The epidemic of gang-related homicides in Los Angeles County from 1979 through 1994

OBJECTIVE: To determine trends in gang homicides and the population at greatest risk for homicide by reviewing all gang-related homicides in Los Angeles County, California, from January 1979 to December 1994. DESIGN: Homicide files of the Los Angeles Police Department and the Los Angeles County Sheriff's Department from 1979 to 1994 involving violent street gang activity were reviewed. Gang files were reviewed for demographic data, weapons used, homicides by drive-by shootings, and times and geographic areas of occurrence. SETTING: Los Angeles County from January 1, 1979, to December 31, 1994. MAIN OUTCOME MEASURES: Age, race, and sex of gang-related homicide victims; frequency of weapon use; and the change in gang-related homicide rates during the study period. RESULTS: A total of 7288 gang-related homicides occurred in Los Angeles County from 1979 through 1994; 5541 of these homicides occurred in Los Angeles Police Department and Los Angeles County Sheriff's Department jurisdictions. During the study period, the proportion of all homicides that were gang related increased from 18.1% to 43.0% (P < .001). Of the 5541 gang-related homicide victims, 4580 (85.6%) were aged 15 to 34 years, 93.3% were African American or Hispanic, 5157 (93.2%) were male, 3559 (64.2%) were gang members, and 1408 (25.4%) occurred during drive-by shootings. Firearms were used in an increasing proportion of homicides, from 71.4% in 1979 to 94.5% in 1994. Homicides by semiautomatic handguns dramatically increased during the study period. Gang-related homicide rates for African-American males aged 15 to 19 years increased from 60.50 per 100,000 population per year in 1979 to 1981 to 192.41 per 100,000 population per year in 1989 to 1991. CONCLUSIONS: Gang-related homicides in Los Angeles County have reached epidemic proportions and are a major public health problem. To prevent gang violence, the root causes of violent street gang formation must be alleviated, the cycle of violent street gang involvement must be broken, and access to firearms must be limited.     

Sj?gren''s syndrome with acute renal failure

STUDY OBJECTIVE: "Suicide by cop" is a term used by law enforcement officers to describe an incident in which a suicidal individual intentionally engages in life-threatening and criminal behavior with a lethal weapon or what appears to be a lethal weapon toward law enforcement officers or civilians to specifically provoke officers to shoot the suicidal individual in self-defense or to protect civilians. The objective of this study was to investigate the phenomenon that some individuals attempt or commit suicide by intentionally provoking law enforcement officers to shoot them. METHODS: We reviewed all files of officer-involved shootings investigated by the Los Angeles County Sheriff's Department from 1987 to 1997. Cases met the following criteria: (1) evidence of the individual's suicidal intent, (2) evidence they specifically wanted officers to shoot them, (3) evidence they possessed a lethal weapon or what appeared to be a lethal weapon, and (4) evidence they intentionally escalated the encounter and provoked officers to shoot them. RESULTS: Suicide by cop accounted for 11% (n=46) of all officer-involved shootings and 13% of all officer-involved justifiable homicides. Ages of suicidal individuals ranged from 18 to 54 years; 98% were male. Forty-eight percent of weapons possessed by suicidal individuals were firearms, 17% replica firearms. The median time from arrival of officers at the scene to the time of the shooting was 15 minutes with 70% of shootings occurring within 30 minutes of arrival of officers. Thirty-nine percent of cases involved domestic violence. Fifty-four percent of suicidal individuals sustained fatal gunshot wounds. All deaths were classified by the coroner as homicides, as opposed to suicides. CONCLUSION: Suicide by cop is an actual form of suicide. The most appropriate term for this phenomenon is law enforcement-forced-assisted suicide. Law enforcement agencies may be able to develop strategies for early recognition and handling of law enforcement-forced-assisted suicide (suicide by cop). Health care providers involved in the evaluation of potentially suicidal individuals and in the resuscitation of officer-involved shootings should be aware of law enforcement-forced-assisted suicide as a form of suicide.     

Extremity handgun injuries in children and adolescents

The majority of gunshot wounds in the urban pediatric population are inflicted by handguns. This study reviewed the trauma center management of 66 handgun injuries to the upper and lower extremities among 51 children who were aged < or =16 years. As expected, gunshot wounds were more frequent in adolescent males and were usually intentional. About half of the children had police records prior to the gunshot wounds. Fifty-two percent of the extremity handgun injuries resulted in fractures, most commonly to the tibia or forearm. Seventy-nine orthopedic procedures were recorded with an average hospital stay of 4.3 days. Permanent morbidity was undoubtedly underestimated due to poor long-term follow-up.     

Differential effects of normal aging on sources of standard N1, target N1 and target P300 auditory event-related brain potentials revealed by low resolution electromagnetic tomography (LORETA)

More teenagers in the United States die from gunshot wounds than from all natural causes of disease combined. Firearm-related mortality accounts for almost half of all deaths among African American teens. Residents of central cities have the highest probability of experiencing violent crimes. This article describes an innovative community-based intervention designed to break the cycle of violence among youth in metropolitan Atlanta. The intervention, Kids Alive and Loved (KAL), emerged from the African American community as one mother's response to the violent death of her 17-year-old son. The authors describe how her response to tragedy gave birth to a culturally appropriate intervention for youth exposed to violence. This article delineates the evolution of KAL, the role of community partners in the design of the intervention, and how diffusion of innovation theory has implications for understanding the KAL approach to breaking the cycle of violence.     

Gunshot injuries in the head-neck area--basic principles, diagnosis and management

Bullet wounds are a rare occurrence during times of peace. Recently, however, there has been a general increase in the number and severity of this type of trauma in our case load. First, the possible firearms and the individual types of ammunition will be discussed. Based on this background, the possible types of wounds are presented. Principally, one distinguishes ricocheting shots from grazing ones, and those leaving bullets lodged in the body from those with perforating wounds. The extent of tissue damage depends on internal lacerations, on the compression of the tissue and on the temporary cavitation along the projectile path. In contrast to other types of injuries, which are caused by a blow or impact to the face or skull, gunshot traumas are characterized by an irregular path, as well as, by localized destruction of bones with associated effects. In this connection, the severity of the bullet wound also depends upon the extent of involvement of the viscerocranium. As causes of gunshot wounds during times of peace, suicidal intent, the negligent handling of firearms and especially brutal crimes are those which come into consideration first and foremost. The diagnostic aspect of firearm wounds, beside anamnesis, comprises comprehensive X-ray diagnostics for a complete picture. From the therapeutic side, tetanus serum and antibiotics as a prophylactic are recommended initially. The operative treatment should take place depending on the injury with the removal of a possible projectile. Bullet wounds always require an interdisciplinary approach to treatment.     

Shotgun wounds in children. Not just accidents

OBJECTIVE: To characterize the demographic characteristics of shotgun wounds in children and adolescents across various regions within a state. DESIGN: Retrospective case study. SETTING: Accredited trauma centers in Pennsylvania. PATIENTS: All patients less than 18 years old who sustained shotgun wounds. DATA COLLECTION: Patient data were collected from the Pennsylvania Trauma Systems Foundation statewide trauma registry for January 1987 through December 1994. Data reviewed included age, race, sex, region, nature of injury, assailant, location of incident, length of stay in the hospital and intensive care unit, Injury Severity Score, organs injured, death, and discharge disposition. RESULTS: Over 8 years there were 95 shotgun wounds in patients with a mean +/- SD age of 14.0 +/- 3.7 years; the male-to-female ratio was 5.8:1. The incidence of shotgun wounds in urban areas increased threefold during the second half of the study; the incidence in nonurban regions was unchanged. Eighteen deaths (19%) occurred, 17 (94%) within 24 hours and 10 (56%) because of intracranial injury. Overall, unintentional shotgun wounds were most common (n = 46 [48%]), followed by assaults (n = 37 [39%]) and suicides (n = 8 [8%]). The highest per capita incidence of shotgun wounds occurred in urban areas, typically the result of an assault (n = 30 [73%]). In nonurban areas, shotgun wounds were usually unintentional (n = 36 [67%]); 34 (63%) occurred in the home. In contrast, in urban areas, 26 shotgun wounds (63%) occurred on the street. Overall, 14 fatal shotgun wounds (78%) occurred in the home. Operative intervention was required for 57 patients (60%). Ultimately, 67 patients (71%) were discharged to home. CONCLUSIONS: In urban areas, shotgun wounds are increasing in incidence, often occur on the street, and often result from assault. In nonurban areas, shotgun wounds are usually unintentional, often occur in the home, and are more often lethal than shotgun wounds in urban areas. Multiple-organ injury, surgery, and lengthy hospital stays are common.     

Successful salvage using mismatched umbilical cord blood transplant in an adult with recurrent acute myelogenous leukemia failing autologous peripheral blood progenitor cell transplant: a case history and review

OBJECTIVE: To investigate the relationship between asthma and obesity in children and adolescents. DESIGN: Medical record review. SETTING: Urban community health center. PARTICIPANTS: One hundred seventy-one children aged 4 to 16 years, 85 with asthma and 86 nonasthmatic controls. MAIN OUTCOME MEASURES: Diagnosis of asthma, age, and sex-adjusted body mass index (weight in kilograms divided by the square of the height in meters). RESULTS: Seventy-eight percent of the sample was Hispanic, 17% was African American, 2% were white, and 3% were other minorities. There were significantly more children with asthma (30.6%) who were very obese (> or =95th body mass index percentile) compared with controls (11.6%) (P=.004). Children with asthma were also significantly more overweight than controls (mean+/-SD, 22.5%+/-28.3% vs 12.0%+/-19.6% overweight; P=.004). The difference in obesity between children with asthma and controls was significant for both sexes and across the 4.5 to 10.9 years and 11 to 16 years age groups. Asthma severity was not related to obesity. CONCLUSION: Asthma is a risk factor for obesity in children and adolescents.     

Gunshot fatalities in Stockholm, Sweden with special reference to the use of illegal weapons

During the years 1980-1992 the Swedish legislation regarding possession and use of firearms has remained fairly unchanged. Simultaneously the reported incidence of both stolen firearms and confiscation of illegally possessed handguns has increased significantly. In order to determine the impact of this trend on gunshot mortality, all victims of firearm fatalities subjected to medicolegal autopsy in the Stockholm area 1980-81 and 1990-91 were studied. The overall two-year rate increased from 50 to 65, homicides and suicides contributing seven new cases each; accidents and "not determined" comprising only 0 to 2 cases in each period. Suicides were four times as common as homicides in the former period; ca. three times as common in the latter. Thus, a 70% increase in homicidal shooting has occurred (from 10 to 17), and the fatal use of illegal firearms increased from 50% to 93%. As expected, there was a definite male dominance (96%) among perpetrators as well as among victims (85%). Concerning suicides, the rate in the latter period was 18% above that in the former; illegal guns were used in 30% in 1990-91 as compared to 20% 1980-81. The pattern of wounding in suicides was similar to that reported in earlier studies; confirming that entrance wounds in the back, extremities and lower abdomen are indicative of homicide. Thus, common sense knowledge of firearm fatalities are confirmed: More widespread access to illegal weapons conveys a higher rate of gunshot fatalities. The perpetrator is likely to be male. Suicidal shots are usually aimed at the head (mouth, temple, forehead) or precordium. Most gunshot suicides are committed by means of legally possessed firearms.     

Sleep timing and quantity in ecological and family context: A nationally representative time-diary study.

Associations between demographic characteristics, school schedules, activity choices, family functioning, and sleep behaviors were estimated using nationally representative time-diary data from 2,454 children (ages 5.5 to 11.9 years) and adolescents (ages 12.0 to 19.1 years). For weekdays, African American adolescents, Asian children, and those with earlier school start times and longer travel times to school reported fewer sleep hours. More time spent watching television (for children), doing homework (for adolescents), and engaging in religious activities predicted fewer hours, whereas a longer time spent on meals predicted greater hours of weekday sleep. For younger children, greater parental warmth predicted more hours of weekday sleep, whereas for adolescents, stricter household rules were protective. On weekends, African American adolescents and Hispanic children slept less, and there were strong effects of activity choices including time spent on television, computer and videogames, sports, religious activities, socializing, and employment. In accounting for age-related decreases in sleep hours from childhood to adolescence, earlier school start times, greater hours of homework, greater paid employment, less time spent on meals, and fewer household rules were all significant mediators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expression of vascular endothelial growth factor during the development of cardiac hypertrophy in spontaneously hypertensive rats

Specific features usually allow recognition of entrance and exit wounds in bones. Exits are often more irregular, and usually larger than entrances. The aim of this paper is to compare the size of 17 entrance and exit gunshot wounds from a series of 13 forensic cases. The results of this work confirm the usually accepted fact that exit wounds in bones tend to be larger than the entrances resulting from the same shot. In all but one case the exits were larger than the entrances in this study. Though the bullet loses velocity after penetrating, the ballistic behavior (deformation and instability of the projectile) explains this tendency.     

Caught in the crossfire: children, guns, and trauma

Violence, especially that related to the use of firearms, has become a leading cause of death in children in the United States. Providing physical and psychosocial care for the child with a gunshot wound is a nursing challenge. Nurses can and must play a major role in helping to prevent this public health problem.     

Prevention of Vibrio vulnificus infections. Assessment of regulatory educational strategies

CONTEXT: Vibrio vulnificus-related disease caused by eating contaminated raw oysters prompted California to implement regulatory educational initiatives in 1991. OBJECTIVE: To assess California guidelines and education efforts with regard to the prevention of V. vulnificus infections in Los Angeles County and to evaluate compliance with state regulations mandating posting of warning signs concerning risks of eating raw oysters. DESIGN: Review of epidemiologic investigations of V. vulnificus infections in Los Angeles County between 1993 and 1995; telephone interviews of patients or surrogates; and a survey of restaurants serving raw oysters in Los Angeles County. SETTING: General community. MAIN OUTCOME MEASURES: Prior warning of patients and posting of warning signs in restaurants. RESULTS: Recent cases of V. vulnificus infections in Los Angeles County suggest that a unique, vulnerable group (uninsured Hispanic men with viral or alcoholic liver disease) has not been reached through education efforts. Of a total of 11 cases, information regarding being warned about the hazard of eating raw shellfish was available for 8; of these, only 1 case was reported as having been warned, but he had misunderstood the preventive message. Warning signs were not posted adequately in more than 50% of restaurants surveyed and one third of these establishments had signs in English only. Warnings were never located on dining tables and rarely included in menus. CONCLUSION: A more effective strategy is required to prevent V.vulnificus infections in Los Angeles County.     

Gunshot wounds of the extremities in children

A ten-year review of gunshot trauma in Manitoba was prompted by an increasing incidence in gunshot trauma in children. Of 54 children treated from 1964 through 1973 60% sustained injury to one or more extremities. Fifteen children sustained long bone fractures, usually complete and often comminuted. All fractures united and there was only one instance of osteomyelitis. The major complication in gunshot wounds to the skeletally immature was limb length inequality secondary to epiphyseal plate injuries. This complication occurred in nine children. In three children there was in epiphyseal growth disturbance, even though the missile did not appear to pass through the plate but only in close proximity to it. Joint contractures secondary to skin loss and resulting subsequent skin contracture were also common. The amount of debridement required following gunshot trauma in children appears to be somewhat less than is recommended for similar injuries sustained by adults in time of war.     

Endoscopic management of subcutaneous gunshot wound with irrigation technique

The application of the endoscope to the treatment of gunshot wounds has never been reported to our knowledge, with the exception of the laparoscope and the sigmoidscope in abdominal gunshot wounds. We report a patient with a subcutaneous gunshot wound who was treated endoscopically using the irrigation technique. The patient was a 25-year-old man who had been shot in the upper arm. The bullet was found near the thoracic spine via radiograph. At surgery the endoscope was inserted into the wound and irrigation was started. Excellent views could be obtained by irrigation, and the endoscope was advanced along the path of the bullet. The bullet and several fragments were removed with two additional small incisions. The method described herein seems beneficial in that (1) it is less invasive than conventional surgical debridement with a long incision, (2) it may provide information helpful in diagnosing the condition and the location of the bullet and its path, and (3) saline irrigation may have a cleansing effect.     

Gunshot wounds to the mandible and midface: evaluation, treatment, and avoidance of complications

As American society becomes progressively violent, an ever-increasing number of gunshot wounds are being seen across the United States. Particularly challenging are injuries that involve the mandible and midface, not only because of problems with reconstructing bone and soft-tissue defects but also because of emergent problems with airway obstruction and neurovascular compromise. We present 40 cases of gunshot wounds to the mouth, mandible, and maxilla treated at Wake Forest University Medical Center during the past 7 years. The focus of this retrospective analysis is on emergency evaluation and treatment, complications encountered, and operative techniques used for reconstruction. Special emphasis is placed on recognizing and avoiding the complications of these injuries.     

Street children in Latin America

Worldwide, millions of children live on the streets. These children typically have access to neither health care nor education. Sometimes subjected to violence in the home before taking to the street, street children are seen by many as worthless, and many countries have used violent and punitive measures to eliminate them. New approaches have recently been implemented to return these children to society and their families. In the case of South America, children who are on the street are home-based and spend much of the day on the street, but have some family support and usually return home at night. Children of the street are street-based children who spend most days and nights on the street and are functionally without family support. Studies suggest that 80-90% of street children in Latin America have some contact with their families. Surveys also indicate that street children in Latin America are 8-17 years old, with 9 years old being the average age upon entering the street. Girls comprise 10-15% of street children and Black and mixed race children may be over-represented among street children in the region. Both published and unpublished research findings are used to shed light upon the status of street children in South America. The authors consider how many street children there may be, why there are street children, the problems they encounter, and what can be done to help them.     

Site of entrance wound and direction of bullet path in firearm fatalities as indicators of homicide versus suicide

In a retrospective study, 288 firearm deaths were analysed to identify factors indicating homicide. The cases were classified as suicides (213), homicides (54), accidents (14) and undetermined cases (7). A number of factors, related to the circumstances and the autopsy findings, were studied. Whereas 41% of the homicide victims were females, women only constituted 1.4% of the suicide victims. The mean age was 37 and 50 years among homicide and suicide victims, respectively. Most suicides were committed at or in the vicinity of the residence, whereas a majority of the homicides occurred elsewhere. The majority of the suicide victims had either left a suicide note or had medical records of previous psychiatric illness. In all groups, shotguns were the most frequent weapon used. Fifty-seven percent of the homicide victims, but only three percent of the suicide victims had sustained more than one gunshot wound. One-third of the homicide victims were shot at close range. Alcohol was present in one-third of both homicide and suicide victims. Whereas 38% of the homicidal gunshot wounds had their entrances at anatomical regions typical of suicide, the direction of the bullet path often differed from the directions recorded in suicides. Hence, in this material, an entrance wound in the right temple indicated suicide, but in combination with a direction back-to-front, the wound was more likely to be homicidal. This study suggests that an estimation of the direction of the internal bullet path should be conducted in firearm fatalities, and that this factor may assist in the determination of the manner of death.     

Penetrating chest injuries in children: a review of 94 cases

Ninety-four children with penetrating chest injuries were treated at Dicle University School of Medicine during a 6-year period. The mean age was 11.51 +/- 3.31 years, and the male:female ratio was 5.25:1. Forty-five had stab wounds, 27 had high-velocity gunshot wounds, 13 had low-velocity gunshot wounds, seven had a bomb (shrapnel) injury, one had a shotgun wound, and one had a horse bite. Sixty patients had isolated thoracic injuries, and 34 had associated injuries. The most common thoracic injury was hemothorax (28), followed by hemopneumothorax (25). Tube thoracostomy alone was sufficient in 79.8% of the patients (75 of 94). Thoracotomy was performed in 4.25% (4 of 94). In two of the five observed patients, delayed hemothorax developed. The mean duration of hospitalization was 5.13 +/- 1.93 days. The mean Injury Severity Score was 14.71 +/- 8.62. Prophylactic antibiotics were used in all patients. The morbidity rate was 8.51% (8 of 94). Only one death occurred after cervical tracheal repair. The study suggests that the majority of penetrating chest injuries in children can be treated successfully by tube thoracostomy alone or in conjunction with expectant observation.     

School-based disaster mental health services: Clinical, policy, and community challenges.

The consequences of Hurricane Katrina have far-reaching implications for the mental health system in the Gulf Coast region, with some of the most vulnerable survivors being children and adolescents. School-based services have been proposed as an ideal way to provide care; however, significant challenges remain in providing trauma-informed services in schools postdisaster. The authors discuss the consultation and training activities of the Los Angeles Unified School District Trauma Services Adaptation Center for Schools and Communities following Hurricane Katrina. Issues related to the dissemination of evidence-based treatment in schools following a disaster are discussed, as are the particular needs of providers and school staff and the importance of community collaboration in identifying ways to adapt implementation strategies for specific communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children in the streets of Brazil: drug use, crime, violence, and HIV risks

The presence of vast numbers of unsupervised and unprotected children is a phenomenon that is common throughout Latin America, and in few places are the street children more visible, and reviled, than in Brazil. Estimates of their numbers in Brazil have ranged from 7 to 17 million, but more informed assessments suggest that between 7 and 8 million children, ages 5 to 18, live and/or work on the streets of urban Brazil. Accounts of drug misuse among street youths in Brazil are commonplace. Numerous scientific studies and media stories have reported the widespread use of inhalants, marijuana and cocaine, and Valium among street children. Also common is the use of coca paste and Rohypnol. Risk of exposure to HIV is rapidly becoming an area of concern because of the large number of street youths engaging in unprotected sexual acts, both renumerated and nonrenumerated. Moreover, Brazil's street children are targets of fear. Because of their drug use, predatory crimes, and general unacceptability on urban thoroughfares, they are frequently the targets of local vigilante groups, drug gangs, and police "death squads." Although there have been many proposals and programs for addressing the problems of Brazilian street youth, it would appear that only minimal headway has been achieved.