Trends in community violence in England and Wales 2005–2009

Purpose

Injury records from Emergency Departments (EDs) have been studied over the last decade as part of the work of the National Violence Surveillance Network (NVSN) and provide information about local, regional and national violence levels and trends in England and Wales. The purpose of the current study is to evaluate overall, gender, age-specific and regional trends in community violence in England and Wales from an ED perspective from January 2005 to December 2009.

Methods

Violence-related injury data were collected prospectively in a stratified sample of 77 EDs (Types 1, 3 and 4) in the nine Government Office Regions in England and in Wales. All 77 EDs were recruited on the basis that they had implemented and continued to comply with the provisions of the 1998 Data Protection Act and Caldicott guidance. Attendance date, age and gender of patients who reported injury in violence were identified using assault-related attendance codes, specified at the local level. Time series statistical methods were used to detect both regional and national trends.

Results

In total 221,673 (163,384 males: 74%) violence-related attendances were identified. Overall estimated annual injury rate was 6.5 per 1000 resident population (males 9.8 and females 3.4 per 1000). Violence affecting males and females decreased significantly in England and Wales over the 5-year period, with an overall estimated annual decrease of 3% (95% CI: 1.8–4.1%, p < 0.05). Attendances decreased significantly for both genders across four out of the five age groups studied. Attendances were found to be highest during the months of May and July and lowest in February. Substantial differences in violence-related ED attendances were identified at the regional level.

Conclusions

From this ED perspective overall violence in England and Wales decreased over the period 2005–2009 but increased in East Midlands, London and South West regions. Since 2006, overall trends according to Crime Survey for England and Wales (CSEW), police and ED measures were similar, though CSEW and ED measures reflect far greater numbers of violent incidents than police data. Causes of decreases in violence in regions need to be identified and shared with regions where violence increased.     

Trends in violence in England and Wales 1995-2000: an accident and emergency perspective

BACKGROUND: Prevention of violence-related injury has become an important public health issue but national, regional and local data are lacking. The aims of this study were to determine trends, seasonality and rates of violence-related injury according to Accident and Emergency (A&E) recorded data in England and Wales over a 5 year period, 1995-2000. METHODS: A stratified sample of 58 major A&E departments in England and Wales were recruited for the study. Electronic data on age, gender and date of attendance of all those reporting violence-related injury over a 5 year period, May 1995 to April 2000, were retrieved. Injury rates (number of injured per 100 resident population) were computed and ordinary least-squares regression analysis was used to evaluate linear and non-linear trends in these time series data. RESULTS: A total of 353442 (258719 males: 73 per cent) violence-related attendances were identified. Overall annual violence-related attendance did not change significantly (p > 0.05) but attendance of females aged 11-17 years increased steadily and significantly (p < 0.05) over the 5 year period. Health-region, gender- and age-specific increases in violence-related attendance slowed (p < 0.05). Compared with spring there were significantly lower levels of violence in autumn and winter for both males and females (p < 0.05). Violence affecting males aged 18-30 years was not subject to seasonality. Males, those aged 18-30 years and those living in the northern and western regions in England and Wales were at highest risk of violence-related injury. CONCLUSIONS: This national study from the perspective of health services suggests that violence did not increase over the period 1995-2000. Slowing of age-, gender- and health-region-specific increases in violence-related injury suggests that violence is coming under control. The reasons for significant trends in individual urban centres deserve further study, and could provide important new directions for violence prevention.     

Winning, losing, and violence

BACKGROUND: Although international sports events attract huge interest, and results can be a barometer of popular national standing, their impact on violent behaviour has not been investigated. METHODS: Associations between assault related emergency department (ED) attendances and international sporting events (home and away rugby and soccer matches) in a European capital city (Cardiff) served by one ED, between 1 May 1995 and 30 April 2002 were investigated. The frequency of assault related ED attendances were studied relative to whether the national team won or lost, controlling for potential covariates: match attendance, match location (home/away), results (win/lose), net scores, and day of match (weekend/weekday). Multiple linear regression was used to identify significant associations with ED assault related attendances. RESULTS: Matches which the Wales team won (p = 0.03), match attendance (p<0.001), and weekend matches (p<0.001) were positively associated with ED assault related injury attendances. Assault frequency measured in this way was no different for home and away matches. CONCLUSIONS: Assault injury resulting in ED treatment was more frequent when national teams won than when they lost. Sport type made no difference. Violence prevention efforts should be increased on international match days, when the national team is expected to win, when match attendance is large, and for away as well as home matches.     

A generic consensus assessment of undergraduate competence in forceps exodontia in the United Kingdom

The assessment of competence in clinical skills has become more frequent in published healthcare curricula and syllabuses recently. There are agreed mechanisms for the assessment of competence in the post‐graduate environment, but no consensus within the undergraduate curriculum. This paper seeks to develop an agreed generic checklist for the assessment of competence in forceps exodontia. Materials and methods:  A modified Delphi process was undertaken with representatives from all UK dental schools (n = 13) to develop a generic checklist for the assessment of competence in forceps exodontia. A content analysis of the assessments employed by each school was used to help discussion and inform the Delphi process. Results:  Seven schools currently employ a summative assessment of competence in forceps exodontia, with the majority employing a structured clinical objective test (n = 6). From the seven assessments, there were a total of 29 putative items and 10 putative domains identified for a generic checklist. These were reduced to five domains and 19 items through the content analysis and Delphi process, and a generic overarching checklist was created. Conclusion:  Using this generic checklist, it may now be possible to pool data inter‐institution to perform more powerful analyses on how our students obtain, or fail to obtain competence in forceps exodontia.     

Haematologic and growth response to prepartum administration of vitamin A in calves

Injectable vitamin A was given to six pregnant beef cows in their last third of pregnancy to study the effect of this vitamin in their calves. Average birth weight and growth rate of calves from the treated cows were higher than that of calves from the nontreated cows. Prepartum vitamin A injections also resulted in a significant increase (P less than 0.05) in the mean corpuscular volume (MCV), total serum protein and globulin fraction of serum protein in calves of treated cows.     

Conservative approach in the management of mandibular fractures in the early dentition phase. A case report and review of the literature

A case is described of the management of bilateral fractures of mandible as a result of being kicked by a horse, in a 2-year-old child. The fractures were treated without any surgical intervention and the child made a good recovery with good function and appearance. The fractured mandible in children under the age of 5 years provides us with difficult treatment options. By encompassing the anatomical and developmental potential of facial tissues, both hard and soft, the majority of these cases can be managed conservatively. This negates the disadvantages of attempting potentially growth disturbing interventional surgery.     

Dental students' knowledge and compliance in cross infection control procedures at a UK dental hospital

OBJECTIVES: To assess the knowledge and clinical practice of dental students in infection control procedures at a UK dental hospital.
DESIGN: A questionnaire concerning various aspects of infection control was completed by all clinical dental students under examination conditions. Their actual clinical practice was later observed and certain aspects recorded.
SETTING: A UK dental hospital.
SUBJECTS: One hundred and eleven dental students from three clinical years completed the questionnaire. Clinical practice for all 3 years was observed in a total of 280 treatment events.
METHODS: The questionnaire was marked by two of the authors and observations recorded by another author. MAIN OUTCOME MEASURES: Degree of compliance with recognised policy for infection control.
RESULTS: Knowledge of infection control procedures was variable particularly concerning duties usually undertaken by the dental nurse. The suggested high compliance with masks and eye protection was not always apparent in clinical practice, although virtually all students washed their hands prior to donning gloves, which were worn by all students.
CONCLUSION: There can be marked differences between what students say they would do and what they actually do in clinical practice. The topic of infection control requires a pro-active approach throughout the course, since results for the final year were not significantly different from the other clinical yearS. Ways of improving compliance are discussed.