Alcohol and illicit drug abuse and the risk of violent death in the home.

CONTEXT: While acute alcohol and illicit drug use are common in homicide and suicide victims, the role of chronic substance use in violent death is unclear. OBJECTIVE: To measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and use of illicit drugs. DATA SOURCES: Data obtained from a case-control study of risk factors for homicide and suicide in 3 large metropolitan areas of the United States. DESIGN: Matched case-control study including 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analyzed by means of conditional logistic regressions in which other potential risk factors for violent death were also considered. OUTCOME AND EXPOSURE MEASURES: Homicide and suicide victims were identified from medical examiner reports in Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information about alcohol or illicit drug use, and history of alcohol-related hospitalization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject were also obtained. RESULTS: The risks of homicide and suicide associated with alcohol or illicit drug use were elevated, as were the risks of violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users were at increased risk of homicide (odds ratio, 1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8). CONCLUSIONS: Alcohol and illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for non-substance-abusing individuals living in households in which other members abused alcohol or drugs. The concept of the individual at risk of homicide should be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.

Nucleic acid sequences coding for internal antisense peptides: are there implications for protein folding and evolution?

We have asked whether coding segments of nucleic acids generate amino acid sequences which have an antisense relationship to other amino acid sequences in the same chain (i.e. 'Internal Antisense'), and if so, could the internal antisense content be related to the structure of the encoded protein? Computer searches were conducted with the coding sequences for 132 proteins. The result for each search of a specific sequence was compared to the mean result obtained from 1000 randomly assembled nucleic acid chains whose length and base composition were identical to that of the native sequences. The study was conducted in all three reading frames. The normal reading frame (frame one) was found to be contain lower amounts of internal antisense than the randomly assembled chains, whereas the frame two results were much higher. The internal antisense content in frame three was not significantly different from that in the random chains. The amount of internal antisense in frames two and three was correlated with the GC content at the center position of the codons in that frame, but this correlation was absent in frame one. No correlation with chain length was found. Qualitatively similar results were obtained when the random model was limited to retain the same purine/pyrimidine ratio as the native chains at each position in the codons, but in this case the internal antisense in frame three was also significantly greater than the computer-generated sequences. The results suggest that the internal antisense content in the correct reading frame has a qualitatively different origin from that in the other two frames. The high amount in frames two and three is apparently an artifact resulting from the asymmetric distribution of G and C in the codons, while the low amount in frame one may suggest evolutionary selection against internal antisense. Thus, the results do not support a relationship between internal antisense and protein structure.

Gun ownership as a risk factor for homicide in the home.

BACKGROUND: It is unknown whether keeping a firearm in the home confers protection against crime or, instead, increases the risk of violent crime in the home. To study risk factors for homicide in the home, we identified homicides occurring in the homes of victims in three metropolitan counties. METHODS: After each homicide, we obtained data from the police or medical examiner and interviewed a proxy for the victim. The proxies' answers were compared with those of control subjects who were matched to the victims according to neighborhood, sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. RESULTS: During the study period, 1860 homicides occurred in the three counties, 444 of them (23.9 percent) in the home of the victim. After excluding 24 cases for various reasons, we interviewed proxy respondents for 93 percent of the victims. Controls were identified for 99 percent of these, yielding 388 matched pairs. As compared with the controls, the victims more often lived alone or rented their residence. Also, case households more commonly contained an illicit-drug user, a person with prior arrests, or someone who had been hit or hurt in a fight in the home. After controlling for these characteristics, we found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide (adjusted odds ratio, 2.7; 95 percent confidence interval, 1.6 to 4.4). Virtually all of this risk involved homicide by a family member or intimate acquaintance. CONCLUSIONS: The use of illicit drugs and a history of physical fights in the home are important risk factors for homicide in the home. Rather than confer protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance.

Violent death in children in a metropolitan county: changing patterns of homicide, 1958 to 1982.

Death rates from homicide in children younger than 15 years of age in the United States have increased during the last 30 years. Previous studies have suggested a typology consisting of fatal child abuse in young children and community violence in older children. We reviewed the data from the Cuyahoga County, Ohio, coroner's office pertaining to homicides in children less than 15 years of age between 1958 and 1982 and obtained similar findings. The homicide rates for city children increased from 1.1 to 6.7/100,000 in the first 20 years and then stabilized. Nonwhite boys had the highest death rates except in one period. Assailants were usually adolescent and young adult men of the same race; however, 43% of children less than 5 years of age were killed by women. The older the child, the more likely the homicide was to have been committed by a nonrelative, outside of the home, and with a firearm. Overall, firearms are the leading cause of homicide (36.2%). The temporal characteristics of child homicides are also described.

Adolescent suicide: an overview.

Etiological theories of suicide are reviewed from epidemiological, individual (both biological and psychological), and psychosocial perspectives. Cohort and population-model approaches as explanations for the two- to three-fold increase in completed suicide rates observed in adolescents and young adults over the past 25 years are presented. The results of the authors' study of suicides in adolescents and young adults in Cuyahoga County, Ohio, to test these hypotheses are summarized. This study revealed marked cohort differences in suicide rates and provided partial support for the "population-model" approach. Differences between suicide rates in adolescents and other age groups are discussed, as are data from some minority groups. The role of depression in adolescents and various studies of diagnostic approaches (e.g., structured diagnostic assessments, biological markers, clues during intensive psychotherapy or psychoanalysis, studies of high-risk diagnostic groups) are reviewed. Lastly, treatment employing individual, family, and group approaches to classical psychoanalytic or cognitive psychotherapy as well as the role of pharmacological treatments are considered.

Bimodality of glycosylated hemoglobin distribution in Pima Indians: relationship to fasting hyperglycemia.

Glycosylated hemoglobin (HbA1) concentrations were determined in 300 Pima Indians aged 15 yr and older. Frequency distributions of HbA1 were unimodal in the 15--24-yr-old age group, but were bimodal in those aged 25 yr and over. The bimodality indicated that the subpopulation with diabetes could be identified by the presence of elevated HbA1 levels. This group was comprised primarily of subjects who also had fasting plasma glucose levels of less than or equal to 140 mg/dl, but subjects with impaired glucose tolerance without fasting hyperglycemia had HbA1 levels that were not significantly higher than those with normal glucose tolerance. The prevalence of diabetic retinopathy was much higher in the subgroup with elevated HbA1 levels and increased with increasing HbA1 level. HbA1 levels and triglyceride concentrations showed only a modest association. HbA1 determinations provided no advantage over fasting or post challenge glucose levels in the diagnosis of diabetes.

Fasting and two-hour post-load glucose levels for the diagnosis of diabetes. The relationship between glucose levels and complications of diabetes in the Pima Indians.

The frequency distributions of both the fasting and two-hour post-load plasma glucose levels were bimodal in the Pima Indian population aged 25 years and over. The hyperglycaemic component of this distribution represents those with diabetes mellitus, as some 30 percent of this group had evidence of the specific vascular complications of the disease, whereas these abnormalities were virtually absent in those with lower glucose levels. The bimodal characteristics of the frequency distributions were utilized to define optimal criteria to separate those with and without diabetes. The sensitivity and specificity of these criteria for fasting and two-hour glucose levels were compared and were found to be similar. The fasting glucose determination, however, was more reproducible and stable, as well as being easier to obtain, indicating that it is the better measurement for diagnostic purposes. The optimal level for diagnosis of 7.5 mmol/l (136 mg/dl) for the fasting glucose and the equivalent two-hour value of 14 mmol/l (250 mg/dl), were higher than many previously recommended diagnostic levels. Nevertheless, there was no evidence that subjects with lower levels were at appreciable risk of developing the specific complications of diabetes. Subjects with impaired glucose tolerance (IGT), but without fasting hyperglycaemia, should not be diagnosed as having diabetes mellitus.

Violent death in a metropolitan county: II. Changing patterns in suicides (1959-1974).

Suicide rates in Cuyahoga County (metropolitan Cleveland) rose from 10.2 in 1958 to 12.5 per 100,000 populations in 1974 (23 per cent increase) with the greatest rise among nonwhite males (from 5.9 to 13.1, or 122 per cent). Increased rates were observed in both the city (19 per cent increase) and suburbs (35 per cent increase). Rates increased among young non-white and white adults of both sexes aged 15--34 years, but decreased slightly among adults aged 65 years and older. These findings are consistent with national trends. Alcohol was present in the blood of one-fourth of the individuals who were "dead on arrival," and at intoxicating levels in 20 per cent. There were increasing percentages of victims with positive blood alcohol and with intoxicating levels during the study period. White male victims in the city had significantly higher frequencies of such findings than their counterparts in the suburbs. The rates of suicide committed by firearms rose among all race-sex groups, with the greatest increase among city nonwhite males (2.1 to 7.7, or 267 per cent). Suicide by chemical agents (roughly one-half being barbiturates) increased in all groups except city nonwhite males, with the greatest increase among white males and suburban white females. Firearms among males and poisoning among females displaced asphyxia as the leading modes of suicide.

Violent death in a metropolitan county. Changing patterns in homicide (1958-74).

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Normal glucagon response to arginine infusion in "prediabetic" Pima Indians.

To determine whether abnormalities in glucagon secretion might precede the onset of hyperglycemia in diabetes mellitus, 32 prediabetic Pima (American) Indians, 27 normal Pima Indians and 34 normal Caucasians received an infusion of arginine monochloride (5 mg/kg/min for 40 minutes) with measurement of glucose, insulin, and glucagon. [Prediabetes is the period between conception and the development of diabetes. In most studies the term is used to characterize patients who on genetic grounds are believed to be at high risk of developing the disease, including the normoglycemic monozygotic co-twin of a diabetic or the normoglycemic offspring of two diabetic parents. The latter definition is used in the present study recognizing that in the final analysis the true prediabetic can be identified only in retrospect after the development of diabetes.] The three groups had similar mean fasting glucagon levels. During arginine infusion, the prediabetic Indians reached a mean maximum glucagon level of 315 +/- 14 pg/ml (mean +/- 1 SEM) compared with 294 +/- 20 pg/ml in the normal Indians and 292 +/- 25 pg/ml in the normal Caucasians. The calculated mean areas above baseline under the glucagon curves were 5704 +/- 324 pg-min/ml in the prediabetics, 5189 +/- 446 pg-min/ml in the normal Indians, and 4239 +/- 613 pg/min/ml in the normal Caucasians. The differences among the groups in these variables were not statistically significant. Thus, arginine induced hyperglucagonemia could not be identified as a characteristic of the prediabetic state in Pima Indians.

Arginine-stimulated hyperglucagonemia in diabetic Pima Indians.

Groups of 27 nondiabetic Pima Indians, 34 nondiabetic Caucasians, and 12 diabetic Pima Indians with recent onset of their disease received an arginine infusion to determine if (1) nondiabetic Pima Indians and Caucasians had a similar glucagon response to arginine and (2) diabetic Pimas had excessive glucagon response to arginine as reported in other racial groups. The fasting glucagon levels in the three groups were not significantly different. During arginine monochloride infusion (5 mg./kg./minute for 40 minutes) the diabetic Pimas had glucagon levels significantly higher at 10 minutes and at all sampling points thereafter than the normo-glycemic Pimas. Plasma insulin levels also increased during the infusion but, notably, never differed significantly between these two groups. There was no significant difference in the glucagon levels at any sampling point between the nondiabetic Pimas and Caucasians. The differences in glucagon levels between the nondiabetic and diabetic Indians are similar to those differences reported between diabetic and nondiabetic subjects of other racial origins.

Comparison of the value of the two- and one-hour glucose levels of the oral GTT in the diagnosis of diabetes in Pima Indians.

In many population and screening studies of diabetes, the one-hour glucose level of the GTT has been used to define the diabetic status of subjects. The one-hour postglucose load determination has been preferred over the two-hour value by many investigators primarily because of convenience and justified on the basis of the high correlation between the two values. Venous plasma glucose levels, one and two hours after 75-gm. carbohydrate load, were determined on over 1600 Pima Indians. In most sex and age groups, the frequency distributions of both the one-hour and two-hour glucose levels were clearly bimodal. By the logarithms of the glucose values these distributions were consistent with a model of two overlapping Gaussian distributions. The data indicate that for the Pima the amount of overlap of the distributions was greater for the one-hour than for the two-hour values. For each sex and decade the probabilities of misclassification of a normal as "hyperglycemic" and vice versa were smaller for the two-hour than for the one-hour values. Such misclassifications for the two-hour levels averaged 6.6 per cent and 11.6 per cent for the one-hour levels. The reproducivility of the GTT taken one to three weeks apart in a sample of ninety-nine Pima Indians showed that the two-hour level was superior to the one-hour level as measured by the mean values of the absolute difference between log GTT levels for test and retest values. The one-hour measurements also gave more disagreements between the classifications of diabetic status than the two-hour test values. If a single measure of glucose tolerance is to be selected for the diagnosis of diabetes among Pima Indians, these data provide a mathematical rationale for preferring the two-hour level to the one-hour determination.

Hyperinsulinemia and hypoinsulinemai. Insulin responses to oral carbohydrate over a wide spectrum of glucose tolerance.

Oral glucose tolerance tests using a 75 gm. carbohydrate load were performed on 396 Pima Indians. Subjects were divided into groups on the basis of two-hour plasma glucose levels and the patterns of insulin response examined. Two-hour insulin levels were highest in the group with two-hour plasma glucose levels between 140-169 mg,/100 ml. and then fell progressively until levels about 400 mg./100 ml. were reached. Half and one-hour insulin levels showed little change in the groups with two-hour glucose levels up to 170 mg,/100 ml., but at higher glucose levels these insulin levels also progressively diminished. Fasting insulin levels were relatively unchanged over the entire range of glucose inintolerance. Obesity was the most important factor influencing the fasting insulin levels. Glucose level was the major determinant of post-load insulin responses, but these were also significantly influenced by obesity. No effect of age or sex on insulin levels was demonstrated. Comparison with other published data indicated that different interpretations of insulin response in subjects with "mild diabetes" have resulted from comparisons of groups with different degrees of glucose tolerance.

Accidental firearm fatalities in a metropolitan county (1958-1973).

A study of accidental firearm fatalities in Cuyahoga Count, Ohio, (Metropolitan Cleveland) from 1958-1973, inclusive, has shown a threefold increase in the rate of such deaths since1967. They are more frequent in the central city than in the suburbs, show a male preponderance, are more common in nonwhites, have a peak prevalence in the 25-34-year age range and usually happen in the home. Approximately half of the adult victims had been drinking alcoholic beverages when shot. It is hypothesized that the frequency of accidental firearm fatalities is primarily related to the number of guns, particulary handguns, in civilian possession. The data indicate that a loaded firearm in the home is more likely to cause an accidental death than to be used as a lethal weapon against and intruder.