Fatores associados a óbitos por ferimentos por arma de fogo: em atendimentos móveis pré-hospitalares de um samu regional do Paraná / Factores asociados con muertes por lesiones causadas por armas de fuego: en servicios móviles prehospitalarios de un samu regional de Paraná / Factors associated with deaths from firearm injuries: in pre-hospital mobile care at a regional samu in Paraná

RESUMO Objetivo: analisar perfil sociodemográfico, morbimortalidade e distribuição espacial de vítimas de ferimentos por armas de fogo atendidas pelo serviço de atendimento móvel de urgência. Métodos: estudo transversal dos registros de atendimento de 603 vítimas de ferimento por arma de fogo atendidas pelo Serviço de Atendimento Móvel de Urgência. Utilizaram-se estatística descritiva, análise de associação univariada e mapa de Kernel para distribuição espacial. Resultados: a maioria das vítimas era do sexo masculino (94%), com idade entre 21 e 30 anos (61,5%). A maioria dos óbitos (73,7%) ocorreu nessa mesma faixa etária. A distribuição espacial demonstrou a maior parte das vítimas em municípios conurbados da região metropolitana, com elevada morbimortalidade. Conclusão: houve maior prevalência de vítimas e óbitos em homens, na faixa dos 21 aos 30 anos, com ferimento em cabeça e pescoço e múltiplos sítios. Nesta amostra não foi possível estabelecer relação estatística significativa entre as cidades das ocorrências, porém se notam focos bem expressivos nas cidades de Sarandi e Paiçandu. Os resultados podem fornecer subsídios para formular políticas públicas para prevenção da violência e preparo para atenção às emergências.

RESUMEN Objetivo: analizar el perfil sociodemográfico, la morbimortalidad y la distribución espacial de las víctimas de lesiones causadas por armas de fuego atendidas por el servicio móvil de urgencias. Métodos: estudio transversal de los registros de atención de 603 víctimas de lesiones por armas de fuego atendidas por el servicio móvil de urgencias. Se utilizó estadística descriptiva, análisis de asociación univariante y el mapa de Kernel para la distribución espacial. Resultados: la mayoría de las víctimas eran hombres (94%), entre 21 y 30 años de edad (61,5%). La mayoría de las muertes (73,7%) ocurrió en este mismo grupo de edad. La distribución espacial mostró la mayoría de víctimas en los municipios conurbados de la región metropolitana, con alta morbilidad y mortalidad. Conclusión: hubo mayor prevalencia de víctimas y muertes en hombres, entre 21 y 30 años, con lesiones de cabeza y cuello y múltiples lugares. A pesar de haberse observado focos bastante expresivos en las ciudades de Sarandí y Paiçandu, en esta muestra no se ha logrado establecer una relación estadísticamente significativa entre las ciudades de los incidentes. Los resultados podrían proporcionar información relevante para formular políticas públicas de prevención de la violencia y preparación para la atención de emergencias.

ABSTRACT Objective: to analyze the sociodemographic profile, morbidity and mortality and spatial distribution of victims of firearms injuries attended by the mobile emergency care service. Methods: cross-sectional study of the care records of 603 firearm injury victims attended by the Mobile Emergency Care Service. Descriptive statistics, univariate association analysis and Kernel map were used for spatial distribution. Results: most of the victims were male (94%), aged between 21 and 30 years (61.5%). Most deaths (73.7%) occurred in this same age group. The spatial distribution showed the majority of victims in conurbated municipalities in the metropolitan region, with high morbidity and mortality. Conclusion: there was a higher prevalence of victims and deaths in men, aged 21 to 30 years, with head and neck injuries and multiple sites. In this sample it was not possible to establish a statistically significant relationship between the cities of the occurrences, but there are quite expressive focuses in the cities of Sarandi and Paiçandu. The results can provide input to formulate public policies for preventing violence and preparing for emergency care.

Guerra civil não-declarada? Um recorte do status da violência urbana em uma capital no Brasil / Undeclared civil war? Urban violence in major city in Brazil

RESUMO Objetivo: a violência civil é responsável por 2,5% da mortalidade mundial, matou mais pessoas no século XXI do que o somatório de todas as guerras deste período. Este estudo descreve as vítimas de violência admitidas em um hospital de referência em trauma em Salvador - Bahia, Brasil e analisa o impacto dos diferentes tipos de violência interpessoal. Métodos: foram incluídos vítimas de violência interpessoal admitidas entre julho de 2015 e julho de 2017. 1296 pacientes (média de idade foi 30,3 anos, 90% do sexo masculino) foram divididos em três grupos de acordo com o mecanismo de violência interpessoal: espancamento, ferimentos por projétil de arma de fogo (FPAF), ferimentos por arma branca (FAB). Os grupos foram comparados de acordo com as seguintes variáveis: idade, sexo, mecanismo de trauma, Revised Trauma Score (RTS) na admissão, necessidade de internamento em unidade de tratamento intensivo (UTI), tempo de internamento, necessidade de transfusão de hemocomponentes e morte. Resultados: FPAF foram o principal mecanismo de injúria (59%), seguido por agressão (24%) e FAB (17%). As vítimas de FPAF apresentaram a menor média de RTS na admissão, maior necessidade de uso de hemocomponentes e de internamento em UTI. Vítimas de espancamento tiveram a maior média de duração de internação hospitalar (11,6±19,6 dias). Os FPAF causaram 77,4% das mortes. Conclusão: vítimas de FPAF são mais críticas, requerendo maior tempo de tratamento em UTI, mais hemocomponentes e maior mortalidade comparativamente às vítimas de FAB e espancamento.

ABSTRACT Purpose: Civil violence is responsible for 2.5% of deaths worldwide; it killed more people in the 21st century than the sum of all wars. This study describes violence victims treated at a trauma reference hospital in Salvador, Brazil and analyzes the impact of different types of interpersonal violence. Methods: Interpersonal violence victims admitted between July 2015 and July 2017 were included. The 1,296 patients (mean age: 30.3 years; 90% male) were divided into three groups according to the mechanism of interpersonal violence: 1) beating, 2) firearm injury and 3) stab wound (STW) injury. The groups were compared for the following variables: age, gender, trauma mechanism, Revised Trauma Score (RTS) at admission, need for intensive care unit (ICU) attention, length of hospital stay, need for transfusion of blood products and death. Results: Gunshot wounds (GSW) were the primary mechanism of injury (59%), followed by beating (24%) and STW (17%). Gunshot wound victims had a lower mean RTS upon admission, increased need for blood products and more Intensive Care Unit (ICU) admissions. Beating victims had the longest mean hospital stay (11.6 ± 19.6 days). The GSW group accounted for 77.4% of all deaths. The in-hospital mortality rate was significantly higher in the GSW group (12.7%) than in the beating group (5.4%) and in the STW group (4.9%). Conclusions: Gunshot wound victims are more critical: they require longer ICU stays, more transfusions of blood products and exhibit increased mortality compared with STW and beating victims.

Juvenicidio armado: homicidios de jóvenes y armas de fuego en América Latina / Armed juvenicide: youth homicides and firearms in Latin America

RESUMEN ​Este artículo analiza el impacto de las armas de fuego en los homicidios de jóvenes en América Latina en la actualidad. Para ello, se realizó un estudio epidemiológico descriptivo transversal a partir de los datos de la Organización Panamericana de la Salud. Se encontraron 14.427 muertes por agresiones con armas de fuego de jóvenes, con una tasa de 14,3 por 100.000 jóvenes para el año 2014 en América Latina. Así, el 80% de todos los homicidios de jóvenes de entre 10 a 19 años de la región fueron cometidos con armas de fuego. Esto afecta especialmente a los varones, cuya tasa asciende a 26,5 por 100.000 muertes por agresiones con armas de fuego, aunque en el caso de las mujeres no se descarta que, en su mayoría, se trate de feminicidios. Además, se registraron 1.828 muertes con armas de fuego de intención no determinada (especialmente provenientes de Venezuela y Argentina) y 284 muertes con armas de fuego en intervenciones legales (mostrando la mayor letalidad policial hacia los jóvenes). La tasa corregida pasa a ser de 16,4 por 100.000 jóvenes muertos por terceros con armas de fuego en América Latina. Se plantea la necesidad de políticas de control de armas y desarme, de campañas de desestigmatización y de programas de desarrollo de la juventud, que reduzcan las actuales condiciones que propician e invisibilizan el llamado "juvenicidio armado" en América Latina.

ABSTRACT This article analyzes the impact of firearms in the homicides of young people in Latin America today. A cross-sectional descriptive epidemiological study was carried out based on data from the Pan American Health Organization. There were 14,427 deaths due to assaults with firearms in young people, that is, a rate of 14.3 per 100,000 young people for the year 2014 in Latin America. Thus, 80% of all homicides in young people between 10 to 19 years of age in the region were committed with firearms. This especially affects young males, with a rate of 26.5 per 100,000 deaths due to assault with firearms, although it should not be overlooked that the deaths among women are largely femicides. In addition, 1,828 deaths of undetermined intent with firearms (especially in Argentina and Venezuela) and 284 deaths with firearms in legal interventions (showing higher policy lethality among young people) were registered. The corrected rate is therefore 16.4 young people killed by others with firearms per 100,000 youth in Latin America. The need for gun control and disarmament policies, de-stigmatization campaigns and youth development programs is discussed, in order to reduce the current conditions that foster and invisibilize the so-called "armed juvenicide" in Latin America.

"Juvenicidio armado": homicidios de jóvenes y armas de fuego en América Latina / "Armed juvenicide": youth homicides and firearms in Latin America

RESUMEN ​Este artículo analiza el impacto de las armas de fuego en los homicidios de jóvenes en América Latina en la actualidad. Para ello, se realizó un estudio epidemiológico descriptivo transversal a partir de los datos de la Organización Panamericana de la Salud. Se encontraron 14.427 muertes por agresiones con armas de fuego de jóvenes, con una tasa de 14,3 por 100.000 jóvenes para el año 2014 en América Latina. Así, el 80% de todos los homicidios de jóvenes de entre 10 a 19 años de la región fueron cometidos con armas de fuego. Esto afecta especialmente a los varones, cuya tasa asciende a 26,5 por 100.000 muertes por agresiones con armas de fuego, aunque en el caso de las mujeres no se descarta que, en su mayoría, se trate de feminicidios. Además, se registraron 1.828 muertes con armas de fuego de intención no determinada (especialmente provenientes de Venezuela y Argentina) y 284 muertes con armas de fuego en intervenciones legales (mostrando la mayor letalidad policial hacia los jóvenes). La tasa corregida pasa a ser de 16,4 por 100.000 jóvenes muertos por terceros con armas de fuego en América Latina. Se plantea la necesidad de políticas de control de armas y desarme, de campañas de desestigmatización y de programas de desarrollo de la juventud, que reduzcan las actuales condiciones que propician e invisibilizan el llamado "juvenicidio armado" en América Latina.

ABSTRACT This article analyzes the impact of firearms in the homicides of young people in Latin America today. A cross-sectional descriptive epidemiological study was carried out based on data from the Pan American Health Organization. There were 14,427 deaths due to assaults with firearms in young people, that is, a rate of 14.3 per 100,000 young people for the year 2014 in Latin America. Thus, 80% of all homicides in young people between 10 to 19 years of age in the region were committed with firearms. This especially affects young males, with a rate of 26.5 per 100,000 deaths due to assault with firearms, although it should not be overlooked that the deaths among women are largely femicides. In addition, 1,828 deaths of undetermined intent with firearms (especially in Argentina and Venezuela) and 284 deaths with firearms in legal interventions (showing higher policy lethality among young people) were registered. The corrected rate is therefore 16.4 young people killed by others with firearms per 100,000 youth in Latin America. The need for gun control and disarmament policies, de-stigmatization campaigns and youth development programs is discussed, in order to reduce the current conditions that foster and invisibilize the so-called "armed juvenicide" in Latin America.

Trauma cardíaco fatal na cidade de Manaus/AM, Brasil / Fatal cardiac trauma in the city of Manaus, Amazonas state, Brazil

RESUMO Objetivo: determinar o índice de trauma cardíaco fatal na cidade de Manaus e esclarecer os mecanismos de trauma e de morte, o tratamento hospitalar prévio, assim como as lesões associadas ao trauma cardíaco. Métodos: estudo retrospectivo, observacional, transversal, que revisou os laudos de necropsias do Instituto Médico Legal de Manaus entre novembro de 2015 e outubro de 2016, cuja causa mortis foi lesão cardíaca. Resultados: o índice de trauma cardíaco foi de 5,98% (138 casos) dentre 2306 necropsias realizadas no período do estudo. Homens foram afetados em 92%. A mediana de idade foi de 27 anos (14 a 83). A arma de fogo foi o mecanismo de trauma em 62,3% e a arma branca em 29,7%. A exsanguinação foi responsável pela maioria das mortes e o tamponamento cardíaco esteve presente em segundo lugar. Óbito no local ocorreu em 86,2%. Os ventrículos foram as câmaras mais lesionadas. O hemotórax foi descrito em 90,6%. Apenas 23 (16,7%) doentes foram removidos até o pronto socorro, porém seis deles (26,2%) não foram submetidos à toracotomia, apenas à drenagem de tórax. O pulmão foi acometido em 57% unilateralmente e 43% bilateralmente. Conclusão: o trauma cardíaco fatal representou um índice de 5,98% na cidade de Manaus. A maioria dos doentes morre na cena do trauma, geralmente devido à exsanguinação causada por ferimento de arma de fogo. Cerca de um quarto dos pacientes que chegaram ao pronto socorro e morreram, não foram diagnosticados com trauma cardíaco em tempo hábil.

ABSTRACT Objective: to determine the frequency of fatal cardiac trauma in the city of Manaus, Brazil, between November 2015 and October 2016, and to clarify the mechanisms of trauma and death, previous hospital treatment, as well as the injuries associated with cardiac trauma. Methods: retrospective, observational, and cross-sectional study, which reviewed the necropsy reports of individuals whose cause of death was cardiac injury. Results: the cardiac trauma rate was of 5.98% (138 cases) out of 2,306 necropsies performed in the study period by Instituto Médico Legal (IML) de Manaus (IML is a Brazilian institute responsible for necropsies and cadaveric reports). Males accounted for 92% of the cases. The median age was 27 years (14-83). Gunshot wounds (GSW) was the trauma mechanism in 62.3% and stab wound (SW) in 29.7%. Exsanguination was responsible for most of the deaths and cardiac tamponade was present in second place. On-site death occurred in 86.2% of the cases. The ventricles were the most common site of cardiac injury. Hemothorax was identified in 90.6% of the individuals. Only 23 patients (16.7%) were taken to the hospital (Emergency Room), but six (26.2%) were submitted only to chest drainage, not to thoracotomy. The lung was unilaterally affected in 57% of the cases and bilaterally in 43%. Conclusion: fatal cardiac trauma represented an index of 5.98% in the city of Manaus. Most patients die at the scene of the trauma, usually due to exsanguination caused by gunshot wound. About a quarter of patients who reached the hospital and died were not diagnosed with cardiac trauma in time.

Firearm injuries received in emergency room of a Nigerian Teaching Hospital: Aanalysis of pattern, morbidity, and mortality

Background: The morbidity and mortality associated with civilian firearm injury in developing countries is appreciable. The increasing incidence of gunshot casualties received in hospital emergency rooms is an emerging concern. The aim of this study was to determine the pattern and outcome of firearm injuries in a civilian setting of a developing country. Materials and Method: This was a retrospective analysis of data on the entire patients with firearm injury received in the emergency room of Federal Teaching Hospital Abakaliki from January 2005 to December 2014. Results: There were 214 casualties, male-to-female ratio was 8:1, and mean age was 31.7 ± 0.80 years. The causes of injuries were armed robbery (59.9%), assault (33.6%), and accidental (6.5%). The incidence of armed robbery­related injury peaked in May and was higher in rainy season (P < 0.018), urban areas (P < 0.001) and at night-time (P < 0.033), whereas the incidence of assault-related injury peaked in April and was higher in dry season in rural areas and at day-time. Duration of hospital admission ranged from 1 to 184 days and mean was 16 days. Prolonged duration of hospital admission correlated with perforating wound (P < 0.001), high-velocity gunshot (P < 0.001), fractures (P < 0.001) and wound infection (P < 0.001). Preventable death rate was high, although mortality rate was 5.6%. A high mortality rate correlated with visceral injury (P < 0.001) and hypovolaemic shock (P < 0.001). Conclusion: The temporal distribution of firearm injury varies in location and aetiology of gunshot. This and the factors for relatively high morbidity and preventable death rate observed call for preventive strategies as well as improvement in pre-hospital and emergency room care

Abordaje supraclavicular para el traumatismo vascular subclavio / Supraclavicular approach for subclavian vascular injuries

Introducción: la lesión traumática de los vasos subclavios no es frecuente. La causa fundamental está centrada en las heridas por armas de fuego y por objetos perforo-cortantes. La hemorragia o un hematoma en la zona de la base del cuello o tórax superior nos hacen pensar en esta lesión. El tratamiento depende principalmente de la estabilidad hemodinámica del paciente y los recursos disponibles. Este puede ser quirúrgico convencional o reparación endovascular. Objetivos: exponer los beneficios del abordaje supraclavicular para el tratamiento quirúrgico urgente de la lesión de vasos subclavios. Métodos: se realizó un estudio observacional, retro y prospectivo para recolectar la información de los pacientes atendidos por lesión traumática de vasos subclavios en nuestro centro, desde noviembre de 2011 hasta octubre de 2015. Resultados: de los pacientes intervenidos, 10 fueron hombres y una mujer. Todas las lesiones fueron por objetos perforo-cortantes. El tipo de lesión más frecuente fue la laceración de vena subclavia (63,6 por ciento). La vía de abordaje más utilizada fue la cervicotomía en tercio inferior con prolongación supraclavicular con clavicectomía y osteosíntesis ulterior. Hubo 3 fallecidos (27,3 por ciento). Conclusiones: la herida de vasos subclavios sucede más frecuente por objetos perforo-cortantes y tiene una alta mortalidad, la vía supraclavicular resultó la de mejor exposición para repararla. La prontitud del tratamiento fue la variable que más influyó en la morbilidad y mortalidad de esta afección(AU)

Introduction: traumatic injury of the subclavian vessels is rare. The main cause is focused on ballistic trauma and pierced-sharp objects. Bleeding or hematoma in the areas of the neck base or the upper chest lead us to think of this injury. Treatment depends mainly on the patient's hemodynamic stability and available resources. This may be conventional surgical or endovascular repair. Objectives: expose the benefits of supraclavicular approach to the urgent surgical treatment of the subclavian vessel lesions. Methods: a prospective and retro observational study was performed to gather information from patients treated for traumatic lesion of subclavian vessels in our hospital from November 2011 to October 2015. Results: out of the operated patients, 10 were men and one was woman. All lesions were drilled-sharp objects. The most common type of injury was the subclavian vein laceration (63.6 percent). The most commonly used approach was the cervicotomy in the lower third with supraclavicular clavicotomy clavicectomía and further extension with osteosynthesis. There were 3 deaths (27.3 percent). Conclusions: subclavian vessel wounds most frequently occur due to perforating-cutting objects and has a high mortality. The supraclavicular approach was the best access for repair. The promptness of treatment was the variable that most influenced the morbidity and mortality of this condition(AU)

Homicídios, álcool e drogas em Belo Horizonte, Minas Gerais, Brasil, 2000-2009 / Homicidios, alcohol y drogas en Belo Horizonte, Minas Gerais, Brasil, 2000-2009 / Homicides, alcohol and drugs in Belo Horizonte, Minas Gerais State, Brazil, 2000-2009

OBJETIVO: estimar a prevalência e fatores associados aos resultados de exames post mortem positivos para álcool (EPA), maconha (EPM) e/ou cocaína-crack (EPCC) entre residentes de Belo Horizonte-MG, Brasil, vítimas de homicídio no período 2000-2009. MÉTODOS: estudo transversal, com dados do Sistema de Informações sobre Mortalidade (SIM); utilizou-se regressão de Poisson para obter razões de prevalência (RP) e intervalos de confiança (IC95%). RESULTADOS: foram incluídos 8.091 homicídios; destes, 29,7% dos óbitos apresentaram EPA, EPM e/ou EPCC; mais frequentes entre homens (RP=1,87; IC95% 1,65;2,11), jovens (RP=1,39; IC95% 1,26;1,53), sem companheiro/a (RP=1,64; IC95% 1,49;1,81), negros (RP=1,66; IC95% 1,51;1,82), de baixa escolaridade (RP=1,42; IC95% 1,28;1,57), agredidos por arma de fogo (RP=1,81; IC95% 1,63;2,01), ocorridos em via pública (RP=1,82; IC95% 1,64;2,01). CONCLUSÃO: integrar ao SIM informações forenses permitiu captar comportamentos de risco - uso de álcool e drogas pela vítima -, fortalecendo as informações sobre mortalidade como ferramenta de dimensionamento da questão violência interpessoal-drogas no Brasil.

OBJETIVO: estimar la prevalencia y factores asociados a resultados de exámenes post mortem positivos para alcohol (EPA), marihuana (EPM) y/o cocaína-crack (EPCC) entre residentes en Belo Horizonte-MG, Brasil, víctimas de homicidio en el período 2000-2009. MÉTODOS: estudio transversal con datos del Sistema de Información de Mortalidad (SIM); utilizamos regresión de Poisson para obtener razones de prevalencia (RP) e intervalo de confianza (IC95%). RESULTADOS: se incluyeron 8.091 homicidios; de estos, 29,7% de las muertes mostró EPA, EPM y/o EPCC con mayor frecuencia entre hombres (RP=1,87; IC95% 1,65;2,11), jóvenes (RP=1,39; IC95% 1,26;1,53), sin compañero(a) (RP=1,64; IC95% 1,49;1,81), negros (RP=1,66; IC95% 1,51;1,82), con bajo nivel educativo (RP=1,42; IC95% 1,28;1,57), agredidos con armas de fuego (RP=1,81; IC95% 1,63;2,01) y ocurridos en la vía pública (RP=1,82; IC95% 1,64;2,01). CONCLUSIÓN: la integración de información forenses al SIM permitió identificar conductas de riesgo, como uso de alcohol y drogas, fortaleciendo la información sobre mortalidad como una herramienta para dimensionar el complejo problema de violencia interpersonal y drogas en Brasil.

OBJECTIVE: to estimate the prevalence and factors associated with the results of post mortem examinations positive for alcohol (EPA), marijuana (EPM) and/or crack-cocaine (EPCC) among people resident in Belo Horizonte-MG, Brazil, who were homicide victims between 2000-2009. METHODS: This was a cross-sectional study using Mortality Information System (SIM) data; Poisson regression was used to obtain prevalence ratios (PR) and confidence intervals (95%CI). RESULTS: 8,091 homicides were included in the study; in 29.7% of deaths EPA, EPM and/or EPCC were found more frequently among males (PR=1.87; 95%CI: 1.65; 2.11), youth (PR=1.39; 95%CI: 1.26; 1.53), those with no partner (PR=1.64; 95%CI: 1.49; 1.81), black skin color (PR=1.66; 95%CI: 1.51; 1.82), low education (PR=1.42; 95%CI: 1.28; 1.57), injured by firearms (PR=1.81; 95%CI: 1.63; 2.01) and occurrence in the street (PR=1.82; 95%CI: 1.64;2.01). CONCLUSION: integrating forensic information with SIM data enabled risk behaviors - alcohol and drug use by the victim - to be captured, thus strengthening mortality information as a tool for estimating the size of the complex problem of interpersonal violence and drugs in Brazil.

Tendencia temporal de la mortalidad por armas de fuego en Argentina, 1980-2012 / Time trend study of firearm mortality in Argentina, 1980-2012

Este trabajo analiza el impacto de las armas de fuego en la mortalidad entre los años 1980-2012 en Argentina. Para ello se realiza un estudio epidemiológico descriptivo de la tendencia temporal, a través de las siguientes variables: sexo, grupos de edad, intencionalidad y jurisdicción. Los datos fueron obtenidos en la Dirección de Estadísticas e Información en Salud del Ministerio de Salud de la Nación. Se encontraron 87.671 muertes por armas de fuego. Los varones representaron el 85,7% y su tasa más alta fue para el año 2002 con 21,2 muertes por 100.000 habitantes. El grupo de edad que concentró la mayor cantidad de muertes por armas de fuego fue el de 20 a 29 años (25,6%). Las tasas ajustadas más altas corresponden a los años 2000-2002 con valores entre 10,0 y 11,6 muertes por cada 100.000 habitantes, período que coincide con la crisis económico-institucional que atravesó el país. La provincia de Buenos Aires fue el lugar de residencia del 49,1% de las muertes. En la discusión se abordan dimensiones político-económicas e ideológico-culturales en la relación entre armas, violencias, ciencia y sociedad.

This work analyzes the impact of firearm mortality between 1980 and 2012 in Argentina. For this purpose a descriptive epidemiological time trend study was carried out including the following variables: sex, age group, intentionality and jurisdiction. Data was obtained from the Office of Health Statistics and Information of the Argentine Ministry of Health. A total of 87,671 deaths due to firearms were discovered, of which 85.7% occurred in men. The highest mortality rate due to firearms corresponded to the year 2002, reaching 21.2 deaths per 100,000 inhabitants. The age group concentrating the largest number of deaths due to firearms was that of 20-29 years, accounting for 25.6% of all deaths. The highest adjusted rates corresponded to the years 2000-2002, with values of 10.0 to 11.6 deaths per 100,000 inhabitants. This time period coincides with the institutional-economic crisis the country experienced. The province of Buenos Aires was the place of residence of 49.1% of the deceased. In the discussion, political-economic and ideological-cultural dimensions of the relations among firearms, violence, science and society are considered.

Circumstances and factors associated with accidental deaths among children, adolescents and young adults in Cuiaba, Brazil / Circunstancias e fatores associados as mortes por causas acidentais entre criancas, adolescentes e jovens em Cuiaba, Brasil

CONTEXT AND OBJECTIVE Analysis on accidents from the perspective of population segments shows there is higher incidence among children, adolescents and young adults. Since the characteristics and circunstances of the event are closely related to educational, economic, social and cultural issues, identifying them may contribute towards minimizing the causes, which are often fatal. The aim here was to identify the environmental, chemical, biological and cultural factors associated with deaths due to accidents among children, adolescents and young adults in Cuiabá, in 2009. DESIGN AND SETTING This was a descriptive cross-sectional study conducted in Cuiabá, Mato Grosso, Brazil. RESULTS Thirty-nine accidental deaths of individuals aged 0 to 24 years were examined: 56.4% due to traffic accidents; 25.6%, drowning; 10.3%, aspiration of milk; 5.1%, falls; and 2.6%, accidentally triggering a firearm. Male victims predominated (82.1%). The presence of chemical, environmental and biological risk factors was observed in almost all of the homes. Regarding cultural factors and habits, a large proportion of the families had no idea whether accidents were foreseeable events and others did not believe that the family's habits might favor their occurrence. Delegation of household chores or care of younger siblings to children under the age of 10 was common among the families studied. CONCLUSION The results point towards the need to have safe and healthy behavioral patterns and environments, and to monitor occurrences of accidents, thereby structuring and consolidating the attendance provided for victims. .

CONTEXTO E OBJETIVO Ao analisar os acidentes sob o prisma dos segmentos populacionais, observa-se grande incidência em crianças, adolescentes e jovens. A frequência e as características e circunstâncias do evento estão intimamente relacionadas com fatores educacionais, econômicos, sociais e culturais, e a identificação desses fatores pode contribuir para minimizar essas causas, muitas vezes fatais. O objetivo foi identificar os fatores ambientais, químicos, biológicos e culturais associados com óbitos por acidentes, ocorridos entre crianças, adolescentes e jovens em Cuiabá, em 2009. TIPO DE ESTUDO E LOCAL Este é um estudo descritivo, transversal, realizado em Cuiabá, Mato Grosso, Brasil. RESULTADOS Foram analisados 39 óbitos acidentais ocorridos de 0 a 24 anos (56,4% por acidente de transporte, 25,6% por afogamento, 10,3% por aspiração de leite, 5,1% por queda e 2,6% por disparo acidental de arma de fogo). Houve predomínio no sexo masculino (82,1%). Observou-se a presença de fatores químicos, ambientais e biológicos na quase totalidade das residências. Quanto aos fatores culturais e hábitos, grande parte das famílias não soube referir se o acidente constitui evento previsível e outra parte não acredita que os hábitos da família favorecem sua ocorrência. Delegar aos filhos menores de 10 anos os afazeres domésticos ou o cuidado de irmãos menores é comum entre as famílias estudadas. CONCLUSÃO Os resultados apontam para a necessidade de adotar comportamentos e ambientes seguros e saudáveis, bem como monitorizar a ocorrência dos acidentes, estruturando e consolidando o atendimento às vítimas. .

Peripheral arterial embolism of pellets after shotgun injury to the abdomen: A case report.

Dealing with shotgun injury to the abdomen it is important to be aware of the possibility of missile emboli and their potential clinical effects because it usually causes vascular trauma but intravascular missile embolism is relatively rare. Vascular trauma following shotgun injuries may involve laceration of the vessel wall, pseudoaneurysm, arteriovenous fistula or missile embolism. A pellet embolus should be suspected in all cases where gunshot entry wound is present with or without an exit wound. We recently encountered a case of a close-range shotgun injury to the abdomen with subsequent embolisation of pellets to bifurcation of popliteal artery both lower limbs. However, pellet embolus is asymptomatic, there is still debate over best management because conservative management avoids surgical risks and operative removal prevents the possibility of embolus related life threatening complications. This case shows that it is necessary to do whole body imaging in all cases of shotgun injury whether exit wound present or not.

La mortalidad por armas de fuego en Argentina entre 1990 y 2008 / Firearm mortality in Argentina, 1990-2008

Este es un estudio epidemiológico descriptivo de la mortalidad por armas de fuego en Argentina, 1990-2008. Se analizaron los porcentajes y las tasas de mortalidad por armas de fuego entre las jurisdicciones del país. Los datos provienen de la Dirección de Estadística e Información en Salud, Ministerio de Salud y Ambiente, República Argentina. Entre 1990-2008 se produjeron 358.484 muertes por causas externas de las cuales el 16,6% (59.339) correspondieron a armas de fuego. La Provincia de Buenos Aires presentó el porcentaje y tasas cruda y ajustada superiores. Las jurisdicciones de la Región Pampeana (incluye Provincia de Buenos Aires) presentaron un perfil más homogéneo y similar al del país: aumento de las tasas en 1999-2002 y disminución en 2003-2006. Estos hallazgos se explicarían en parte por el deterioro socioeconómico vivido en Argentina a fines del siglo XX, que habría tenido mayor impacto en Provincia de Buenos Aires, por ser ésta una de las provincias con mayor desarrollo y dinamismo económico de Argentina. La situación de Provincia de Buenos Aires habría estado agravada por el hecho de tener una de las fuerzas policiales más represivas del país.

This is a descriptive epidemiological study of firearm mortality in Argentina, 1990-2008. The study compared the firearm mortality percentages and rates between the country's jurisdictions. The data are from the Office of Health Statistics and Information, Ministry of Health. From 1990 to 2008 there were 358,484 deaths from external causes, of which 16.6% (59,339) were caused by firearms. The Province of Buenos Aires showed the highest percentage and crude and adjusted rates. The jurisdictions in the Pampeana region (including the Province of Buenos Aires) showed a more homogeneous profile, similar to that of the country as a whole, with an increase in the rates from 1999 to 2002 and a decrease from 2003 to 2006. These findings are partially explained by the country's deteriorating socioeconomic conditions in the late 20th century, with a greater impact on Buenos Aires, one of the provinces of Argentina with the greatest development and economic dynamism. The situation in Buenos Aires was aggravated by the fact that the Province has one of the country's most repressive police forces.

Death due to airgun injury: a case report.

In medicolegal practice, the examination of injuries is very important to solve the medicolegal problems like weapon identification, age of the injury, fatality, ante mortem or postmortem etc. Commonly the firearms are classified like rifled guns and smooth bored guns. Usually cases encountered are from these weapons. In these weapons gun powder is used to propel the projectile. The preliminary knowledge of these weapons is important to identify the weapon. In case of airgun, compressed air is used to propel the projectile. An airgun is a rifle, pistol or shotgun which fires projectiles by means of compressed air or gas in contrast to a firearm which burns a propellant. Most airguns use metallic projectiles called as pellets. The death due airgun is rare. The death that happened in this case is discussed in detail due to rarity of its kind. During the injury examination, the analysis of the injury is important. Its size, shape, nature of margins, abrasions coller, grease coller, tattooing, soot, and burns are all to be noted in firearm injuries to decide the weapon, entry or exit wound etc.

Penetrating chest injuries: a medicolegal analysis.

Penetrating injuries are one of the commonest methods of committing murder, of which penetrating injuries of the chest/heart are very serious and prove fatal in most of the cases (1). In a post mortem study of penetrating chest injuries at Lucknow, majority of the victims were adult male between 20-50 years of age. In majority of the cases injuries were caused by firearms usually a shot gun. Injuries by knives and daggers were also seen in few cases. Injuries were seen on the front of chest, predominantly on the left side, in majority of the cases. Lungs were damaged in all the cases. Heart; aorta & other thoracic organs were also injured in substantial number of cases. In the cases where heart was found damaged, the right ventricle was injured in majority of the cases. Two-third of the victims died within three hours after getting injuries, either on the spot or in the way to the hospital. All the cases of penetrating chest injuries were homicidal & personal rivalry was the single most common reason behind these deaths.

Informações sobre mortalidade por causas externas e eventos de intenção indeterminada, Paraná, Brasil, 1979 a 2005 / Data on mortality from external causes and events of undetermined intent, Paraná State, Brazil, 1979 to 2005

Foi analisada a qualidade do Sistema de Informações sobre Mortalidade (SIM) para óbitos por causas externas no Estado do Paraná, Brasil, entre 1979 e 2005, focalizando os eventos de intenção indeterminada. Os óbitos foram agrupados em acidentes de transporte, homicídios, suicídios, eventos de intenção indeterminada, e calculadas a mortalidade proporcional e a variação percentual anual dos coeficientes entre triênios. Os acidentes de transporte foram as causas mais freqüentes de óbito no período e, a partir de 1997, os homicídios passam à segunda posição. Os óbitos por eventos de intenção indeterminada por arma (de fogo ou branca) reduziram de 4,8 por cento em 1981 para 0,3 por cento em 2005. Os coeficientes dos eventos (todos) de intenção indeterminada passaram de 14,9 óbitos por 100 mil habitantes em 1979/1981 para 2,0 em 2003/2005. A variação percentual anual foi de -13,1 por cento entre 1980 e 1985; -6 por cento entre 1996 e 2000 e -11 por cento entre 2000 e 2004. Os resultados evidenciam a boa qualidade do SIM sobre causas externas no Estado do Paraná, permitindo análises com potencial para subsidiar ações de prevenção e promoção da saúde.

This study analyzed the quality of data from the Mortality Information System (SIM) for deaths due to external causes in the State of Paraná, Brazil, 1979 to 2005, focusing on events of undetermined intent. Deaths were grouped in motor vehicle accidents, homicides, suicides, and events of undetermined intent, and proportional mortality and relative annual variation of rates over the three-year period were analyzed. Motor vehicle accidents (more than 30 percent of the total) were the most frequent causes of death throughout the period, and since 1997 homicides have become the second most frequent cause. Deaths due to events of undetermined intent caused by weapons (firearms or knives) decreased from 4.8 percent in 1981 to 0.3 percent in 2005. Mortality rates for events of undetermined intent (overall) decreased from 14.9 deaths per 100,000 inhabitants in 1979-81 to 2.0 in 2003-05. Annual percentage variation was -13.1 percent from 1980 to 1985, -6 percent from 1996 to 2000, and -11 percent from 2000 to 2004. The findings show the good quality of SIM data on external causes in the State of Paraná, allowing analyses with the potential to support programs to prevent injuries as well as health promotion measures.

Heridas por armas de fuego y traumas vasculares: una ventana a la violencia civil en Caracas

Las muertes por violencias en Venezuela han aumentado gradualmente hasta convertirse en un problema de salud pública, de acuerdo a los datos de epidemiología y estadística vital del Ministerio de Salud y Desarrollo Social, entre 1850 y 2005, el reporte de un mayor número de traumas por armas de fuego atendidos en centros hospitalarios nacionales y el aumento de biopsias vasculares traumáticas, en población masculina joven. Las tasas de mortalidad por agresiones aumentaron un 93,7 por ciento entre 1995 y 2005. De acuerdo a la forma de ataque en las agresiones, el ataque por arma de fuego aumentó de un 53,4 por ciento en 1980 a 87,2 por ciento en 2005. Entre 1990 y 2002, en 1307 biopsias analizadas en el Instituto Anatomopatológico "Dr. José Antonio O'Daly", de la Universidad Central de Venezuela, 300 fueron vasculares y 70 de ellas traumáticas. El 90 por ciento ocurrió en varones, el 74,3 por ciento fueron producidas por armas de fuego y el 57 por ciento era menor de 30 años. El 78,6 por ciento de las lesiones vasculares traumáticas estuvieron localizadas en arterias de las extremidades

Deaths by violence in Venezuela had increased gradually becoming a public health problem, according to epidemiological and vital statistics data from the National Public Health Service, between 1950 and 2005, reports on more number of gun fire arms lesions attendedin national care centres and an increase of traumatic vascular biopsies in the young male population. Aggression death rates increased 93,7% between 1995 and 2005. According to the aggression type of attack, gun fire arms attack increased from 53,4% in 1980 to 87,2% in 2005. From 1990 to 2002, out of 1307 biopsies analyzed at the “Dr. José Antonio O’Daly”, Anatomopathological Institute in the Central University, 300 were vascular and 70 of them traumatic. The 90% occurred in males, 74,3% were produced by gun fire arms and 57% were younger than 30 years old. The 78,6% of the traumatic vascular lesions were located in the extremities

Caracterização dos casos de suicídio em uma capital do Nordeste Brasileiro / Characterization of suicide cases in a Brazilian Northeastern capital

Trata-se de estudo quantitativo, descritivo e retrospectivo que objetivou caracterizar o suicídio no município de Teresina-PI, no período de 2000-2005, quanto aos aspectos sócio-demográficos, meios utilizados e período (mês) de ocorrência. Os resultados foram obtidos através de laudos do Instituto de Medicina Legal, evidenciam um índice maior de suicídio entre os homens (71,3 por cento) com maior incidência da população jovem, com predomínio entre os solteiros (54,9 por cento). Os grupos ocupacionais com maior percentual foram os estudantes (23,8 por cento). O método mais freqüente foi de enforcamento (66 por cento), seguido de arma de fogo (13,1 por cento). A realização de intervenções em busca da diminuição das taxas existentes é primordial, pois estas corresponderam ao quarto lugar em relação a todas as mortes de causas violentas ocorridas no município.

A descriptive, retrospective study which aimed to characterize suicide in the municipality of Teresina, Piauí, the period of 2000-2005, in regards to the social demographic aspects, means of death and period (month) of the act. The results were obtained through the Institute of Legal Medicine, they show a greater rate of suicide among men (71.3 percent) with a greater frequency of the youth population, predominance among the single (54.9 percent). The occupational groups with the greatest percentage were students (23.8 percent). The most frequently used method was hanging (66 percent) followed by firearms (13.1 percent). The use of interventions in hopes of lowering the current rates is imperative, as suicide occupies fourth place in relation to all causes of violent deaths in the municipality.

Se trata de un estudio cuantitativo, exploratorio, descriptivo y retrospectivo que objetiva caracterizar el suicidio en el municipio de Teresina-PI, en el período de 2000-2005, en cuanto a los aspectos socio-demográficos, medios utilizados y período (mes) ocurridos. Los resultados fueron obtenidos a través de laudos del Instituto de Medicina Legal, evidencian un índice mayor de suicidios entre los hombres (71,3 por ciento) con mayor incidencia en la población joven, con predominio entre los solteros (54,9 por ciento). Los grupos ocupacionales con mayor porcentual fueron los estudiantes (23,8 por ciento). El método más frecuente fue de ahorcamiento (66 por ciento), seguido de arma de fuego (13,1 por ciento). La realización de intervenciones en busca de la disminución de las tasas existentes es primordial, pues éstas correspondieron al cuarto lugar con relación a todas las muertes por causas violentas ocurridas en el municipio.

[Pattern of firearm related injuries: results of a multi-center study]

Firearm-related injuries pose a serious public health problem in many countries, such as the United States and South Africa. The aim of this study was to report the pattern of firearm injuries using data collected by the national trauma project. The national trauma project has been conducted by Trauma and Surgery Research Center of Sina Hospital in 8 cities of Iran [Tehran, Shiraz, Tabriz, Ahvaz, Kermanshah, Mashhad, Babol and Qom] and it includes information of 16753 trauma patients. Overall, 104 patients [0.6%] were identified as having sustained a firearm injury. They were 94 [90.4%] males and 10 [9.6%] females, with a mean age of 28.2 +/- 10.3 [range, 15 to 60 years]. The age group of 21-30 years comprised 49.5% of our patients. Extremity injury was the most common type of injury [47.9%]. Eight patients [7.6%] died resulting from the severity of injuries, with head injury as the main cause of death in 4 of them [50%]. Most patients [73.3%] sustained injuries in an assault. More restricted rights toward keeping and using firearms seem to be necessary. Awareness of physicians of firearm related injuries and their treatment is essential for the appropriate management of patients and reduction of hospital mortality in victims. On the other hand, attempts should be made to build an especial system for monitoring firearm-related injuries in Iran

Violência urbana: um desafio para o pediatra / Urban violence: a challenge for pediatricians

OBJETIVOS: Apresentar os principais aspectos da abordagem da criança e do adolescente vítima de violência urbana e destacar o papel do pediatra nas ações socioeducativas para o seu enfrentamento. FONTES DOS DADOS: Busca bibliográfica em base de dados MEDLINE, LILACS e SciELO, no período de 1993 a 2005, utilizando as palavras-chave "violência urbana em crianças e adolescentes". Políticas e relatórios institucionais sobre violência urbana também foram utilizados. SíNTESE DE DADOS: Apresenta-se uma discussão sobre a relação causal da violência, partindo de um enfoque pessoal até chegar a uma visão macroestrutural. A literatura sugere que a violência urbana seja um produto da ação de determinantes pertencentes à várias instâncias e também de comportamento de risco específico. Trata-se de um fenômeno complexo, preocupante, que apresenta elevados índices de morbimortalidade em crianças e adolescentes. Especial atenção foi dada aos homicídios e aos desfechos psicológicos decorrentes de atos violentos. A arma de fogo é o instrumento que mais mata os adolescentes e jovens do sexo masculino, mesmo quando comparada com todas as outras causas de óbito nessa faixa etária. CONCLUSÕES: A violência urbana é um dos principais problemas sociais no Brasil. Sua prevenção exige ações intersetoriais e multiprofissionais, com a participação articulada do Estado e da sociedade civil. Através de uma prática assistencial ampliada, os pediatras são capazes de atuar na prevenção, detecção e tratamento das vítimas e suas famílias, ajudando-as a estabelecer relações saudáveis e dinâmicas com seu ambiente e com elas próprias.