RESUMO
The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U. S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.
Assuntos
Suicídio/estatística & dados numéricos , Adolescente , Causas de Morte , Criança , Intervenção em Crise , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , New Mexico/epidemiologia , Prevenção do SuicídioRESUMO
Suicide is among the leading causes of death in the United States, and in women the second leading cause of injury death overall. Previous studies have suggested links between intimate partner violence and suicide in women. We examined female suicide deaths to identify and describe associated risk factors. We reviewed all reports from the New Mexico Office of the Medical Investigator for female suicide deaths occurring in New Mexico from 1990 to 1994. Information abstracted included demographics, mechanism of death, presence of alcohol/drugs, clinical depression, intimate partner violence, health problems, and other variables. Annual rates were calculated based on the 1990 census. The New Mexico female suicide death rate was 8.2/100,000 persons per year (n = 313), nearly twice the U.S. rate of 4.5/100,000. Non-Hispanic whites were overrepresented compared to Hispanics and American Indians. Decedents ranged in age from 14 to 93 years (median = 43 years). Firearms accounted for 45.7% of the suicide deaths, followed by ingested poisons (29.1%), hanging (10.5%), other (7.7%), and inhaled poisons (7.0%). Intimate partner violence was documented in 5.1% of female suicide deaths; in an additional 22.1% of cases, a male intimate partner fought with or separated from the decedent immediately preceding the suicide. Nearly two-thirds (65.5%) of the decedents had alcohol or drugs present in their blood at autopsy. Among decedents who had alcohol present (34.5%), blood alcohol levels were far higher among American Indians compared to Hispanics and non-Hispanic Whites (p = .01). Interpersonal conflict was documented in over 25% of cases, indicating that studies of the mortality of intimate partner violence should include victims of both suicide and homicide deaths to fully characterize the mortality patterns of intimate partner violence.
Assuntos
Alcoolismo/psicologia , Armas de Fogo , Relações Interpessoais , Suicídio/estatística & dados numéricos , Violência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologiaRESUMO
OBJECTIVE: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data. METHODS: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978-1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults. RESULTS: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased. CONCLUSIONS: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.
Assuntos
Ferimentos por Arma de Fogo/epidemiologia , Ferimentos Perfurantes/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Intervalos de Confiança , Serviço Hospitalar de Emergência , Feminino , Armas de Fogo/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Estudos Retrospectivos , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Ferimentos Perfurantes/mortalidadeRESUMO
To compare the epidemiology of farm with non-farm occupational injury deaths, we reviewed state medical examiner data for all occupational injury deaths in New Mexico from 1980 to 1991. We identified 53 farm-related injury deaths for a rate of 21.3 per 100,000 worker-years. Farm workers were four times more likely than non-farm workers to die from occupational injury. American Indians had the highest farm injury death rate. Farm decedents were older than non-farm decedents (t498 = 6.29, p < 0.0001). Half of the farm decedents were 50 years of age or older; one-third were 60 years of age or older. Crush injuries accounted for half of all farm injury deaths including 18 of 23 motor vehicle deaths, half of these involving a tractor rollover. One in six farm injury deaths were from electrocution: one in five involved alcohol. Our study indicates that New Mexico has high farm-related injury mortality related to tractor use, alcohol intoxication, farm animals, and exposure to electricity. American Indians and older males are especially susceptible to these factors.
Assuntos
Acidentes de Trabalho/mortalidade , Agricultura/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Acidentes de Trabalho/prevenção & controle , Adolescente , Adulto , Idoso , Causas de Morte , Estudos Transversais , Feminino , Humanos , Incidência , Indígenas Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Fatores de Risco , Ferimentos e Lesões/prevenção & controleRESUMO
STUDY OBJECTIVE: To define the contribution of domestic violence (DV) to homicides in women in New Mexico and to examine differences in ethnicity, mechanism, previous documented injuries, incidence of sexual assault, and use of alcohol or illicit drugs between DV- and non-DV-related homicides. METHODS: We carried out a retrospective analysis of reports of the state office of the medical investigator (OMI) reports from all female homicides from 1990 to 1993 in New Mexico. A homicide was defined as being related to DV if the perpetrator was a current or former male intimate partner. The chi-squared and Mann-Whitney tests were used to analyze data. RESULTS: The OMI investigated 134 homicides in women for an overall fatality rate of 4.3 per 100,000. A male intimate partner was the perpetrator in 62 cases (46%). The rate of DV homicide among American Indians (4.9 per 100,000) was significantly higher than that among Hispanics (1.7) and non-Hispanic whites (1.8)(RR=2.8; 95% confidence interval (CI), 1.5 to 5.1). Firearms were almost two times as likely to be used in DV homicides as in non-DV homicides (RR=1.8; 95% CI, 1.2 to 2.6). Evidence of old injuries was found more often in DV homicide cases (35.5%) than in non-DV cases (83%) (RR=4.3; 95% CI, 1.8 to 9.8). The presence of alcohol or other drugs was higher among non-DV homicide victims (69%) than DV homicide victims (54.3%) (P=.03). CONCLUSION: American Indian women are at particularly high risk of homicide, including DV homicide. Firearms were overrepresented in DV homicides, suggesting that removing firearms from the homes of previous DV perpetrators would be a useful public health strategy. Alcohol or illicit drugs were found in approximately two thirds of New Mexico women who were victims of homicide. The high prevalence of history of previous injuries among DV homicide victims indicates that early identification of DV victims in the emergency department and other health care settings is an important point of intervention.
Assuntos
Violência Doméstica/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Violência Doméstica/etnologia , Feminino , Homicídio/etnologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Mortalidade , New Mexico/epidemiologia , Estudos RetrospectivosRESUMO
STUDY OBJECTIVE: To examine specific risks for occupational injury deaths in New Mexico. DESIGN: Retrospective review of state medical investigator reports from 1980 through 1991 with regard to industry, agent of death, gender, ethnicity, location, and alcohol and other drug involvement. PARTICIPANTS: New Mexico residents who were fatally injured while on the job. RESULTS: We identified 613 deaths: 87.1% unintentional, 10.6% homicides, and 2.3% suicides. Industries with the most fatalities were construction (11.8%), oil/gas (10.6%), and farming (8.6%). The primary agents of death were motor vehicles (41.7%), firearms (10.1%), and falling objects (10.0%). Almost all (95.6%) of the decedents were male. However, females were overrepresented among homicide deaths (P < .0001). Most unintentional injuries occurred in rural areas (69.1%), whereas most homicides (73.4%) and suicides (71.4%) occurred in urban areas. Drug or alcohol use was evident in 19.4% of cases. CONCLUSION: New Mexico has a high rate of occupational injury death, which appears to be associated with rural location and use of motor vehicles and alcohol.
Assuntos
Acidentes de Trabalho/mortalidade , Ocupações , Ferimentos e Lesões/mortalidade , Acidentes de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Feminino , Homicídio/estatística & dados numéricos , Humanos , Indígenas Norte-Americanos , Masculino , Pessoa de Meia-Idade , Veículos Automotores , New Mexico/epidemiologia , Estudos Retrospectivos , Fatores de Risco , População Rural , Fatores Sexuais , Transtornos Relacionados ao Uso de SubstânciasRESUMO
Hantavirus infection with respiratory involvement is a new clinical entity. The respiratory and cardiovascular abnormalities associated with hantavirus infection define the hantavirus pulmonary syndrome (HPS). We present two cases of HPS and discuss the presentation, epidemiology, emergency department management, and differential diagnosis. Treatment of HPS involves intensive care monitoring, airway management, and cardiovascular support. Because human hantavirus infection with respiratory involvement has been recognized recently in all geographic regions of the United States, it is important for emergency physicians to recognize this syndrome's characteristic symptoms and laboratory abnormalities. The fulminant clinical course of HPS and its 65% mortality rate underscore the importance of early recognition if potentially life-saving interventions are to be initiated.
Assuntos
Algoritmos , Infecções por Bunyaviridae/diagnóstico , Infecções por Bunyaviridae/terapia , Indígenas Norte-Americanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Orthohantavírus , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Doença Aguda , Adulto , Infecções por Bunyaviridae/classificação , Infecções por Bunyaviridae/epidemiologia , Cuidados Críticos/métodos , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Humanos , Pneumopatias/classificação , Pneumopatias/epidemiologia , México/epidemiologia , Monitorização Fisiológica , Gravidez , Complicações Infecciosas na Gravidez/classificação , Complicações Infecciosas na Gravidez/epidemiologia , Índice de Gravidade de Doença , SíndromeRESUMO
STUDY OBJECTIVE: To determine if the mechanism of fatal childhood pedestrian injuries correlated with location, injury pattern, and age of the pedestrian and to determine ethnic differences in fatality rates. DESIGN: Retrospective review of state medical investigator reports and autopsies from 1986 to 1990. Logistic regression and chi 2 were used to test for statistically significant differences between the groups in our data set. TYPE OF PARTICIPANTS: New Mexican children, 0 to 14 years old fatally injured by moving vehicles. RESULTS: Sixty-four children died for an overall fatality rate of 3.8 (per 100,000). Native American children and children younger than 5 years experienced the highest fatality rates. Children younger than 5 years were more likely to be crushed under the wheels of a slow-moving vehicle in both a nontraffic and a traffic location, whereas older children were found more often to have died from injuries from a high-speed impact event in a traffic location (P < .001). Leg fractures (P = .001) and spinal fractures (P = .02) occurred more frequently in impact than crush injuries. CONCLUSION: Young children are at risk for a crush injury in both the traffic and nontraffic environment.
Assuntos
Acidentes de Trânsito/mortalidade , Ferimentos e Lesões/mortalidade , Adolescente , Fatores Etários , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Etnicidade , Feminino , Humanos , Lactente , Masculino , Grupos Minoritários , New Mexico/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Ferimentos e Lesões/etnologiaRESUMO
STUDY OBJECTIVE: To explore the relationship between social conditions and fire mortality rates among children. DESIGN: Retrospective analysis of fire fatalities in children 0 to 14 years old in New Mexico. SETTING: State Office of the Medical Investigator. TYPE OF PARTICIPANTS: All 57 New Mexico children 0 to 14 years old who died from fire-related injuries from 1981 through 1991. INTERVENTIONS: Medical investigator and autopsy records were reviewed and abstracted. Demographic and housing figures were obtained from US Census reports. Data were analyzed by chi 2 or by Fisher's exact test, with Bonferroni correction for multiple comparisons. RESULTS: Two thirds of decedents were male (P = .0014), and three fourths were less than 5 years old (P < .0001). Children living in mobile homes had triple the mortality rate of those in houses or apartments, and children in homes without plumbing (substandard) had more than ten times the mortality rate of those in houses or apartments (P < .0001). Two thirds of the victims in substandard homes were Native American (P < .0001). Errors or negligence of adults occurred in more than half of the deaths. Eighty-two percent of decedents died at the scene; only 11% reached a burn center. CONCLUSION: Substandard homes are associated with an increased fire mortality rate among children. Strategies to prevent childhood fire fatalities should address housing conditions and adult safety practices. Enhanced prehospital or burn unit care is unlikely to greatly affect childhood fire mortality rates.
Assuntos
Queimaduras/mortalidade , Incêndios/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Adolescente , Queimaduras/etnologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Etnicidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , New Mexico/epidemiologia , Estudos Retrospectivos , População Rural , Fatores SocioeconômicosRESUMO
STUDY OBJECTIVE: To determine the relationship among helmet use, alcohol use, and ethnicity in people killed on motorcycles. DESIGN: Retrospective review of all motorcycle fatalities in New Mexico from 1984 through 1988. SETTING: Office of the Medical Investigator, State of New Mexico. TYPE OF PARTICIPANTS: All decedents of motorcycle crashes in New Mexico from 1984 through 1988. INTERVENTIONS: Review of all autopsies, medical investigator reports, traffic fatality reports, and toxicological studies on fatally injured motorcyclists. RESULTS: Nine of the helmeted drivers (18%) were legally intoxicated compared with 67 of the nonhelmeted drivers (51%) (chi 2 = 15.7, P less than .0001); 42 of the white nonHispanic decedents (37%), ten of Hispanic decedents (12%), and none of the Native-American decedents were wearing helmets. The head and neck region was the most severely injured body region in 42 of the nonhelmeted cases (84%) and in eight of the helmeted cases (50%) (Fisher's exact test, P less than .02). CONCLUSION: There is an association between nonuse of helmets and alcohol intoxication in fatally injured motorcyclists in New Mexico. Strategies for preventing motorcycle fatalities should address alcohol abuse and ethnicity in conjunction with helmet use.
Assuntos
Acidentes de Trânsito/mortalidade , Intoxicação Alcoólica/complicações , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Escala Resumida de Ferimentos , Acidentes de Trânsito/prevenção & controle , Adolescente , Adulto , Idoso , Intoxicação Alcoólica/sangue , Intoxicação Alcoólica/etnologia , Causas de Morte , Criança , Etanol/sangue , Feminino , Custos de Cuidados de Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , Indígenas Norte-Americanos/estatística & dados numéricos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Estudos Retrospectivos , Fatores de Risco , População Branca/estatística & dados numéricosRESUMO
STUDY HYPOTHESIS: Risk factors associated with unintentional gunshot fatalities among children include gender and race of the decedent, type of firearm used, and whether loaded guns are stored within the home. STUDY POPULATION: All New Mexico children 0 to 14 years old unintentionally killed by a firearm between 1984 and 1988. METHODS: The New Mexico Office of the Medical Investigator master mortality file was reviewed retrospectively to identify all unintentional firearm fatalities occurring in New Mexico children during a five-year period. Medical investigator, autopsy, and police reports were analyzed to identify epidemiologic factors associated with these deaths. Chi-square and Fisher's exact tests were used to analyze the data. RESULTS: Twenty-five unintentional firearm fatalities were identified. These deaths occurred most frequently among children playing with loaded firearms found within the home. A disproportionate number involved handguns. CONCLUSIONS: The study results provide a basis for preventive strategies that limit accessibility or decrease lethality of loaded firearms within the home.
Assuntos
Acidentes/mortalidade , Ferimentos por Arma de Fogo/mortalidade , Prevenção de Acidentes , Adolescente , Criança , Pré-Escolar , Feminino , Armas de Fogo/legislação & jurisprudência , Armas de Fogo/estatística & dados numéricos , Humanos , Lactente , Masculino , New Mexico/epidemiologiaRESUMO
Compression of the chest causing facial petechiae, violaceous facial hue, subconjunctival hemorrhages, and frequent mental status abnormalities has been termed traumatic asphyxia. We identified 35 such cases occurring in the State of New Mexico from 1980 to 1985 from records of the Office of the Medical Investigator (n = 30) and from cases presenting to the University of New Mexico Trauma Center (n = 5). Among those found at highest risk for traumatic asphyxia were people ejected from motor vehicles, men working under cars that were inadequately supported and fell onto the victims, children under the age of 5 years who were crushed under household furniture, and people involved in construction activities. Traumatic asphyxia following a moving motor vehicle accident was significantly associated with alcohol ingestion (p less than 0.001). Preventive and therapeutic strategies should focus on the groups and events identified.
Assuntos
Asfixia/epidemiologia , Traumatismos Torácicos/epidemiologia , Acidentes , Acidentes de Trânsito/prevenção & controle , Adolescente , Adulto , Asfixia/etiologia , Asfixia/prevenção & controle , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , New Mexico , Traumatismos Torácicos/complicaçõesRESUMO
On February 2, 1980, a riot broke out among the 1,157 inmates at the New Mexico State Penitentiary and 139 people were injured. Of these, 33 died. Survivors had a variety of problems resulting from blunt or penetrating trauma, acute intoxication with drugs, or smoke inhalation. Fourteen percent of the casualties arrived at local hospitals in serious or critical condition. A study of the injury patterns revealed a significant difference (P less than .001) in the incidence of severe head trauma in those who had died compared to those who survived. Most of the seriously or critically ill survivors suffered from acute poisoning or from penetrating wounds.