Injury Epidemiology最新文献

Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, characterized by both motor and non-motor symptoms. Falls and fractures are common in advanced PD but the risk of fractures in newly diagnosed people with PD and the impact of treatment with levodopa is understudied.

Methods: We investigated the risk of fractures among Medicare beneficiaries with incident PD age ≥ 67 compared to controls. Among PD cases only with continuous Part D medication coverage, we examined the effect of levodopa treatment on fracture risk. We identified incident PD cases (N = 68,150) within a population-based sample of 2017 Medicare beneficiaries. Controls (N = 272,600) were matched 4:1 on age, sex, and month/year of the date of PD diagnosis. We used claims data from 2017-2019 to follow cases and controls to identify new fractures. Our primary outcome was any fracture. We classified fractures secondarily by body region (spine/vertebral, torso, pelvis, upper extremity, lower extremity [and separately hip]). We used competing risks regression models to estimate subhazard ratios (SHR) and 95% confidence intervals (CI) for the association between fracture and PD after adjusting for covariates. Among PD cases with continuous medication coverage (N = 61,317), we examined the effect of levodopa treatment in PD cases ever prescribed levodopa for 90 days (≥ 1 prescription fill).

Results: Following PD diagnosis/control reference date, the most common fracture location in incident PD cases and controls was in the hip, followed by the spine. PD cases had a greater risk of any fracture in all body regions compared to controls at any given time: any fracture (SHR 1.35, 95% CI 1.31-1.39), spine (SHR 1.47, 95% CI 1.35-1.59), hip (SHR 1.36, 95% CI 1.30-1.44), and upper extremity (SHR 1.34, 95% CI 1.22-1.48). PD cases who used levodopa for 90 days had a lower risk of any fracture (SHR 0.76, 95% CI 0.72-0.81) than those without treatment. This was also true for individual fracture types in all body regions with the exception of the torso and pelvis.

Conclusion: Medicare beneficiaries with incident PD have a greater risk of fracture in all body regions compared to controls and this risk may be reduced with levodopa use.

Background: Hazing-defined as an act that is required to gain entry into a group and humiliates, degrades, abuses, endangers, or otherwise embarrasses an individual, irrespective of willingness of the person-is a persistent problem in the United States (US) military, and can manifest in physical and emotional harm, and in extreme circumstances, death. However, the presentation of hazing, including the exact experiences and resulting outcomes is scarcely studied, leaving a gap in understanding and a need to specifically investigate this issue.

Methods: A cross-sectional study was conducted by administering a survey with questions about hazing experiences and outcomes to 227 service members at a military installation in the Southeast United States over 14 months. Frequency of hazing experiences and outcomes were derived. To understand how the large number of variables related to each other, a cluster analysis provided Jaccard measures of similarities amongst experience variables. Logistic regressions were conducted to test the association between the experiences and outcomes of hazing.

Results: A total of 227 service members answered the survey; the final cleaned sample resulted in 202 participants who were primarily active-duty (94.0%), in the Army (95.6%), enlisted rank (E1-E4; 58.5%), male (69.6%), and white (49.4%). Almost one-fifth (19.8%) of the participants endorsed experiencing hazing at the installation, and over a fifth endorsed experiencing hazing in the form of sexual violence (22.4%), being tricked (27.8%), and acting like a servant (22.3%). Hazing experiences were significantly associated (p < 0.05) with greater odds of several types of negative physical (ORs ranging from 2.8 to 15.9) and mental health outcomes (ORs ranging from 4.7 to 68.0) and multiple effects on the organization, such as desire to leave the military (ORs ranging from 2.9 to 34.1), since arriving at the current military location.

Conclusions: Hazing manifests in various manners and results in harmful consequences for both individuals and the organization. The present study provides an understanding of hazing through descriptive epidemiology, which can help both leaders and practitioners address the issue.

Background: This study provides a contemporary estimate of how many adult US gun owners had a gun stolen in the past five years, along with information about the demographic and gun-related characteristics of these victims.

Methods: Data come from the 2024 National Firearms Survey, designed by the authors and conducted by the research firm Ipsos in December 2024. Close to 13,000 (n = 12,860) of those invited to take this on-line survey completed it (59% completion rate). Respondents who reported that they personally owned a gun (n = 4059) were asked "In the past 5 years, have you had any firearms stolen from you?" Respondents who answered in the affirmative were asked detailed questions about their most recent gun theft incident that occurred in the past five years. Data were weighted to provide national estimates.

Results: Among the 4,059 gun owners in the study, 47 reported having had one or more guns stolen in the past five years, representing a weighted estimate of 1.4% (95% CI 0.9, 1.8) of gun owners, or approximately 1 million adults. Gun owners who had carried a handgun in the month prior to the survey were three times more likely to report having a gun stolen than those who had not carried (OR 3.9, 95% CI 2.1, 7.4). Gun owners who stored a gun in their car (OR 3.6, 95% CI 1.4, 9.2), and those who stored some of their guns loaded and unlocked compared to owners who stored all their guns unloaded and locked (OR 3.6, 95% CI 1.4, 9.6) were also three times more likely to have a gun stolen. Three fifths (60%) of the most recent gun theft incidents reported by respondents occurred in the victim's home. An additional 15% were from cars, and 25% from all other places. In about a quarter of these thefts (28%), at least one gun had been recovered by the time of the survey. Two-thirds (68%) of respondents reported their most recent gun theft to police (over 80% of non-Hispanic White gun owners compared to about half of other gun owners). One quarter of these theft victims had insurance that covered the firearm.

Conclusion: Gun carrying, keeping a gun in one's car, and storing guns loaded and unlocked may increase harm to the community by increasing the number of guns that get into the hands of criminals.

Objectives: To conduct a scoping review of research on government spending and violence.

Methods: We searched nine databases for peer-reviewed publications evaluating the association between government spending on public goods and services and (other- or self-directed) violent physical injury or death in the United States.

Results: Of 5,734 screened articles, 33 met the inclusion criteria. Over one-third of studies were published in the last ten years (n = 13). Studies most commonly evaluated spending at the state (n = 19), county (n = 5), and city (n = 5) levels. Studies examined spending on social welfare (n = 21), health (n = 12), education (n = 9), law enforcement (n = 8), and/or community development (n = 2). Outcomes were homicide/assault (n = 28) and suicide (n = 17). All studies were ecologic, 24 were serial cross-sectional, and most (n = 28) made attempts to control for confounding. Findings were mixed, but studies of social welfare, health, and education most commonly found that increased spending was significantly associated with reductions in violence.

Conclusions: While research has varied somewhat in methodology and findings, results of this scoping review indicate that government investments in supportive services may be promising structural interventions to prevent violence and promote safety and health.

Background: A nationally representative longitudinal survey in the USA found a decrease in population-level support for political violence from 2022 to 2023. This individual-level analysis of those data examines associations between the occurrence of 18 specified life events and subsequent change in views on political violence.

Methods: Participants in the Life in America Survey were members of the Ipsos KnowledgePanel. Wave 2 of the survey was fielded online May 18-June 8, 2023; all respondents to 2022's Wave 1 who remained in KnowledgePanel were invited to participate. We calculated individual scores for 2022 and 2023 on 35 political violence measures from the first component of an ordinal principal components analysis and computed the difference in scores for individual respondents from 2022 to 2023 to represent a 1-year change in these measures. Our principal outcomes are adjusted mean differences in change scores from 2022 to 2023 between individuals experiencing and not experiencing the 18 life events.

Results: The completion rate was 84.2%; there were 9385 respondents. Support for political violence decreased for 19.9% of respondents, increased for 14.2%, and remained unchanged for 65.9%. When events were considered individually in a model that adjusted for sociodemographic characteristics and other life events, only "things improved for me financially" was associated with decreased support for political violence among respondents as a whole; "I gave up on politics" was associated with an increase. No event was associated with change among both men and women when they were analyzed separately. Among respondents who reported in 2022 that violence was usually or always justified for at least 1 political objective, no events were associated with change in support for political violence. Among those who strongly approved in 2022 of left-wing violent extremist organizations or movements, "my political beliefs changed a lot" was associated with a large decrease.

Conclusions: In this cohort, few life events were associated with changes in support for political violence across the entire population, but there were important subset findings. The findings support interventions to improve measures of economic well-being across the population and to encourage belief change among extremists as political violence prevention measures.

Background: Extreme Risk Protection Orders (ERPOs) are civil legal tools that temporarily restrict firearm access for individuals deemed to pose a risk of harm to themselves or others. Although ERPOs are strictly civil orders, their implementation often overlaps with other legal and behavioral health interventions. This qualitative study examined patterns among individuals subject to law enforcement-filed ERPOs in Washington State who intersect with arrest and involuntary transportation for behavioral health evaluation, and how these intervention pathways relate to ERPO outcomes.

Methods: Of the 859 ERPOs granted at the temporary level in Washington State between 2016 and 2022, 57.6% (n = 495) involved one of the three intervention pathways: arrest (29.6%, n = 254), involuntary transport for behavioral health evaluation (26.1%, n = 224), or both (2.0%, n = 17) during the precipitating event that led to ERPO filing. We conducted qualitative analysis using the pen portrait method for n = 130 of these 495 cases to examine how risk was framed in court narratives and how those narratives corresponded with intervention pathways and ERPO outcomes.

Results: Narratives that emphasized self-harm frequently described involuntary transport, while those highlighting threats to others often involved arrest. Other factors, including firearm presence, mental health history, and how intent was described, emerged as recurring narrative elements and corresponded with specific intervention pathways. Judges ordered behavioral health evaluations in 36.3% of granted one-year ERPOs, but no clear patterns emerged between intervention pathways and this outcome.

Conclusions: Findings suggest that law enforcement narratives were associated with how ERPO cases unfolded and which systems became involved. These findings highlight how variation in the way risk is framed in ERPO petitions, particularly around perceived intent, danger to self versus others, and contextual factors, can influence how systems respond, even under similar behavioral circumstances.

Background: Occupational injury accounts for the highest rate of morbidity and mortality among firefighters, surpassing other occupations. Canada is particularly susceptible to fires and consequently increased health burden. This study examines trends in firefighters' injury and death claims across Canada, focusing on claim characteristics, mechanisms of injury and disease, and geographic distribution across provinces and territories.

Methods: Data on accepted fatality and time-loss injury claims were collected from the Association of Workers' Compensation Boards of Canada (AWCBC) and WorkSafeBC over 15 years (2007-2021). Linear regression models were used to assess trends in time-loss injury and fatality claims. Chi-square tests were conducted to analyze the distribution of fatalities and injuries across age groups.

Results: A total of 29,499 claims were analyzed, including 1,509 fatalities and 27,990 time-loss injuries, with males representing 92.2% of injury and 99.4% of fatality claims. Cancer was the leading cause of fatalities, accounting for 84.6% of claims with a fatality rate of 993.7 per 100,000 firefighters per year. Traumatic injuries were the primary cause of time-loss claims, comprising 80.6% of cases with a rate of 17,859.1 per 100,000 firefighters per year. Mental health-related claims saw a significant 231.2% increase. The "65 and over" age group had the highest fatality claims (n = 826, 54.7%), with statistically significant differences observed in the distribution of fatalities and injuries between age groups (p = 0.002 < 0.05). Ontario reported the most fatalities (n = 713, 47.3%) and time-loss claims (n = 8591, 30.7%), followed by Quebec, British Columbia, and Alberta.

Conclusion: This study highlights the increasing burden of cancer among Canadian firefighters and the sharp rise in mental health-related claims, emphasizing the need for further research into the occupational health risks faced by firefighters to improve their long-term well-being.

Background: Community violence intervention (CVI) is increasingly considered an important component of comprehensive public safety infrastructure, but research and evaluation of CVI programs remain underdeveloped. There is a critical need for evaluation measures that are developed collaboratively with those most proximate to these interventions and that capture interventions' nuanced and holistic impacts. This paper presents the process and results of a practitioner-academic partnership to co-develop youth-focused CVI evaluation measures in Washington state.

Results: The process of co-developing evaluation measures involved two phases. For phase 1, we created a menu of quantitative measures (n = 60) for each outcome construct in a previously co-developed CVI theory of change by integrating existing measures, identified through a literature review, with insights and recommendations from CVI practitioners gathered during a workshop. For phase 2, we tailored and refined quantitative and qualitative measures with/for 7 CVI programs involved in the collaboration via individual meetings (n = 45 one-hour meetings over the course of 10 months, average = 6.4 meetings per program). The process of refining measures involved extensive discussion around several key considerations, including confidentiality, age appropriateness of questions, and language/jargon. After revisions, each CVI program had a customized list of quantitative and qualitative measures that fit their program and the population they served. We also created an online toolkit accompanying this paper so others may easily use, tailor, and build upon our work.

Conclusions: Our process of co-developing youth-focused CVI evaluation measures drew from existing literature while heavily prioritizing the knowledge, expertise, and capacity of CVI practitioners. This helped facilitate power sharing and responsiveness to community needs, and we believe it resulted in more appropriate and contextually relevant measures. By detailing the iterative process that we took along with the resulting evaluation measures, our intent is to encourage practitioner-academic collaboration and underscore how such partnerships can enhance the field's understanding of CVI implementation and impacts.

Background: Firearm violence is a critical public health issue in the United States. Extreme Risk Protection Order (ERPO) laws have been enacted in many states to prevent firearm violence, including mass violence. Oregon's ERPO law allows family/household members or law enforcement officers to petition a civil court for an order to temporarily restrict a person's access to firearms when at imminent risk of harming themselves or others. This study examined the characteristics of ERPO petitions filed in Oregon that involved mass violence threats.

Methods: ERPO court records for petitions filed from January 1, 2018 to December 31, 2023 were obtained through the Oregon Judicial Case Information Network and abstracted; double coding was completed to assess interrater reliability. Descriptive analyses were conducted to examine characteristics of ERPO petitions filed to prevent mass violence. These petitions were compared to those without mass violence threats using Fisher's exact tests and the Wilcoxon rank sum test.

Results: From 2018 to 2023, 835 ERPO petitions were filed, of which 92 (11.0%) cited a risk of mass violence. ERPO petitions citing threats of mass violence were more likely to be granted (90.2%) than those without such threats (76.3%; p = 0.002). Risks of mass violence to schools or college campuses, specifically, were cited in 27 petitions, all of which were granted. Law enforcement officers filed a larger proportion of the petitions citing threats of mass violence (88.0%) than petitions without such threats (57.9%; p < 0.001).

Conclusions: Our findings suggest that Oregon's ERPO law is being used as intended to address firearm injury risk, including mass violence risk and risk to schools and college campuses. Petitions citing mass violence threats appeared to differ significantly in terms of some characteristics from those citing non-mass violence threat types, including a higher likelihood of being granted. Further research on the use of ERPOs is needed to fully understand the barriers and facilitators to effective implementation of these laws to prevent mass violence.

Background: Concern for political violence in the United States remains high. The limited information available indicates that approval of specific extreme right-wing organizations and social movements is associated with support for and willingness to engage in political violence, but systematic data are lacking. The study objective is to quantify those associations at the individual level in a nationally representative survey sample.

Methods: Cross-sectional analysis from Wave 1 of a nationally representative survey of members of the Ipsos KnowledgePanel, conducted May-June 2022. The exposure is approval (categorized from non-approval to strong approval) of 8 named organizations and social movements, considered individually and together. Principal outcomes are justification for political violence, in general and to advance specific political objectives; willingness to engage in political violence, by type of violence and target population; and expectation of firearm use in political violence. Outcomes are expressed as weighted percentages and adjusted prevalence differences (aPDs, expressed in absolute percentage points (pp)).

Results: The completion rate was 55.8%; there were 8,620 respondents. After weighting, 50.6% of respondents (95% CI 49.4%, 51.7%) were female, and 62.6% (95% CI 61.4%, 63.9%) were white, non-Hispanic; the weighted mean (SD) age was 48.4 (18.0) years. Few respondents (1.4%, 95% CI 1.0%, 1.8%) strongly approved of the organizations and movements considered together. However, strong approvers were much more likely than non-approvers to consider violence usually or always justified to advance specific political objectives and much more willing to engage in political violence; aPDs frequently exceeded 30% points. To advance a political objective, 29.1% (95% CI 18.4%, 39.8%) of strong approvers were very or completely willing to kill someone, and 18.1% (95% CI 8.5%, 27.7%) thought it very or extremely likely that they would shoot someone; prevalences among non-approvers were 0.9% (95% CI 0.5%, 1.2%) and 0.6% (95% CI 0.3%, 0.9%), respectively.

Conclusions: Approval of extreme right-wing organizations and social movements is strongly associated with support for and willingness to engage in political violence. Given continued concern for political violence in the United States and the new possibility that such individuals might join federal law enforcement in large numbers, focused prevention measures are urgently needed.