions.

Questions: In the case of a road traffic crash, do sports utility vehicles (SUVs) and light truck vehicles (LTVs) cause more severe injuries to pedestrians and cyclists than passenger cars? Does any effect differ between adults and children?

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, TRID and Global Index Medicus were searched up to September 2024, with no restrictions by setting or language.

Inclusion criteria: Eligible studies had to compare injury severity between pedestrians and/or cyclists hit by an SUV or LTV versus a passenger car. Only sources using real-world crash data were included.

Main outcome measure: Injury severity, defined either as 'fatal versus non-fatal injury' or as 'killed or seriously injured (KSI) versus slight injury'.

Results: 24 studies were included in the meta-analysis. The results were similar between pedestrians and cyclists. When combining pedestrians and cyclists, the pooled odds of KSI versus slight injury if hit by an SUV/LTV versus a passenger car were higher among adults/all-age samples by 1.24 (95% CI 1.15, 1.34) and higher among children by 1.28 (95% CI 1.19, 1.37). The odds of fatal versus non-fatal injury if hit by an SUV/LTV versus a passenger car increased among adults/all-age samples by 1.44 (95% CI 1.33, 1.56) and among children by 1.82 (95% CI 1.57, 2.11; p=0.006 for heterogeneity by age).

Conclusion: In the case of a crash, SUVs and LTVs cause more severe injuries to pedestrians and cyclists than passenger cars. This effect is larger for fatalities than for KSIs, and the fatality effect is particularly large for children. PROSPERO registration number CRD42024597283.

Background: Formulas for the extraction of continuous and binary effect sizes that are entered into a meta-analysis are readily available. Only some formulas for the extraction of count outcomes have been presented previously. The purpose of this methodological article is to present formulas for extracting effect sizes and their standard errors for studies of count outcomes with person-time denominators.

Methods: Formulas for the calculation of the number of events in a study and the corresponding person time in which these events occurred are presented. These formulas are then used to estimate the relevant effect sizes and standard errors of interest. These effect sizes are rates, rate ratios and rate differences for a two-group comparison and rate ratios and rate differences for a difference-in-difference design.

Results: Two studies from the field of suicide prevention are used to demonstrate the extraction of the information required to estimate effect sizes and standard errors. In the first example, the rate ratio for a two-group comparison was 0.957 (standard error of the log rate ratio, 0.035), and the rate difference was -0.56 per 100,000 person years (standard error 0.44). In the second example, the rate ratio for a difference-in-difference analysis was 0.975 (standard error of the log rate ratio 0.036) and the rate difference was -0.30 per 100,000 person years (standard error 0.42).

Conclusions: The application of these formulas enables the calculation of effect sizes that may not have been presented in the original study. This reduces the need to exclude otherwise eligible studies from a meta-analysis, potentially reducing one source of bias.

Background: Consumer product-related genital injuries in females across all age groups are understudied. Existing research focuses primarily on paediatric populations. We aimed to determine characteristics, trends and predictors of hospitalisation.

Methods: The National Electronic Injury Surveillance System database was queried for female genital injuries from 2013 to 2022. We stratified our population into four age groups (<18, 18-34, 35-54, >54 years). Automated text matching and manual reviews were employed for variable extraction. χ² tests and logistic regression were conducted, accounting for survey design and weights.

Results: 9054 cases representing a national estimate of 252 329 injuries (95% CI 188 059 to 316 599) were identified. Paediatric injuries were most common (61%) and seniors had the highest hospitalisation rates (28%). Falls were common in paediatric (51%) and senior (48%) groups, whereas self-induced and topical application injuries were more frequent among adults aged 18-34 and 35-54. Injuries predominantly involved playground equipment and bicycles in children, razors and massage devices in adults aged 18-34 and 35-54 and household structures in seniors. Hospitalisation increased over the decade from 7% to 9%; significant predictors of hospitalisation were Asian race (OR=3.39, 95% CI 1.83 to 6.30), fractures (OR=7.98, 95% CI 4.85 to 13.1) and urethral injury (OR=3.15, 95% CI 1.30 to 7.63).

Conclusions: Our study identifies distinct patterns in female genital injuries across ages. In the paediatric cohort, injuries are often linked to playgrounds and bicycles. For adults, grooming products are frequently implicated. Seniors commonly suffer injuries from household structures such as bathtubs. These patterns may inform discussions on tailored preventive strategies.

In recent years, the reduction in rates of fatal unintentional injuries to children in the USA has not only plateaued, beginning before the pandemic, but has reversed, with increases across most mechanisms of injury. This study seeks to understand the reasons for this trend, focusing on unintentional injuries to children aged 1-14 years in 2001-2023 and on injuries with the highest fatality rates and with the most substantial increases in the last few years.The highest rate of fatalities and most substantial changes were due to motor vehicle crashes, drowning, fires and burns. Many factors that are associated with the risk of injury fatality actually decreased in prevalence over the last decade while the fatality rates were plateauing and then increasing. These include improved motor vehicle and highway and roadway safety designs, lower rates of cigarette smoking, more homes with carbon monoxide alarms, fewer mobile homes, higher life-jacket use, fewer small recreational boats and decreases in child poverty. Increases in emotional and behavioural disorders are not likely responsible for changes in unintentional injury fatalities in this age group. An important contributor to injury, particularly among the racial groups experiencing the greatest change in the mortality trajectory, is the sociocultural economic environment in which children live, learn and play. Smartphone use by teens and caregivers was the one risk factor which dramatically increased over the last decade, and distraction from mobile phone use stands out as likely the greatest culprit in this increase in fatalities.

Background: Mobility disability impacts approximately 12% of the US population; females are overrepresented among persons with mobility disability. Those with mobility disability are at increased risk of suicide compared with their non-disabled counterparts. Suicide using a firearm has increased among females in the last two decades. This study aims to describe and explore significant circumstantial variables (eg, socio-demographic, health indicators) preceding firearm suicide among females with mobility disability as compared with females without mobility disability.

Methods: This is a secondary comparative, retrospective analysis of the narrative data from the National Violent Death Reporting System Restricted Access Database. Persons with mobility disability were identified through text mining and manual review and subsequently analysed with a summative form of content analysis. Pearson/Fisher's X² or t-tests were used to assess differences in the circumstantial variables between those with and without mobility disabilities.

Results: Among female firearm suicide decedents, persons with mobility disability were more commonly older (p<0.001), identified as a homemaker (p<0.001), were perceived to be in a depressed mood before death (p<0.05), had a history of suicidal thoughts (p<0.05) and were perceived to have physical pain (p<0.001); they less commonly had relationship problems (p<0.05).

Conclusions: Females with mobility disability who die by firearm suicide may be differentiated from suicide decedents without mobility disability by age, employment status, depressive mood, relationship problems and physical pain. The significance of these variables as independent risk factors for firearm suicide may be tested with prospective study designs, which in turn may inform the development of targeted or disability-inclusive prevention strategies.