A review of gunshot deaths in Strathclyde--1989 to 1998

Profile of unnatural mortalities in Northern part of Ghana; a forensic-based autopsy study

INTRODUCTION

Bereavement is usually difficult to come to terms with. However, sudden, violent or traumatic death can be particularly hard to accept for any family, group or nation as a whole. A retrospective study of all autopsies on unnatural and traumatic deaths of medico-legal importance was made at the Komfo Anokye Teaching Hospital from 2008 to 2016.

METHODS

Information on cause of death and other relevant detail as well as demographics were extracted from the Autopsy Log Book of the department of pathology, Komfo Anokye Teaching Hospital where data on cause of death from autopsy findings and other relevant data were gathered and kept secured. The data was then analyzed using SPSS version 22.

RESULTS

Findings from the study showed that Road Traffic Accidents (RTA) contributed to 58.51% of the total forensic death cases of a total of the 1470 registered unnatural deaths. Males accounted for 75.37% of deaths as compared to 24.63% for females. The mean age for the various cause of unnatural deaths was 34 years. The age ranges from a minimum of 0.02 year (1 week) to a maximum of 97 years with median age of 33. The modal age is 30 years with 75 cases. 1108 males and 362 females were involved, resulting in a gender ratio of 3:1. The age group 30-39 recorded the highest percentage of deaths due to Hanging, Gunshots, RTA and Falls with 22.45%, 34.69%, 21.75% and 25.44% respectively. Children aged ≤9 recorded the highest number of deaths due to chemical poisoning and drowning with 25.5 8% and 40.00% of cases respectively. People in the extremes of ages (≤9 and ≥ 70) recorded the least number of death cases by percentage.

CONCLUSION

Road traffic accident is therefore the leading cause of unnatural traumatic deaths as it accounted for more than half of all unnatural traumatic death cases reported in the forensics department. Men, especially the youth are also more prone to violent unnatural deaths compared to women in general. It is shown that, men die more in the various categories than women. Males are likely to die on the average, 3 times more than the females by any of the manner of deaths.

Alcohol Use and Firearm Violence

Although the misuse of firearms is necessary to the occurrence of firearm violence, there are other contributing factors beyond simply firearms themselves that might also be modified to prevent firearm violence. Alcohol is one such key modifiable factor. To explore this, we undertook a 40-year (1975-2014) systematic literature review with meta-analysis. One large group of studies showed that over one third of firearm violence decedents had acutely consumed alcohol and over one fourth had heavily consumed alcohol prior to their deaths. Another large group of studies showed that alcohol was significantly associated with firearm use as a suicide means. Two controlled studies showed that gun injury after drinking, especially heavy drinking, was statistically significant among self-inflicted firearm injury victims. A small group of studies investigated the intersection of alcohol and firearms laws and alcohol outlets and firearm violence. One of these controlled studies found that off-premise outlets selling takeout alcohol were significantly associated with firearm assault. Additional controlled, population-level risk factor and intervention studies, including randomized trials of which only 1 was identified, are needed. Policies that rezone off-premise alcohol outlets, proscribe blood alcohol levels and enhance penalties for carrying or using firearms while intoxicated, and consider prior drunk driving convictions as a more precise criterion for disqualifying persons from the purchase or possession of firearms deserve further study.

Suicide by firearms on the island of Crete: a 9-year record

BACKGROUND

Whereas firearm suicide mortality has been a longstanding public concern worldwide, in Greece no systematic analysis has been reported so far despite the recent evidence of a rising rate of gun ownership.

AIMS

To estimate the proportion of firearm suicides on the island of Crete, Southern Greece, well-known for its widespread gun ownership; to describe the victims' sociodemographic profile and firearm-related suicide variables; and to assess the severity of suicidal intention in the group.

METHODS

Records of suicides between 1999 and 2007 were reviewed and information was extracted into a computerized database. A rating of the circumstances section of the Beck's Suicide Intent Scale (SIS) for each case was also performed.

RESULTS

The firearm suicide rate was 1.3 per 100,000, with males constituting the vast majority. These men were more likely to be less than 55 years of age, to have lived in the western part of the island, to have some degree of planning prior to the suicidal act, and to have used a shotgun, but less likely to have left a note.

CONCLUSIONS

As an important first step toward implementing preventive initiatives the authors stress the need for a thorough look at the sociocultural factors associated with firearms in the region.

A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria

BACKGROUND

Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism.

METHOD

Patients admitted to the University of Calabar Teaching Hospital, Calabar with PAT from February 2005 to January 2008 were prospectively studied.

RESULTS

Seventy-nine patients presented with abdominal trauma, among which 39 (49%) were PAT. There were 37 males and two females, whose ages ranged from 5 to 54 years (mean 27.8 years). Stab wound (18; 46.1%) was the commonest injury, while gunshot wound (15; 38.5%) ranked second. Others were road traffic accident (two patients), fall, cow horn injury, shrapnel, and criminal abortion (a patient each). The commonest injury was evisceration of the omentum and small intestine, which occurred in 13 (36%) patients. Five (14%) patients suffered small intestinal perforations, while three (8%) had liver, splenic and colonic injuries, respectively. Others were rectal injury (four patients), mesenteric injury and perforated stomach (two patients each), and a patient with diaphragmatic injury. The outcome was fatal in two (5%) patients.

CONCLUSION

Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.

Police deaths in New York and London during the twentieth century

OBJECTIVES

To describe the incidences and causes of occupational police deaths in New York City in the United States and Greater London in the United Kingdom during the twentieth century. To assess the relation between overall societal violence and violence directed toward police officers in these metropolitan areas.

DESIGN AND SETTING

Ecological study of New York and London from 1900 through 1999.

MAIN OUTCOME MEASURES

Intentional and unintentional occupational police mortality rates for New York and London were estimated for each decade. The general population homicide rates of both New York and London were assessed for their correlation with their respective intentional occupational police mortality rates.

RESULTS

During the 20th century, 585 police officers in New York and 160 police officers in London died while participating in law enforcement activities. New York had markedly greater intentional police mortality rates compared to London throughout most of the 20th century, but these differences decreased significantly by the end of the century. Intentional gunshot wounds comprised 290 police deaths in New York, but only 14 police deaths in London. In New York, gun shot wounds (both intentional and unintentional) accounted for more occupational police deaths (51.6%) than did all other injury mechanisms combined. In London, motor vehicle collision was the most common cause (47.5%) of occupational police death. There were no apparent correlations between the general population homicide rates and intentional police mortality rates in either New York (r(2) = 0.05, 95% CI -0.77 to 0.81) or London (r(2) = 0.34, 95% CI -0.61 to 0.89).

CONCLUSIONS

During the 20th century, both intentional and unintentional occupational police mortality rates were significantly greater in New York compared to London. These differences are likely from several socioeconomic, cultural, and occupational factors. The declines in police deaths in New York during the latter part of the 20th century indicate that at least some measures taken by the New York Police Department have been successful at significantly reducing the incidence of both intentional and unintentional police deaths.

Firearm-related deaths in two industrial cities of Turkey and their province

We aimed to describe the characteristics of forensic autopsies of firearm-related deaths in two industrial cities of Turkey, in order to provide further data for the characterisation of firearm-related fatalities in Turkey, having the remarkable scarcity of such information from Turkey in mind. In the period from January 1999 until the end of 2003, 3463 autopsy records of the Morgue Departments of the Bursa and Kocaeli branch of the Turkish Council of Forensic Medicine were reviewed. Of the autopsies, 14.3% were firearm-related deaths. Of the cases, 17.8% were females and 82.2% were males. The median age was 34 for males and 25 for females. 51.3% were in the age group 21-40. The most frequent manner of death was homicide (62.2%). Both in suicides and in homicides, handgun weapons were the preferred weapons. 70.9% of the victims had a single entrance wound site and most common site was head (39.2%). In homicides 73.4% of the entrance wounds were caused by distant range shots. Death occurred in hospital and during the transfer to the hospital in 14.5% and 7.4% of the cases, respectively. The most common scene was outdoors in homicides (48.1%) and house in suicides (60.5%). Alcohol was found in 6.3% of the cases. It is obvious that private gun ownership should be strictly limited and the illegal availability should be prevented in order to decrease firearm-related deaths in Turkey.

A distant-range, suicidal shotgun wound of the back

The case being reported is one of a shotgun fatality with a thoracic back wound. A 23-year-old man was shot from a distance with trajectories going from back to front and on a nearly horizontal level. These findings observed in the autopsy could represent homicide, but scene investigation and police records were interpreted and it became clear that the case was suicide. Thus, this case shows that the determination of the manner of death requires a careful forensic investigation including autopsy findings, scene investigation, and reconstruction of the events.

Shotgun shooting in northern India--a review (1980-1999)

Central Forensic Science Laboratory (CFSL), Chandigarh undertakes the examination of the crime cases of some northern states of India. The shooting cases of last two decades (1980-1999) involving shotguns were analysed in this laboratory. This paper consists of the study of 360 actual cases of shotguns for evaluation of various parameters, such as type of firearm, number of firearm and firing, location of wound, age, occupation, sex and caste of accused and victim, etc. Out of 360 cases, 253 (70%) were classified as homicidal, 68 (19%) accidental, 11 (3%) suicidal, 9 (2.5%) hunting and 19 (5.5%) cases of insufficient information including the cases of illegal possession of firearm. Single Barrel Breech Loading (SBBL) gun 144 (40%) was preferred over Single Barrel Muzzle Loading (SBML) 109 (30.3%), Double Barrel Breech Loading (DBBL) 72 (20%) and Double Barrel Muzzle Loading (DBML) gun 35 (9.7%). All the breechloader guns were of 12 bore. Muzzleloader gun were recovered only from the remote rural areas. Three hundred and thirty-one (92%) cases involved single, 22 (6%) double and 7 (2%) more than two shotgun. Majority of cases were found of single firing 288 (80%), followed by double 29 (8%) and multi-firing 18 (5%). Eleven (3%) cases were of misfiring and in 14 (4%) cases information was not available. Accidental and suicidal cases had only one firing. The mean age for male and female victim was 31 and 24 years, respectively. Occupationally, agriculture is predominating over business, service and security guards for accused and for victim agriculture followed by service, business, student and security guards are in the descending order. Caste wise the most aggressive community of Kshatriyas is predominating as accused and victim over lower cast people. Head (64%) being a vital part was chosen most frequently for committing suicide followed by body (36%). Service personnel committed maximum number of suicide.

Gunshot suicides in England--a multicentre study based on coroners' records

BACKGROUND

Gunshot suicides account for 2.5% of suicides in England and Wales. This amounts to more than 100 deaths per year. Information about such deaths may assist in the development of suicide prevention strategies.

METHOD

We have examined coroners' inquest records for all gunshot suicides between 1st January 2000 and 31st December 2001 in 24 coroners' jurisdictions in England.

RESULTS

Fifty-eight gunshot suicides were identified, including one homicide-suicide. Ninety-three per cent of cases were male. Sport or occupational usage was the main reason for owning the gun. Ten per cent were farmers or farm-workers. In 20% of cases the gun did not belong to the individual who used it for suicide. This was more likely in younger suicides. Seven (12.1%) individuals used illegally owned handguns. Large amounts of alcohol had been consumed before the act in nine cases. Nearly three-quarters (72.9%) of individuals with diagnostic information had a probable diagnosis of depression. However, only 22.4% had ever had contact with psychiatric services. Two shotgun certificate holders were under the care of psychiatric services at the time of their death and two others had a history of previous self-harm.

CONCLUSIONS

Strategies to reduce the number of gunshot suicides need to focus on limiting access to guns. These include restricting access to guns by non-certificate holders and those who may be at increased risk of suicide, and holding regular gun amnesties.

Acute alcohol use and suicidal behavior: a review of the literature

BACKGROUND

Both acute and chronic use of alcohol are associated with suicidal behavior. However, the differing relationship of each component of alcohol use and possible causal mechanisms remain unclear.

METHODS

This article reviews and summarizes associations between acute alcohol consumption (with and without intoxication) and suicidal behavior (both completed suicide and suicide attempts) among adults 19 years and older, as presented in literature published between 1991 and 2001. Possible mechanisms and methodologic challenges for evaluating the association are also discussed. An application of a research design (the case-crossover study) that has the potential for addressing the effects of acute alcohol use over and above usual or chronic use is presented.

RESULTS

The majority of articles reviewed were restricted to descriptive studies that documented the prevalence of suicide completers or attempters who tested positive for alcohol use. A wide range of alcohol-positive cases were found for both completed suicide (10-69%) and suicide attempts (10-73%). Common methodologic limitations included the lack of control groups (for evaluating risk conferred by alcohol use), selection and ascertainment bias, and small sample sizes. The results of the case-crossover pilot study indicated substantially higher risk of suicide during or shortly after use of alcohol compared with alcohol-free periods.

CONCLUSIONS

Although there is a substantial literature of published studies on acute alcohol use and suicidal behavior, the majority of studies focus on completed suicide and report prevalence estimates. Findings from such studies are subject to several possible sources of bias and have not advanced our knowledge of mechanisms in the association between acute alcohol use and suicidal behavior. The case-crossover design may help to overcome some limitations of these studies and facilitate evaluation of associations and possible causal mechanisms by which acute alcohol use is linked to suicidal behavior.

Firearm-related mortality: a review of four hundred-forty four deaths in Diyarbakir, Turkey between 1996 and 2001

The current study is based on a retrospective investigation of firearm deaths in Diyarbakir, which were autopsied by the Diyarbakir Branch of the Council of Forensic Medicine during the 6- year period. Four hundred-forty four deaths were investigated from January 1996 through December 2001, including homicide (296 cases, 66.7%), suicide (120 cases, 27%) and accidental shootings (28 cases, 6.3%). The age range of all firearm deaths in the study period was 5 to 75 years with a median age of 29.8 years. The majority were in the groups aged 16-25 years (38.7%). In the homicide group, 248 subjects (83.8%) were male, and 48 (16.2%) were female. The 31.1% of the homicide victims were in the group aged at 20-30 years. Of the 120 suicide victims, 56 (46.7%) were in the group aged 16-20 years. The head was by far the favoured site, accounting for 82 (68.3%) deaths: entry wounds in the right temple accounted for 72 of these. Twenty-eight cases were accidental shootings and 18 of them were male (64.3%). Twelve of the 28 accidental victims (42.9%) were in the group aged 0-10 years. The eight cases were due to their own accidental shootings, and the remaining 20 cases were shot by others. Our findings show that the contributing factors for increasing death by firearm are terrorists' activities, traditional habits of obtaining and using guns and blood feuds.

Suicide by firearm, a unique pattern from Iran

Throughout the one-year period from March 21, 2002 to March 21, 2003, the Legal Medicine Organization of Iran in Tehran investigated 27 firearms suicides. The crude mortality rate from firearms suicides was about 0.21 per 100,000 (the rate of suicide in Tehran is around 9.8 per 100,000).All of the victims were young males. Military rifles were responsible for the majority of the suicides. The most common sites of entrance wounds were the submentum (37%) and chest (25.9%). In 84.6% of the cases gunshots were fired from contact or near contact range. With the exception of 1 of the suicides, all were committed at either garrisons or police stations. The unique pattern of suicides found in this series is discussed in the context of availability of method.

Firearm fatalities. A preliminary study report from Iran

During the one-year period from March 2002 to March 2003 there were 89 firearm fatalities investigated by the Legal Medicine Organization of Iran in Tehran. We determined the characteristics of these 89 firearm deaths which comprised 0.83% of all postmortem examinations. Of these, 60.7% were homicides, 30.3% suicides, 4.5% accidental, and 4.5% unclassifiable. Most victims were young male. Military rifles were responsible for almost all suicides, whereas in homicide handguns were the preferred weapons. The most common site of entrance wounds in suicides were the under the chin (37%) and chest (25.9%). In homicide group, 42.6% of entrance wounds were located in the head. The suicidal gunshots were fired from contact/near contact range in 84.6% while this was the case in only two cases of the homicides. All but one of the suicides were committed at the garrisons or police stations. The unique pattern of suicide that was found in this series was not similar to that reported in earlier studies. We believe our pattern of firearm fatalities must be in great part due to the Iran's strict gun control regulations and cultural background.