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This paper, as the third of the series, is devoted to gauge ammunition, which may be a problem in ballistic opinions. The paper reviews existing cartridges of the type used in smoothbore weapons (bullet cartridges, non-penetrating, compressed powder, flash-bang, signal, adapter-type, and training cartridges). The paper also presents homemade special cases of gauge ammunition, as well as ammunition used for "peculiar" purposes. The second part of the paper discusses other uses of specialty gauge ammunition, specifically its use as mortar ammunition, propelling charges, pyrotechnic tools, and to start combustion engines.

Background: Death threats are common in the therapist's office. Many therapists don't know how to handle these.
AIM: To provide background information and tools for the practitioner who receives a homicidal threat from a patient.
METHOD: A systematic literature review of the epidemiology, diagnostics, risk assessment and treatment of homicidal threats.
RESULTS: During consultation, a death threat is not equatable with the announcement of murder. There are far more instances where the patient does not follow through with their threat. A psychotic disorder, an antisocial personality disorder, alcohol abuse, (bipolar) depression, long-existing (severe) domestic violence, possession of a weapon or a previous conviction for a death threat are important risk increasing factors. The risk assessment evaluates the motives and the proclivity to act. emdr and aggression regulation therapy appear to be effective treatments for underlying trauma and anger. However, psycho-dynamic aspects and feelings of countertransference should also be taken into account during therapy. Three Dutch guidelines about professional secrecy are important when making an assessment about whether or not one should break the rules of confidentiality.
CONCLUSION: Any practitioner who may be faced with a homicidal patient should have ready access to the relevant guidelines. Mental health institutions are encouraged to actively support this process.

Background: Gun buyback programs aim to remove unwanted firearms from the community with the goal of preventing firearm injury and death. Buyback programs are held in many communities, but evidence demonstrating their effectiveness is lacking. The purpose of this study is to compare firearms collected at buyback events to crime guns and firearms used in homicides and suicides., Methods: Detailed firearm and case data were obtained from the Hartford Police Department and the Office of the Chief Medical Examiner from January through December of 2015. Information was reviewed for guns collected at buyback events, crime guns confiscated by police, and for weapons associated with firearm fatalities. Detailed firearm data included type, manufacturer, model, and caliber (small, ≤ 0.32 caliber; medium, 0.357 caliber to 9 mm; large, ≥ 0.40 caliber). χ analyses were used for comparisons between groups., Results: In 2015, 224 crime guns were seized by the Hartford Police, 169 guns were collected at four community buyback events, and there were 187 firearm-related deaths statewide (105 suicides, 81 homicides, 1 legal intervention). Comparisons between buyback, crime, and fatality-related firearms are shown in the table below. Medium caliber handguns account for the majority of crime guns and fatalities, and buyback programs collected smaller caliber handguns. The demographics of individuals who turn in guns at buyback events and commit suicide are similar: age (buyback, 63 ± 11; suicide, 52 ± 18; homicide, 34 ± 12 years), sex (buyback, 81%; suicide, 91%; homicide, 84% men), and race (buyback, 80%; suicide, 97%; homicide, 47% white)., Conclusion: Handguns account for the majority of crime guns and firearm-related fatalities in Connecticut. Buyback programs are both an opportunity to remove unwanted handguns from the community and to remove firearms from the homes of individuals at increased risk of suicide., Level of Evidence: Epidemiologic/therapeutic study, level IV.

Handgun waiting periods are laws that impose a delay between the initiation of a purchase and final acquisition of a firearm. We show that waiting periods, which create a "cooling off" period among buyers, significantly reduce the incidence of gun violence. We estimate the impact of waiting periods on gun deaths, exploiting all changes to state-level policies in the Unites States since 1970. We find that waiting periods reduce gun homicides by roughly 17%. We provide further support for the causal impact of waiting periods on homicides by exploiting a natural experiment resulting from a federal law in 1994 that imposed a temporary waiting period on a subset of states., Competing Interests: The authors declare no conflict of interest., (Copyright © 2017 the Author(s). Published by PNAS.)

Many intimate partner homicide victims visit emergency departments (EDs) prior to their deaths, yet their lethality risk is not well understood. eHealth interventions for intimate partner violence (IPV) improve provider information, tailor care to victim need and link victims to services. We analyzed ED patients' lethality risk using one such intervention, Domestic Violence Report and Referral (DVRR). DVRR records were assessed for 263 female patients aged 16 and older seen for IPV at an urban, high-traffic, Northern California ED in 2014-15. Multiple linear regression was used to test the association of children's presence at home, pregnancy, age, and abuser-victim relationship with victim's lethality risk using the Danger Assessment (DA) score from the Lethality Risk Assessment for Intimate Partner Femicide. Differences in means were assessed using t- and F-tests. The mean DA score indicated high lethality risk, with a third of respondents (33.1%) reporting very high DA scores. Multiple linear regression models indicated that increasing victim age (β=0.20/year; 95% CI: 0.11-0.29), children's presence at home (β=2.61, 95% CI: 0.63-4.58), and perpetrator reported as dating partner (β=4.50, 95% CI: 1.62-7.38) or ex-partner (β=4.38, 95% CI: 1.10-7.66) were significantly associated with the DA score (p<0.05). Use of DA scores as ED risk assessment tools in response to IPV victimization could help hospital staff and IPV advocates direct resources toward highest-need patients, improving health outcomes without additional burden on hospitals. These results also foreground eHealth interventions' utility in linking providers and IPV advocates and reducing the risk of intimate partner homicide., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This text is a theoretical essay that discusses the concepts, types and scenarios of feminicides, and presents some proposals for the prevention of these premature, unjust and avoidable deaths. The text revisits the original concept of femicide proposed by Diana Russell and Jane Caputti and shows new and old scenarios where these crimes occur. It points to patriarchy, understood as being a hierarchical system of power between men and women, as one of the main determinants of these deaths. It ends by presenting actions and proposals to prevent and combat these gender crimes.

The Instabul Convention is a normative tool for the prevention of women's violence in Europe. Rome 5 Local Healthcare Authority has implemented a synergistic intervention model in joint ventures with all stakeholders and institutions involved: the Tivoli Model. This model provides a synergistic social, health, legal and training approach to prevent violence against women in a logic of preventing an avoidable mortality.

Importance: Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates., Objective: To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence., Design, Setting, and Participants: Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population., Exposures: Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity., Main Outcomes and Measures: Adolescent firearm homicide identified from police and medical examiner's reports., Results: We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2-14.0) or drug use (AOR, 4.4; 95% CI, 1.7-11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8-48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1-9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1-10.3 vs AOR, 7.5; 95% CI, 2.2-25.8)., Conclusions and Relevance: Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities.

Background: Gun buyback programs represent one arm of a multipronged approach to raise awareness and education about gun safety., Methods: The city of Worcester, MA has conducted an annual gun buyback at the Police Department Headquarters since 2002. We analyzed survey responses from a voluntary, 18-question, face-to-face structured interview from December 2009 to June 2015 using descriptive statistics to determine participant demographics and motivations for participation., Results: A total of 943 guns were collected, and 273 individuals completed surveys. The majority of participants were white males older than 55years (42.4%). Participants represented 61 zip codes across Worcester County, with 68% having prior gun safety training and 61% with weapons remaining in the home (27% of which children could potentially access). The top reasons for turning in guns were "no longer needed" (48%) and "fear of children accessing the gun" (14%). About 1 in 3 respondents knew someone injured/killed by gun violence. Almost all (96%) respondents claimed the program raised community awareness of firearm risk., Conclusion: The Worcester Goods for Guns Buyback has collected more than 900 guns between 2009 and 2015. The buyback removes unwanted guns from homes and raises community awareness about firearm safety., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: This review aims to summarise evidence on the effectiveness of interventions to prevent youth violence in Latin America., Methods: A systematic search on 13 academic databases was conducted to locate studies evaluating a primary or secondary prevention intervention in Latin America. Studies could use any type of quantitative design to assess outcomes related to youth violence. A search of websites, references and citation searching was also carried out. The quality of each study was assessed., Results: Nine studies were identified. Most documented positive effects of the interventions on the perception of youth violence present in the community/school. Evidence was found of a reduction in homicides and juvenile crimes in three studies, two of which evaluated a community-based intervention. There were mixed results for the self-report of participation on violent acts. The majority of the studies lacked of a rigorous design., Conclusions: Most of the interventions had some promising results, including the reduction of homicides within communities. Community-based programmes were the most consistent regarding an effectiveness to prevent violence. However, the evidence for Latin America is still scarce and relies on non-rigorously designed studies., Competing Interests: Compliance with ethical standards Ethical approval This article does not contain any studies with human participants performed by any of the authors. Conflict of interest Erika E. Atienzo declares that she has no conflict of interest. Susan K. Baxter declares that she has no conflict of interest. Eva Kaltenthaler declares that she has no conflict of interest.

Purpose: This article covers violence prevention (homicide and suicide) activities in the African American community for nearly 50 years., Method: Drawing on lived experience the works of early and recent efforts by African American physicians, the author illustrates we know a great deal about violence prevention in the African American community., Results: There remains challenges of implementation and political will. Further, most physicians, like the public, are confused about the realities of homicide and suicide because of the two different presentations both are given in the media and scientific literature., Conclusions: Responses to homicide and suicides should be based on science not distorted media reports. There are violence prevention principles that, if widely implemented, could stem the tide of violence., (Copyright © 2017 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Homicide-suicide is the phenomenon in which an individual kills 1 or more people and commits suicide. Research on homicide-suicide has been hampered by a lack of an accepted classification scheme and reliance on media reports. Mass murder-suicide is gaining increasing attention particularly in the United States. This article reviews the research and literature on homicide-suicide, proposing a standard classification scheme. Preventive methods are discussed and sociocultural factors explored. For a more accurate and complete understanding of homicide-suicide, it is argued that future research should use the full psychological autopsy approach, to include collateral interviews., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To estimate the effects on homicide rates of the gang truce that was brokered in El Salvador in 2012., Methods: Mathematical models based on municipal-level census, crime and gang-intelligence data were used to estimate the effect of the truce on homicide rates. One model estimated the overall effect after accounting for the linear trend and seasonality in the homicide rate. In a moderated-effect model, we investigated the relationship between the truce effect and the numbers of MS13 (Mara Salvatrucha 13) and Eighteenth-Street gang members imprisoned per 100 000 population. We then ran each of these two models with additional control variables. We compared values before the truce - 1 January 2010 to 29 February 2012 - with those after the truce - 1 March 2012 to 31 December 2013., Findings: The overall-effect models with and without additional control variables indicated a homicide rate after the truce that was significantly lower than the value before the truce, giving rate ratios of 0.55 (95% confidence interval, CI: 0.49-0.63) and 0.61 (95% CI: 0.54-0.69), respectively. For any given municipality, the effectiveness of the truce appeared to increase as the number of MS13 gang members imprisoned per 100 000 population increased. We did not observe the same significant relationship for imprisoned Eighteenth-Street gang members., Conclusion: In the 22 months following the establishment of a national gang truce, the homicide rate was about 40% lower than in the preceding 26 months. The truce's impact appeared particularly strong in municipalities with relatively high numbers of imprisoned MS13 gang members per 100 000 population.

Objective: To examine whether being pregnant or postpartum was associated with excess risk for homicide among females in Illinois and to describe the association between pregnancy status and homicide by race, ethnicity, and age group., Methods: This is a retrospective, multicohort, ecologic study of females of reproductive age in Illinois between 2002 and 2011 using Illinois Department of Public Health maternal mortality data and vital records data. We compared pregnancy-associated homicides with live births using χ tests. Among maternal deaths in the state, we calculated mortality rates per 100,000 live births for homicide and other violent causes and the leading direct obstetric causes. We calculated aggregate, pregnancy-associated, and nonpregnancy associated homicide rates stratified by race or ethnicity and age group., Results: There were 636 pregnancy-associated deaths in Illinois from 2002 to 2011. Of these, 82 (13%) were the result of homicide (5.0 [95% confidence interval (CI) 4.0-6.2]/100,000 live births). There were 931 homicides among females of reproductive age not associated with pregnancy (2.88 [95% CI 2.70-3.07]/100,000 population). More than half of the homicides were women aged 20-29 years (n=53 [64.6%]), non-Hispanic black women (n=43 [52.4%]), women residing in Cook County (n=47 [57.3%]), and unmarried women (n=57 [69.5%]). Pregnant and postpartum females aged 10-29 years were at twice the risk of homicide compared with their nonpregnant or postpartum counterparts (relative risk 2.20 [95% CI 1.70-2.85]). Non-Hispanic black and Hispanic females experienced higher rates of homicide than non-Hispanic white females irrespective of pregnancy or age., Conclusion: Although all violence against women must be addressed, we recommend that state maternal mortality review committees, in addition to reviewing deaths resulting from obstetric and clinical causes, should conduct in-depth reviews of pregnancy-associated homicides and other violent deaths.

Femicide or the murder of women because of their gender is a recognised public health problem as well as a serious violation of human rights. Its magnitude worldwide is still unknown, given the methodological difficulties to differentiate these murders from other female homicides. The European Union programme entitled «European Cooperation in Science and Technology» (COST) launched the «Femicide across Europe» COST Action in 2013, establishing an optimal European framework for transnational cooperation among experts addressing great social and public health challenges such as femicide. This field note describes the main objectives, the participating groups of experts and the mid-term results of this experience., (Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

This study describes the incidence and epidemiological characteristics of adolescent homicides (15-19 years) in Johannesburg, South Africa. A retrospective population-based study was conducted on cases drawn from the National Injury Mortality Surveillance System. A total of 590 adolescent homicides were registered for 2001-2009 corresponding to an average annual homicide rate of 23.4/100,000. The average annual rate was 39.8/100,000 for males and 7.9/100,000 for females. Black and coloured adolescents had the highest homicide rates. There was a considerable decline in the firearm homicide rates over the study period. In contrast, sharp instrument and blunt force homicides increased. Public places were the predominant scenes for male deaths, while female homicides occurred primarily in residential locations. Most male homicides took place over weekend nights. Alcohol was a prominent feature of homicides. The high homicide rates reported in this study underscore the need to develop interventions directed specifically at adolescents. Prevention efforts are required to pay particular attention to black and coloured adolescent males, and to address the availability of weapons and alcohol use among adolescents.

The empirical literature on sexual homicide has posited the sexual murderer as a unique type of offender who is qualitatively different from other types of offenders. However, recent research has suggested that sexual homicide is a dynamic crime and that sexual assaults can escalate to homicide when specific situational factors are present. This study simultaneously explored the utility of the sexual murderer as a unique type of offender hypothesis and sexual homicide as a differential outcome of sexual assaults hypothesis. This study is based on a sample of 342 males who were convicted of committing a violent sexual offense, which resulted in either physical injury or death of the victim. A series of latent class analyses were performed using crime scene indicators in an attempt to identify discrete groups of sexual offenders. In addition, the effects of modus operandi, situational factors, and offender characteristics on each group were investigated. Results suggest that both hypotheses are supported. A group of offenders was identified who almost exclusively killed their victims and demonstrated a lethal intent by the choice of their offending behavior. Moreover, three other groups of sex offenders were identified with a diverse lethality level, suggesting that these cases could end up as homicide when certain situational factors were present., (© The Author(s) 2014.)

Objective: The Germanwings 9525 incident drew significant attention to the 'plane-assisted suicide' construct, yet little scientific literature exists on this topic. This paper reviews the available literature and applies lessons from the suicide-homicide and men's mental health literature to better understand this construct from a scientific perspective., Methods: A systematic review of the relevant clinical literature was undertaken., Results: Multiple lines of evidence suggests the applicability and relevance of suicide-homicide research and men's mental health to the plane-assisted suicide phenomenon. Plane-assisted suicides occur within an overwhelmingly male, middle aged population who, in addition to suicide, commit large scale acts of murder. Issues of divorce, separation, and threats to masculinity appear integral to an effective prevention program., Conclusion: Further research in the understanding of plane-assisted suicide as a product of neuropsychiatric disorder may advance such prevention efforts and have the opportunity to reduce the loss of life in future tragedies.

Purpose of Review: This review will focus on recent research, initiatives, and legislation regarding the issue of gun violence as it pertains to adolescents., Recent Findings: Homicide and suicide continue to be major killers of adolescents in the United States. Gun homicide kills teens in the most urban areas of the United States at the same rate as suicide kills teens in the most rural areas of the United States. Research on assault-injured youth sheds light on risk factors for teen gun homicide, and has found high rates of illegal gun carrying and retaliatory attitudes among at-risk teens. Suicide research continues to show a strong correlation between gun ownership and accessibility, and risk of completed suicide. Stand Your Ground laws and campus carry laws present unique threats to different populations of American teens., Summary: Given the enormous toll that gun violence takes on adolescent lives, pediatricians should ask about guns in the home and become involved in efforts to strengthen laws that would decrease gun violence.

Among youth 15 to 24 years of age, homicide and nonfatal shootings are the leading causes of mortality and morbidity. Urban youth's attitudes and perceptions about the use of gun violence to resolve conflict present a major barrier to efforts to reduce gun homicides and nonfatal shootings. The current investigation extends the existing literature on attitudes toward guns and shootings among high-risk youth ages 18 to 24 by measuring perceived norms and viewpoints regarding gun violence in two analogous Baltimore City neighborhoods pre-implementation and 1-year post-implementation of the Safe Streets intervention (adapted from the CeaseFire/Cure Violence intervention). The Safe Streets intervention is designed for communities with high rates of gun violence and utilizes outreach workers to identify and build trusting relationships with youth ages 15 to 24 who are at greatest risk of being involved in gun violence. The outreach workers also position themselves in the community so that they can rapidly intervene in disputes that have the potential to lead to gun violence. Chi-squared tests and exploratory structural equation modeling (ESEM) were used to examine changes in attitudes toward gun violence 1 year after the implementation of the Safe Streets intervention. There was a statistically significantly improvement in 43 % of the attitudes assessed in the intervention community post-intervention compared to 13 % of the attitudes in the control community. There was a statistically significant improvement in the violent attitudes toward personal conflict resolution scale after implementation of the intervention in both the intervention (b = -0.522, p < 0.001) and control community (b = -0.204, p < 0.032). Exposure to the intervention (e.g., seeing stop shooting signs in your neighborhood) was also associated with the nonviolent attitudes toward conflict scale. Overall, the study found greater improvement in attitudes toward violence in the intervention community following the implementation of the Safe Streets program. These findings offer promising insights into future community violence prevention efforts.

Background and Objective: Alcohol abuse is common in the USA and is a well-established risk factor for violence. Other drug use and criminal activity are risk factors as well and frequently occur together with alcohol abuse. Firearm ownership is also common; there are >50 million firearm owners in the USA. This study assesses the relationships between alcohol and drug abuse and future violence among firearm owners, which no prior research has done., Design and Study Population: This records-based retrospective cohort study will involve all persons who legally purchased handguns in California in 2001-approximately 116 000 individuals-with follow-up through the end of 2013., Methods: The principal exposures include prior convictions for alcohol-related and drug-related offenses. The primary outcome measure is an arrest following handgun purchase for a violent Crime Index offense: homicide, rape, robbery or aggravated assault. Subjects will be considered at risk for outcome events for only as long as their residence in California can be established independently of outcome events. Covariates include individual characteristics (eg, age, sex, criminal history, firearm purchase history) and community characteristics (eg, demographics, socioeconomic measures, firearm ownership and alcohol outlet density). We will employ survival analytic methods, expressing effects as HRs., Discussion: The results of this large-scale study are likely to be generalisable and to have important implications for violence prevention policies and programmes., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To evaluate the impact of state-level policy changes on assaults on law enforcement officers (LEOs) in the USA., Methods: Pooled time series and cross-sections with negative binomial regression were used to estimate the impact of state-level changes of right-to-carry (RTC), three-strikes and permit-to-purchase (PTP) handgun laws on fatal and non-fatal assaults of LEOs. LEO assaults were stratified by weapon type (all methods, handgun and non-handgun) and whether or not the assault was fatal. Data were collected from the Federal Bureau of Investigation's Law Enforcement Officers Killed and Assaulted database and analysed for the period 1984-2013 for fatal assaults and 1998-2013 for non-fatal assaults., Results: RTC laws showed no association with fatal (p>0.4) or non-fatal (p>0.15) assaults on LEOs. Three-strikes laws were associated with a 33% increase in the risk of fatal assaults on LEOs. Connecticut's PTP law was not associated with fatal (p>0.16) or non-fatal (p>0.13) assaults. Missouri's repeal of its PTP legislation was marginally associated with a twofold increased risk of non-fatal handgun assaults (p=0.089)., Conclusions: This research indicates that three-strikes laws increase the risk of fatal assaults. RTC laws are not associated with increased risk of assault. Missouri's PTP repeal may increase the risk of non-fatal handgun assaults., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Research on suicide and homicide rates has neglected an integrated model seeking to explain social variation in the direction of lethal violence. The present investigation explores the association between measures of social deprivation on the relative incidence of suicide over homicide in Italian provinces. Data refer to official government sources on lethal violence rates and measures of social deprivation. The central dependent variable (SHR) is the tendency towards suicide measured as the suicide rate divided by the sum of the suicide and homicide rates. Data were available for 102 Italian provinces in the Census year 2001. The percentage of the population marked by two indicators of deprivation (low education, household population density) were negatively associated with the SHR. The results are largely consistent with a stream of previous research that connects deprivation with a relatively high probability for disadvantaged populations to direct aggression outwardly in the form of homicide rather than inwardly in the form of suicide. The present study specifies which elements of deprivation best predict the direction of violence and is the first study for the Italian context.

Objective: We determined estimates of homicide among American Indians/Alaska Natives (AI/ANs) compared with non-Hispanic white people to characterize disparities and improve AI/AN classification in incidence and mortality reporting., Methods: We linked 1999-2009 death certificate data with Indian Health Service (IHS) patient registration data to examine death rates from homicide among AI/AN and non-Hispanic white people. Our analysis focused primarily on residents of IHS Contract Health Service Delivery Area counties and excluded Hispanic people to avoid underestimation of incidence and mortality in AI/ANs and for consistency in our comparisons. We used age-adjusted death rates per 100,000 population and stratified our analyses by sex, age, and IHS region., Results: Death rates per 100,000 population from homicide were four times higher among AI/ANs (rate = 12.1) than among white people (rate = 2.8). Homicide rates for AI/ANs were highest in the Southwest (25.6 and 6.9 for males and females, respectively) and in Alaska (17.7 and 10.3 for males and females, respectively). Disparities between AI/ANs and non-Hispanic white people were highest in the Northern Plains region among men (rate ratio [RR] = 9.8, 95% confidence interval [CI] 8.5, 11.3) and among those aged 25-44 years (RR59.0, 95% CI 7.5, 10.7) and 0-24 years (RR57.4, 95% CI 6.1, 8.9)., Conclusion: Death rates from homicide among AI/ANs were higher than previously reported and varied by sex, age, and region. Violence prevention efforts involving a range of stakeholders are needed at the community level to address this important public health issue.

The New York Police Department (NYPD) under Operation Impact deployed extra police officers to high crime areas designated as impact zones. Officers were encouraged to conduct investigative stops in these areas. City officials credited the program as one of the leading causes of New York City's low crime rate. We tested the effects of Operation Impact on reported crimes and arrests from 2004 to 2012 using a difference-in-differences approach. We used Poisson regression models to compare differences in crime and arrest counts before and after census block groups were designated as impact zones compared to census block groups in the same NYPD precincts but outside impact zones. Impact zones were significantly associated with reductions in total reported crimes, assaults, burglaries, drug violations, misdemeanor crimes, felony property crimes, robberies, and felony violent crimes. Impact zones were significantly associated with increases in total reported arrests, arrests for burglary, arrests for weapons, arrests for misdemeanor crimes, and arrests for property felony crimes. Impact zones were also significantly associated with increases in investigative stops for suspected crimes, but only the increase in stops made based on probable cause indicators of criminal behaviors were associated with crime reductions. The largest increase in investigative stops in impact zones was based on indicators of suspicious behavior that had no measurable effect on crime. The findings suggest that saturating high crime blocks with police helped reduce crime in New York City, but that the bulk of the investigative stops did not play an important role in the crime reductions. The findings indicate that crime reduction can be achieved with more focused investigative stops.

Introduction: Interpersonal violence affects millions of people worldwide, often has lifelong consequences, and is gaining recognition as an important global public health problem. There has been no assessment of measures countries are taking to address it. This report aims to assess such measures and provide a baseline against which to track future progress., Methods: In each country, with help from a government-appointed National Data Coordinator, representatives from six to ten sectors completed a questionnaire before convening in a consensus meeting to decide on final country data; 133 of 194 (69%) WHO Member States participated. The questionnaire covered data, plans, prevention measures, and victim services. Data were collected between November 2012 and June 2014, and analyzed between June and October 2014. Global and country-level homicides for 2000-2012 were also calculated for all 194 Members., Results: Worldwide, 475,000 people were homicide victims in 2012 and homicide rates declined by 16% from 2000 to 2012. Data on fatal and, in particular, non-fatal forms of violence are lacking in many countries. Each of the 18 types of surveyed prevention programs was reported to be implemented in a third of the 133 participating countries; each law was reported to exist in 80% of countries, but fully enforced in just 57%; and each victim service was reported to be in place in just more than half of the countries., Conclusions: Although many countries have begun to tackle violence, serious gaps remain, and public health researchers have a critical role to play in addressing them., (Copyright © 2016. Published by Elsevier Inc.)

Objectives: Death from injury is frequently preventable, but injury remains a leading cause of death in the USA. While evidence-based strategies exist to prevent many types of injuries, effective policies for implementing these strategies at the population level are needed to reduce injury deaths. We identified promising injury prevention policies and evaluated their association with injury death rate (IDR)., Methods: We identified 11 injury prevention policies and accessed data on 2013 state and county IDRs. States were divided into strong, moderate and weak tertiles based on total number of policies in place. Adjusted regression modelling compared the strength of state prevention policies with IDRs at the state level and then at the county level to account for variability within states., Results: The strength of state prevention policies (tertile) was not significantly associated with IDR in US states. However, counties in strong policy states had a 11.8-point lower IDR compared with those in weak policy states (p=0.001)., Conclusions: States with more injury prevention policies in place have lower rates of death from injury, particularly when evaluated at the county level. Implementing recommended prevention policies holds potential to prevent injury death in the USA., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

The research-based NETWASS prevention model aims to enable school staff to identify students experiencing a psychosocial crisis that could lead to severe targeted school violence and to initiate appropriate support measures. A detailed analysis of the adolescent psychosocial crisis is conducted at an early stage by evaluating possible warning behaviors, crisis symptoms, a student’s individual and social background, and resources. The model was implemented in 98 schools. During the project duration of seven months staff from 59 schools reported 99 cases of a student’s psychosocial crisis. Three experts conducted a content analysis of the reported qualitative data focusing on crisis symptoms of the students as well as the initiated measures. Results show a broad spectrum of risk factors, whereas aggressive behavior of students was reported most frequently. On the basis of theoretical assumptions, the reported cases were divided into three distinct risk groups. A total of eight high-risk cases were observed and reported by the school staff. The school staff mostly reacted to the student crisis by initiating resource-orientated measures, the expertise of child and youth therapists was mostly requested for the high risk cases. By describing the impact of cases and choice of measures undertaken, the study aims to give an overview of incidents schools as well as clinical psychologists and therapists are confronted with.

Background: Emergency departments (EDs) serve a wide range of patients who present at risk of impending suicide and homicide., Aims: Two statewide surveillance systems were probabilistically linked to understand who utilizes EDs and then dies violently within 6 weeks., Method: Each identified case was matched with four randomly selected controls on sex, race, date of birth, resident zip code, and date of ED visit vs. date of death. Matched-pair odds ratios were estimated by conditional logistic regression to assess differences between cases and controls on reported diagnoses and expected payment sources., Results: Of 1,599 suicides and 569 homicides in the 3-year study period, 10.7% of decedents who died by suicide (mean = 13.6 days) and 8.3% who died by homicide (mean = 16.3 days) were seen in a state ED within 6 weeks prior to death. ED attendees who died by suicide were more likely to have a diagnosis of injury/ poisoning diagnosis or mental disorder and more likely to have Medicare. Those who died by homicide were more likely to have a diagnosis of injury/poisoning and less likely to have commercial insurance., Conclusion: It is essential for research to further explore risk factors for imminent suicide and homicide in ED patients who present for psychiatric conditions and general injuries.

The use of firearms in intimate partner violence (IPV) is widely recognized as an important public health threat. However, what we know about the risks of firearm access on IPV outcomes is limited. Therefore, we conducted a systematic review to determine the state of knowledge on 1) the risks of firearm access and use in IPV and 2) the effectiveness of interventions designed specifically to reduce firearm violence in intimate relationships. Only studies published in English in peer-reviewed journals from 1990 through 2014 were included. Results of the review suggest that, when violent intimates have access to firearms, IPV increases in severity and deadliness; however, increases in severity may not be due to firearm use. Additionally, statutes prohibiting persons under domestic violence restraining orders from accessing firearms are associated with reductions in intimate partner homicide, but certain provisions of these laws and their enforcement may impact their effectiveness. Future research should focus on elucidating the link between firearm access and increased IPV severity and on investigating whether and which specific provisions of domestic violence restraining order laws impact the laws' effectiveness. Additionally, more evaluations of initiatives designed to improve the enforcement of domestic violence restraining order firearm prohibitions are needed., (© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Firearms account for a substantial proportion of external causes of death, injury, and disability across the world. Legislation to regulate firearms has often been passed with the intent of reducing problems related to their use. However, lack of clarity around which interventions are effective remains a major challenge for policy development. Aiming to meet this challenge, we systematically reviewed studies exploring the associations between firearm-related laws and firearm homicides, suicides, and unintentional injuries/deaths. We restricted our search to studies published from 1950 to 2014. Evidence from 130 studies in 10 countries suggests that in certain nations the simultaneous implementation of laws targeting multiple firearms restrictions is associated with reductions in firearm deaths. Laws restricting the purchase of (e.g., background checks) and access to (e.g., safer storage) firearms are also associated with lower rates of intimate partner homicides and firearm unintentional deaths in children, respectively. Limitations of studies include challenges inherent to their ecological design, their execution, and the lack of robustness of findings to model specifications. High quality research on the association between the implementation or repeal of firearm legislation (rather than the evaluation of existing laws) and firearm injuries would lead to a better understanding of what interventions are likely to work given local contexts. This information is key to move this field forward and for the development of effective policies that may counteract the burden that firearm injuries pose on populations., (© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000-10. This decade was characterized by the enactment of a major health care reform-the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population-and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service-those sensitive to public health policies and changes in behaviors, homicide, and diabetes-by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century., (Project HOPE—The People-to-People Health Foundation, Inc.)

Threats and announcements of homicidal violence at schools may have massive consequences like evacuations, police searches, criminal investigations, or loss of the sense of security by students, teachers, and parents. However, there is a lack of systematic studies about that phenomenon. The present article would like to contribute to closing the research gap. It presents results about the frequency and structure of threats and announcements of homicidal violence in schools in Berlin. The study is based on an official dataset from school administration reports of violent acts in Berlin schools which has been studied within the Berlin Leaking-Projekt. The sample consists of 427 threats and announcements of homicidal violence between 1996 and 2007. The study is an exceptional analysis of the phenomenon: it presents crosscutting results about frequency and characteristics of threats and the threatening students as well as results of a longitudinal analysis about the development of threats and announcements. Results show a rate of 0,3 threats and announcements per 1 000 student and year. During the observation time span a steady increase of threats and announcements – year by year, influenced by imitation effects after school shootings – has been observed.