This paper reports register data on a consecutive series of 141 children and teenagers hospitalized due to firearm injuries during a 21-year period in a community with restrictive firearm laws. Most of the injuries were minor and hospitalization was short. Shot by an air gun resulting in an eye injury was the most frequent reason for hospitalization. The patients hospitalized due to firearm injuries were compared with a control group composed of 141 individuals matched pair-wise for sex and age. The total morbidity during the follow-up period of on average 10 years was higher among patients compared with controls concerning both somatic diseases and injuries. All cases of severe psychopathology were found in the patient group. Criminality was higher among patients compared with controls and the former were younger at the time of the first crime compared with the latter. This study indicates that, irrespective of firearm laws, young people suffering from firearm injuries, even if the injury is classified as accidental, run a higher risk of becoming psychosocially disadvantaged and criminal as adults. This makes preventative measures highly necessary not only from a societal point of view, but also to avoid individual suffering in this high-risk group of youngsters.
Forty-nine women who attended a surgical emergency department after being battered are the subjects of this prospective study. The childhood and adolescence of the women had been marked by abuse and violence in the parental home. Most of the women had suffered prolonged, repeated battering. Fifty-one per cent of the women and 88% of their male assailants were considered to be heavy consumers of alcohol and in over half of the cases of battering both the man and the women had been drinking. In most cases the women's own children were present when the mother was beaten. One third of the women stated that they were highly dependent on the man in question emotionally. It is concluded that social heredity, heavy consumption of alcohol and emotional dependence on the male assailant are major reasons for the woman's inability to break away from a relationship characterized by repeated battering.
During the summer seasons of 1978-1983 (56 weeks), trial activity with a physician-manned ambulance helicopter was carried out in the County of Stockholm (population 1.5 million). The area includes an extensive archipelago. Within the region there are 11 large general hospitals, three of which are supplied with a helicopter pad. During the trial period 1 246 helicopter missions were undertaken, of which 943 resulted in emergency transportation of the patient (83% by helicopter, 17% by ambulance). The number of missions per day varied from 0-11, with a mean number of 3.2. The turn-out time from receipt of the call to arrival at the scene of the accident or illness was less than 30 minutes in 75% of the cases. Of the emergency calls, 57% involved cases of illness and 43% accidents. Therapeutic intervention by doctors at the scene was considered to have been of vital importance in 22% of the cases, desirable in 28% and unnecessary in 50%. This intervention was regarded as life-saving in 18 cases (2%). By special training of emergency call operators, the number of unnecessary helicopter missions could be minimised (9% of all missions). To continuing specialisation and centralisation of emergency care with extended catchment areas, demands an advanced transport system. This trial has shown that through the use of a physician-manned ambulance helicopter the emergency care within the region can be centralised with retention of adequate turn-out times.
Eighteen male wife-beaters were compared with 19 battered males concerning their background, history of addiction and present social situation, as well as present violence. The two groups of males had a very similar background including violence in their parental home. Alcohol and drug problems were common, the males generally belonged to the lower social classes and the number of divorcees was large. Many of the battered males had abused someone and the male batterers had been victimized themselves. It is concluded that the roles as victims and assailants vary among these men. The same background and precipitating factors will predestine the male to be a batterer or to be battered, but most probably both.
The social files and medical records of 98 acutely battered wives who attended a surgical emergency department were studied. Although all women had been hospitalized during the decade preceding the present incident, wife battering was documented in the records in only 18%. The majority of the women (73%) were also known to the social services, but battering was documented in less than half of the cases in the social service files. The measures taken by the social services to help the battered women consisted mainly of economic support and psychotherapy. The cooperation between the medical and social services and the police in cases of wife battering was very limited or non-existent. It is concluded that support given to battered women by the formal sources of aid is insufficient. The documentation of the cases is poor, there is a lack of practical measures and the cooperation between the authorities is limited. This study indicates that the social and medical services underestimate the importance of informal help sources like women's groups or shelters which often are the most valued resources by the battered women themselves. With improved cooperation between authorities and between formal and informal sources of aid the battered wives could be helped more effectively.
A prospective study of women attending a surgical emergency department in an 8-month period showed that 117 (9%) had been battered. Offered in-patient treatment was accepted and completed by 58 women (the index group), while 59 declined or did not complete treatment (the drop-out group). Both groups were compared with age-matched controls. In the battered group there were more foreign-born women and more divorces than in the control group. The drop-out group differed from the index group either in being less severely injured and seeking only certification of injury for legal purposes, or in having more previous psychiatric morbidity. The consumption of somatic and psychiatric care during the preceding 10 years was significantly greater in the battered group than in the controls, probably due to the maltreatment and reluctance to report it spontaneously. Breaking of a battering pattern at an early stage requires awareness by surgeons, general practitioners and psychiatrists that recurrent injuries of unclear origin may be due to such violence.
In a retrospective study on 456 women hospitalized at the Departments of Surgery and Oto-rhinolaryngology of Huddinge Hospital for emergency injuries during the years 1978 and 1979, the injuries were found to have been caused by battering in 29%. The majority of the women had been physically abused by their husbands, fiancés or cohabitees. As women seldom seek social or psychiatric assistance for this problem spontaneously, it is an important task of the responsible accident surgeon both to detect battering as the cause of the injuries and to act as mediator in contacting a women's refuge or other social assistance agency.
118 patients with complicated intra-abdominal infections participated in an open randomized comparative multicenter trial in order to compare the clinical and microbiological efficacy and safety of biapenem with imipenem/cilastatin (Tienam). 31 men and 27 women (mean age 52.3 years) were enrolled in the biapenem group, and 43 men and 17 women (mean age 52.3 years) in the imipenem/cilastatin group. The patients received either biapenem 500 mg every 8 h or imipenem/cilastatin 500 mg/500 mg every 6 h by intravenous infusion for up to 13 days (mean 6.5 days). 28/43 evaluable patients (65.1%) receiving biapenem and 27/40 evaluable patients (67.5%) in the imipenem/cilastatin group were clinically cured. The microbiological response was satisfactory in 28/43 evaluable patients (65.1%) receiving biapenem and in 27/40 evaluable patients (67.5%) receiving imipenem/cilastatin. No significant differences in clinical or microbiological efficacy between the two treatment groups were found. The present study shows that biapenem may be useful in the treatment of intra-abdominal infections.
This study is based on interviews with 53 male alcoholics. Its purpose was to study the relationship between childhood conditions, history of alcohol and drug misuse and assaultive and suicidal behaviour. Fifty-seven per cent of the alcoholics reported a history of violent behaviour. Hidden violence, often towards women, was common. One-third of the violent patients had a history of attempted suicide compared to 17% in the non-violent group. The assaultive alcoholics also had a more violent childhood, a higher proportion of fathers with alcohol problems and had started drinking earlier in life. Drug addiction was much more common in this group too. We find support for our hypothesis that there is a positive correlation between violence in the parental home and assaultive and suicidal behaviour and drug misuse later in life. When violent and non-violent alcoholics are compared many of the same characteristics appear as when suicidal and non-suicidal and type 2 and type 1 alcoholics are compared. This study raises the question of adding attempted suicide as a characteristic of the type 2 alcoholic.