Further, the proportion of cases with three or more gunshot wounds doubled from 10% to 20%, as did the proportion of cases with three or more body areas that had been shot, from 5% to 10%
Five cities in New Jersey (Newark, Irvington, East Orange, Orange, and Elizabeth) accounted for 85% of gunshot wounds; 75% of patients were shot in the city in which they lived, 55% within a mile of home, 25% within a block of home, and 15% in their homes.
The New Jersey study included only interpersonal gunshot injuries, not self-inflicted wounds or shots from police.
A second, separate study, gun-related injury and deaths were compared in Arizona for the 2 years before and the 2 years after July 2010, when the state made it legal to carry a concealed weapon without a permit or training.
The proportion of homicides related to guns in southern Arizona increased significantly from 2% to nearly 2.5% after that law was passed. Deaths by firearms increased by 24% among victims of violent crimes and accidents, Dr Rashna F. Ginwalla and her associates reported.
The number of violent crimes and accidents stayed relatively stable, but the risk of any gun-related injury or death increased significantly by 11% after concealed-weapons regulations were eliminated, said Dr Ginwalla, who led the study while at the University of Arizona, Tucson. Dr Ginwalla now works in Rwanda for the University of Virginia, Charlottesville.
"While causality has not been established by this observational study, we have demonstrated an association between an increase in gun availability and gun-related homicides in the state," she said.
Dr Livingston and Dr Ginwalla reported having no financial disclosures.
Report details rise in bath salt-related ED visits
BY NASEEM S. MILLER
From A SAMHSA REPORT
The synthetic drugs "bath salts" accounted for 23,000 of 2.5 million drug-related emergency department visits in 2011, according to a report by the Substance Abuse and Mental Health Services Administration.
The toxicities of the drugs are similar to those of other stimulants seen in the ED, Dr Elinore F. McCance-Katz, SAMHSA’s chief medical officer, said in reporting the first national study to track data on the relatively new drugs.
Treatment is symptomatic, as there are no treatments that are specific to the toxicities related to these drugs, Dr McCance-Katz said. The drugs’ adverse effects include hypertension and tachycardia, depression, suicidal thoughts, agitation and anxiety, and psychosis.
The report, based on the 2011 Drug Abuse Warning Network, or DAWN report, also showed that two-thirds (67%) of bath salt–related ED visits involved the use of another drug: 15% involved combined use of marijuana or synthetic forms of marijuana, and the other 52% involved a variety of other drugs.
Bath salts began to gain national attention in 2011, when poison centers reported a sudden jump to more than 6,000 cases of exposure to the drug, up from 300 cases in 2010.
In April 2013, the DEA put one of the main chemicals in bath salts in the Schedule I category. Several large national drug busts also have taken place in connection with the substance.
Bath salts come in the form of white or brown powder and contain one or more chemicals related to cathinone, an amphetamine-like stimulant. Their labelling implies that they are household products, such as bath salts or jewelry cleaner, and may contain words such as "legal high" or "not for human consumption." They can be taken by mouth, inhaled, or injected.
ED visits spike among California Medicaid patients
BY MICHELE G. SULLIVAN
From JAMA
Medicaid patients in California increased their use of emergency departments by nearly 36% over a 5-year period while ED use by privately insured patients barely increased.
"Increasing ED use by Medicaid beneficiaries could reflect decreasing access to primary care, which is sup
ported by our findings of high and increasing rates of ED use for ambulatory care sensitive conditions by Medicaid patients," wrote Dr Renee Hsia.
Dr Hsia of the University of California, San Francisco, and her coauthors examined rates of ED utilization in California from 2005 to 2010 and broke down the data by insurance status (JAMA. 2013;310[11]:1181-1183). They looked at adult patients younger than 65 years, because these patients "have experienced the greatest changes in insurance coverage in recent years, and are likely to see the biggest shifts as a result of health care reform."
The investigators based their retrospective analysis on the California Office of Statewide Health Planning and Development’s Emergency Discharge Data and Patient Discharge Data. The study grouped patients by insurance status: Medicaid, private, uninsured or self-pay, or other (workers compensation, CHAMPUS/TRICARE, Title V, and Veterans Affairs, and similar coverage).