Violence-related Deaths Research Articles

Fatal childhood injuries in Finland, 1971–2010

BackgroundChildhood injuries are a major public health problem worldwide, injuries being the leading cause of death and disability from early childhood through adolescence.ObjectiveTo examine the 40-year nationwide trends in the...

Mobilizing Communities and Building Capacity for Youth Violence Prevention: The National Academic Centers of Excellence for Youth Violence Prevention

Violence, including its occurrence among youth, results in considerable physical, emotional, social, and economic consequences in the US. Youth violence prevention work at the Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention (CDC) emphasizes preventing youth violence-related behaviors, injuries, and deaths by collaborating with academic and community partners and stakeholders. In 2000 and 2005, DVP funded the National Academic Centers of Excellence (ACE) for Youth Violence Prevention. Most ACE Centers focus on building community capacity and competence so that evidence-based programs for youth violence prevention can be successfully implemented through effective and supportive research-community partnerships. This commentary provides historical information about the ACE Program, including the development, goals, accomplishments of the Centers, and the utilization of a community-based participatory research approach to prevent youth violence.

Large-Scale “Expert” Mortality Surveys in Conflicts—Concerns and Recommendations

SEVERAL LARGE-SCALE RETROSPECTIVE MORTALITY SURveys in conflict settings in Darfur, the Democratic Republic of Congo (DRC), Northern Uganda, and Iraq have had major political implications, and, thus, were scrutinized by policy makers, researchers, and the media. The controversies they generated led to serious criticism—some well-founded, some less so—that may have undermined the credibility of mortality surveys in conflict settings. For example, a 2006 survey estimated that more than 650 000 Iraqis died mostly from violence since the USled invasion in 2003; in contrast, another study found a substantially lower estimate of violence-related deaths at approximately 151 000. A 2007 study estimated that 5.4 million have died in DRC since 1998; another report questioned the methods of this study and claimed that the excess death estimate was at least 3 times too high. Rebuttals from various sources and conflicting studies focused on sampling and nonsampling biases. Given these concerns, higher standards and improved methods are needed for undertaking and reporting large-scale mortality surveys. To track mortality prospectively, a surveillance system should be established as early as possible in humanitarian emergencies. However, humanitarian organizations often rely on cross-sectional surveys to estimate death rates retrospectively. These surveys are time consuming, costly, logistically challenging, and require technical expertise. Methodologies to measure mortality have not been sufficiently validated. Mortality surveys are useful at the beginning of emergencies to document baseline mortality rates, monitor effectiveness of programs, prioritize interventions, and advocate for funding. These surveys generally are not published in peer-reviewed journals and may not attract much attention. These are the “operational” surveys that allow humanitarian organizations to make practical field decisions. They are neither designed to meet publication standards nor to establish precise benchmarks. Although their quality can be improved, these operational surveys are essential surveys to guide field programs. Large-scale mortality surveys in conflict settings—often seeking to measure mortality at a national level and over a relatively long period—have different objectives from smaller operational surveys. These “expert” surveys are rare and primarily conducted for advocacy purposes, to document severity of crises and possible human rights violations, and to call for additional international attention and funding. Their findings are broader in nature and often do not directly effect field interventions. These surveys are complex, expensive, and time consuming to implement and to disseminate results. Sampling design and methods of retrospective mortality surveys in conflict settings are areas of unsettled science. Lack of accurate population data before the crisis is complicated by population displacement, so accurate population listings necessary for random sampling are rarely available. Thus, cluster sampling is a default method in most humanitarian settings and has often meant reliance on 30 30 cluster surveys. Given the uneven distribution of violence, sample sizes, particularly number of clusters, should be significantly larger than have previously been used; especially because many surveys attempt to interpret findings by age, sex, or location. Therefore, 30 30 cluster surveys should rarely, if ever, be used in expert mortality surveys if the purpose is to estimate mortality at a national level. Larger sample sizes with more clusters are needed. Recall periods are another important issue. Shorter periods (eg, 1-3 months) may reduce recall bias and focus results on more proximate mortality events. However, they tend to increase imprecision in estimating rates for a given sample size because the number of deaths in shorter periods is likely to be fewer. Calendar error may also prove more significant in shorter recall periods because an error of only 1 week (eg, when a death occurred) would have a greater effect on estimates. Duration of recall periods in expert surveys should be appropriate to the time dimensions of the crisis-related mortality of interest while ensuring the sample power is sufficient for precision and valid comparisons. Nonsampling errors may be particularly important in expert surveys. Surveyors and survey participants may be under pressure to increase or decrease reported deaths. Who the surveyors are, how they are trained and super-

Law & Psychiatry: Gun Laws and Mental Illness: How Sensible Are the Current Restrictions?

This column describes federal and state laws to restrict access to firearms among people with mental illness. The contribution to public safety of these laws is likely to be small because only 3%-5% of violent acts are attributable to serious mental illness, and most do not involve guns. The categories of persons with mental illnesses targeted by the laws may not be at higher risk of violence than other subgroups in this population. The laws may deter people from seeking treatment for fear of losing the right to possess firearms and may reinforce stereotypes of persons with mental illnesses as dangerous.

Differences in Reporting of Violence and Deliberate Self Harm Related Injuries to Health and Police Authorities, Rawalpindi, Pakistan

BackgroundThe aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan.Methods/Principal FindingsStudy setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46–64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322–8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4–30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101–1 516), police reported 0.5% and ED reported 39.9% of them.ConclusionIn Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence.

EVALUATING COMPLETENESS OF MATERNAL MORTALITY REPORTING IN A RURAL HEALTH AND SOCIAL AFFAIRS UNIT IN VELLORE, INDIA, 2004

Health systems in developing countries infrequently implement and evaluate maternal death surveillance. This study identified under-reported and misclassified maternal deaths among women of reproductive age between 1999 and 2004 in a rural service unit in Vellore, India. In-depth interviews, semi-structured interviews and structured questionnaires were used to identify maternal deaths known to health care providers and community leaders who regularly come in contact with pregnant women. Eighteen under-reported and misclassified cases--or 50% of maternal deaths--were reported. These included 29% of abortion-related and 7% of domestic violence-related deaths. Based on this study's fieldwork, the existing death surveillance system detected 100% of the maternal deaths reported by hospital staff; however, it missed most maternal deaths reported by community workers. The latter are more likely than deaths reported by hospital workers to result from abortion and family violence. The existing surveillance system should be augmented with a community-based death surveillance system. This comprehensive approach identified twice as many maternal deaths than previously recorded and could be applied in other settings. Appropriate public health interventions should be initiated to prevent maternal deaths in this community.

The impact of violence on health in low- to middle-income countries

More than 90% of violence-related deaths occur in low- to middle-income countries (LMICs), where the mortality rate due to violence is almost 2.5 times greater than in high-income countries. Over and above the substantial contribution of violence as a cause of death and physical injuries, victims of violence are also more vulnerable to a range of mental and physical health problems. Several studies describe the deleterious impact of different types of violence on a range of health outcomes, but no review has yet been undertaken that presents a composite overview of the current state of knowledge in LMICs. This paper reviews the scientific literature describing the nature, magnitude and impact of violence on health, describing the current state of violence-prevention policy developments within the global health agenda and highlighting the health consequences, disease burden and economic costs of violence. Although data are limited, the review indicates that costs relating to violence deplete health care budgets considerably and that scarce resources could be better used to address other health threats that hamper development.

Income inequality, social capital and self-inflicted injury and violence-related mortality

The objective of the study was to investigate the relation of income inequality and indicators of social capital to self-inflicted injury mortality (suicide) and violence-related mortality, and to the share of total mortality that is due to these two causes of death in 35 developed countries. An ecological study including 30 European countries, including former communist countries, and five developed countries from other parts of the world was carried out. Countries were included if there was information available about mortality and income inequality, and if they had been included in the European/World Values Surveys of 2000. The main outcome measures were self-inflicted injury and violence-related mortality and the percentage of total mortality that was due to these two causes of death. There were important variations between former communist Europe and other developed countries. In other developed countries income inequality was significantly, but negatively, correlated with self-inflicted deaths, but not with violence-related deaths. In former communist countries, it was found that income inequality was correlated with violence-related deaths, but not self-inflicted deaths. Only in former communist countries did adjusting for the level of preparedness to help others reduce the associations. The expectation that income inequality would have a relatively strong association with the two causes of death indicating mortality due to self-infliction and violence was only partly confirmed, that is, only for former communist countries and only for violence-related mortality. The expectation that adjusting indicators of social capital would lower associations was also only partly confirmed.

Child injuries and violence: the new challenge for child health

Injuries and violence are a significant and growing cause of child death and disability, as well as having other health consequences including mental health, behavioural and reproductive health problems. Every year injuries and violence kill approximately 875 000 children (aged less than 18 years of age) and injure or disable tens of millions more. Injury-related causes account for 3 of the top 15 killers of children aged 0–4 years and for 6 of the top 15 killers of children aged 5–14 years. Child maltreatment has been associated with significantly increased risk of alcoholism, drug abuse, depression, suicide attempt, smoking and sexually transmitted disease. The burden from child injury is most felt in low- and middle-income countries, where 95% of all child-injury deaths occur, and where recorded rates of child maltreatment are substantially higher than in high-income countries. This huge public health problem is all that much more tragic because it is avoidable. Through combinations of prevention and care, most high-income countries have considerably reduced rates of child-injury death and child maltreatment. Consequently, there are huge inequities globally, with annual child-injury mortality of 8.6/100 000 in high-income countries compared with 41.8/100 000 in low- and middle-income countries.1 In other words, rates of child-injury death are more than four times higher in low- and middle-income countries. A large burden of death and morbidity could be avoided by bringing violence and injury rates in low- and middle-income countries down to levels similar to those in high-income countries. Such public health benefits could be achieved by use of proven prevention methods, such as implementing and enforcing safety legislation and standards; promoting home and transport safety; modifying products or the environment; and improving care and rehabilitation of injured children. Programmes to promote safe, sustainable and nurturing relationships between children and their parents or caregivers can substantially reduce child maltreatment, and youth violence prevention programmes can significantly reduce violence-related death and injury in adolescents. These strategies, most of which are affordable and sustainable in all countries, need to be better applied globally. Child injury and violence need to be better incorporated into broader child survival strategies. Child injury and violence have been only minimally addressed thus far by the global health community and by most governments. Likewise, these topics have been inadequately addressed in the scientific literature. An upcoming theme issue of the Bulletin (May 2009) on child injury and violence will seek to address these shortcomings, to promote greater attention to these significant public health problems, to promote greater uptake of known effective prevention and treatment interventions globally, and to stimulate more research on low-cost and sustainable ways to confront these problems especially in low- and middle-income countries where most children live. The Bulletin theme issue will examine the spectrum of child injury and violence prevention and control including epidemiology, prevention, care and rehabilitation. It will contain papers in the categories of Perspectives, Policy and practice, Research, and Lessons from the field. Several papers will be commissioned. In addition, submissions from interested authors are highly encouraged. We welcome papers for all sections of the Bulletin that focus on any of the following topics: surveillance and data collection; evaluation of methods to prevent unintentional injury and violence; health systems strengthening or financing for child injury and violence prevention interventions; or methods for strengthening emergency care and/or rehabilitation of injured and maltreated children. We would especially encourage papers that go beyond the health perspective to address the cross-sectoral nature of the problem. For example, papers on transport safety could encompass the multi-sectoral nature of road traffic injury, including human behaviour, roadway infrastructure and vehicle design, and broader issues of urban design. Papers on violence could include coverage of the multi-dimensional determinants of violence, including parenting, childhood exposures and subsequent health and social consequences, and societal-level factors such as socio-economic disparities. Likewise, papers examining responses to violence could discuss actions involving the educational, welfare and criminal justice sectors, as well as the health sector. Papers discussing how child injury and violence issues can be better addressed in the broader child survival and global health agendas are encouraged. These could include discussions of the relationship of child injury and violence and Millennium Development Goals such as Goal 4 (reducing child mortality). Papers from authors in developing countries are especially encouraged. It is hoped that the papers in this issue will contribute important information that will assist public health practitioners, clinicians, researchers and policy-makers to better confront the eminently preventable problem of child injury and violence. The deadline for submissions is 1 September 2008. Manuscripts should be submitted to: http://submit.bwho.org respecting the Guidelines for Contributors and accompanied by a cover letter mentioning this call for papers. All submissions will go through the Bulletin’s peer review process. ■

New manual for estimating the economic costs of injuries due to interpersonal and self-directed violence

Injuries arising from violence are a major public health problem and a leading cause of death around the world. Globally, violence kills at least 1.6 million people each year. Of...

Community Mobilization to Prevent Youth Violence and to Create Safer Communities

Community Mobilization to Prevent Youth Violence and to Create Safer Communities

Violence-Related Mortality in Iraq from 2002 to 2006

Estimates of the death toll in Iraq from the time of the U.S.-led invasion in March 2003 until June 2006 have ranged from 47,668 (from the Iraq Body Count) to 601,027 (from a national survey). Results from the Iraq Family Health Survey (IFHS), which was conducted in 2006 and 2007, provide new evidence on mortality in Iraq. The IFHS is a nationally representative survey of 9345 households that collected information on deaths in the household since June 2001. We used multiple methods for estimating the level of underreporting and compared reported rates of death with those from other sources. Interviewers visited 89.4% of 1086 household clusters during the study period; the household response rate was 96.2%. From January 2002 through June 2006, there were 1325 reported deaths. After adjustment for missing clusters, the overall rate of death per 1000 person-years was 5.31 (95% confidence interval [CI], 4.89 to 5.77); the estimated rate of violence-related death was 1.09 (95% CI, 0.81 to 1.50). When underreporting was taken into account, the rate of violence-related death was estimated to be 1.67 (95% uncertainty range, 1.24 to 2.30). This rate translates into an estimated number of violent deaths of 151,000 (95% uncertainty range, 104,000 to 223,000) from March 2003 through June 2006. Violence is a leading cause of death for Iraqi adults and was the main cause of death in men between the ages of 15 and 59 years during the first 3 years after the 2003 invasion. Although the estimated range is substantially lower than a recent survey-based estimate, it nonetheless points to a massive death toll, only one of the many health and human consequences of an ongoing humanitarian crisis.

Violence-related mortality and morbidity of humanitarian workers

(1) To determine the rate of violence-related deaths, medical evacuations, and hospitalizations occurring to national and expatriate staff of participating humanitarian organizations; (2) to describe the distribution of all-cause and cause-specific mortality and morbidity of humanitarian workers with regard to possible risk factors. Surveillance study of field-based humanitarian workers; data were regularly collected from headquarters of participating organizations via e-mail and telephone between September 2002 and December 2005. Eighteen humanitarian organizations reported on any death, medical evacuation, or hospitalization of any national or expatriate staff for any cause, in any field location during the study period. None. Risk of violence-related events was calculated as the number of deaths, medical evacuations, and hospitalizations during the study period divided by the total number of field staff for organizations that had staff in those countries where events occurred to the staff of any participating organization. Distribution descriptions are presented as simple proportions. Risk of violence-related deaths, medical evacuations, and hospitalizations was six per 10,000 aid worker person-years. Fifty percent of intentional violence cases were lethal. Intentional violence accounted for 55 percent of all deaths reported, followed by coincidental illness (27 percent) and accidents (15 percent). Aid worker deaths in this group were more frequently caused by intentional violence than either accidents or coincidental illness. The rate of six intentional violence events per 10,000 person-years can be used as a baseline by which to track changes in risk over time.

Adolescent survey non-response and later risk of death. A prospective cohort study of 78 609 persons with 11-year follow-up

BackgroundNon-response in survey studies is a growing problem and, being usually selective, it leads to under- or overestimation of health outcomes in the follow-up. We followed both respondents and non-respondents by registry linkage to determine whether there is a risk of death, related to non-response at baseline.MethodsSample data of biennial surveys to 12-18-year-old Finns in 1979–1997 were linked with national death registry up to 2001. The number of respondents was 62 528 (79.6%) and non-respondents 16 081 (20.4%). The average follow-up was 11.1 years, totalling 876 400 person-years. The risk of death between non-respondents and respondents was estimated by hazard ratios (HR).ResultsThe number of deaths per 100 000 person-years were 229 in non-respondents and 447 in respondents (HR 2.0, 95% CI: 1.5–2.6). The hazard ratios of death were for intoxication 3.2 (95% CI: 1.9–5.4), for disease 3.1 (95% CI: 2.2–4.1), for violence-related injury 2.0 (95% CI: 1.5–2.6) and for unintentional injury 1.8 (95% CI: 1.3–2.4) in non-respondents vs. respondents. The association between non-response and death increased with age at baseline, and the increase persisted after the age of 25.ConclusionOur study demonstrated significantly increased rates of death among adolescent non-respondents in a follow-up. The highest hazard ratios were seen in disease- and violence-related deaths. The death rate varied between respondents and non-respondents by death type. Increased rates of death persisted beyond the age of 25.

Analysis of Injury- and Violence-Related Fatalities in the Ohio Medicaid Population: Identifying Opportunities for Prevention

To identify the leading causes of injury- and violence-related deaths in demographic subgroups of the population in Ohio, by Medicaid status. We used linked Ohio Medicaid and death certificate files, 1992 to 1998, and obtained the probability (p) of dying from a specific mechanism of injury--given death from injury--by Medicaid status, using multinomial multivariable logistic regression analysis. Probabilities were rank-ordered to identify the leading causes of death in each subgroup. The leading cause of injury-related deaths was homicide among Medicaid decedents in the age groups 0 to 4, 15 to 24, and 25 to 44 (p = 0.283, 0.380, and 0.269, respectively), and motor vehicle crashes among nonMedicaid decedents aged 5 to 14, 15 to 24, 25 to 44, and 45 to 74 (p = 0.448, 0.462, 0.293, and 0.293, respectively). Accidental falls ranked first among the elderly (p = 0.593 and 0.414, respectively in Medicaid and nonMedicaid decedents). Suicide and accidental exposure to smoke, fire, and flames also ranked high among the leading causes of injury-related deaths in many population subgroups. Findings from this study, pointing to the vulnerability of population subgroups to certain mechanisms of injury, can be used to formulate targeted prevention strategies.

Temporal trends, gender, and geographic distributions in child and youth injury rates in Sweden

Objective: Sweden has the lowest child injury mortality rate in the world, 5.2/100 000 for children under 15. This paper describes temporal trends in Sweden, as well as gender related...

Narrative Techniques of Fear Mongering

Barry Glassner Narrative Techniques of Fear Mongering AMERICANS LIVE IN PERHAPS THE SAFEST TIME IN HU M A N HISTORY, SO how has it come about that there are so many fears and scares in the air, and so many of them are unfounded? Why, as crime rates plunged over the past decade, did substantial numbers ofAmericans say in surveys that they believe the crime rate is rising or remaining steady? Why, despite numerous studies showing that the number of drug users declined substantially during past two decades, did large numbers of Americans rank drug use as the greatest danger to America’s youth? Why, at a time when most Americans are living longer and healthier, do many people feel they are at great risk of early death from obscure disorders? I suggest that the answer to these and related questions lies, in large measure, in the immense power and money that await individu­ als and organizations who can tap into Americans’ moral insecurities for their own benefit. By fear mongering, politicians sell themselves to voters, TV and print newsmagazines sell themselves to viewers and readers, advocacy groups sell memberships, quacks sell treatments, lawyers sell class-action lawsuits, and corporations sell consumer prod­ ucts. A particularly illustrative current example of the last of these is the highly successful marketing of antibacterial soaps, which tend to be more expensive than conventional soaps, confer no greater protec­ tion in normal household settings, and may well contribute to the emergence of antibiotic-resistant bacteria. Much of the answer to why there are so many misbegotten fears in the air resides in how fear mongers sell their scares. In no small social research Voi 71 : No 4 : W inter 200 4 819 measure they do it the same way discount stores make their profits: they do it on volume. The point is illustrated by a pair of statistics about crime. Between 1990 and 1998, the murder rate in the United States decreased by 20 percent. During that same period, the number of stories about murder on network newscasts increased by 600 percent. Frequent viewers of evening newscasts were unlikely to have the impression that the crime rate was dropping. More than volume is involved, however, in successful fear monger­ ing. Fear mongers deploy narrative techniques to normalize what are actually errors in reasoning. Perhaps the most common of these consists in the christening of isolated incidents as trends. Commonly used in fear mongering about groups of people, this stratagem was used in scares about youth violence from the mid-1990s through mid-2001, a period in which, in actuality, the United States experienced a steep downward trend in youth crime. Faced year after year with comforting statistics during this period, fear mongers recast those statistics as “the lull before the storm,” as a Newsweek headline in 1995 put it. “We know we’ve got about 6 years to turn this juvenile crime thing around, or our countiy is going to be living in chaos,” President Bill Clinton asserted in his 1997 State of the Union address, even though the youth violent crime rate had fallen 9.2 percent the previous year. Six years later the nation was not living with chaos, at least as a result of youth violence, but the bipartisan fear mongering that went on about juvenile crime had demonstrable effects on public percep­ tions. In surveys conducted during the second half of the 1990s, adult Americans estimated that people under 18 committed about half of all violent crimes, although the actual number is 13 percent. One important source for such misperceptions was the public discourse regarding school shootings. The buildup began in the academic year 1996-1997, a year in which violence-related deaths in the nation’s schools actually hit a record low: 19 deaths out of 54 million children. Only one in ten public schools reported any serious crime that year, but that was not the impression conveyed in the news media and by fear-mongering politicians. Time and US News and World Report both 820 social research ran headlines that year referring to “teenage time bombs,” and William Bennett, the former secretary of education, proclaimed in a book...

Caught in the Crossfire: the effects of a peer-based intervention program for violently injured youth

Purpose To assess the effect of a hospital-based peer intervention program serving youth who have been hospitalized for violent injuries on participant involvement in the criminal justice system and violent reinjury and death after hospital discharge. Methods A total of 112 violently injured youth (ages 12–20 years; 80% male; predominantly African-American [60%] and Latino [26%]) hospitalized in Oakland, California participated in a retrospective case–control study. Clients were matched by age and injury severity. Treatment and control youth were followed for 6 months after their individual dates of injury. The outcome variables of rate of entry/reentry into the criminal justice system, rate of rehospitalization for violent injuries and rate of violence-related deaths were compared for treatment and control groups using an odds ratio analysis. Results Intervention youth were 70% less likely to be arrested for any offense (odds ratio [OR] = 0.257) and 60% less likely to have any criminal involvement (OR = 0.356) when compared with controls. No statistically significant differences were found for rates of reinjury or death. Conclusion A peer-based program that intervenes immediately after, or very soon after, youth are violently injured can directly reduce at-risk youth involvement in the criminal justice system.

Ethnic Conflict and Civic Life

While Ashutosh Varshney’s book, Ethnic Conflict and Civic Life: Hindusand Muslims in India, cannot be judged by its cover, it can be judged byits index. His exhaustive and erudite study of riots in India only includesa paltry three references to the Rashtriya Swayemsevak Sangh (RSS) andVishwa Hindu Parishad (VHP), two Hindu nationalist organizations thatplay a central role in such riots. He also fails to mention the Bajrang Dal,the militant Hindu organization responsible for many of the attacks duringthe violence in Gujarat in 2002. This seems to summarize the problemwith his book: It is intriguing yet incomplete.The reason for this omission becomes clear from his central thesis:Riots seldom occur where integrated networks of civic engagement exist;riots are a common feature where interdependency is absent. Varshney, aprofessor of political science at the University of Michigan, surveys sixcities in India: three riot-prone (Hyderabad, Ahmedabad, Aligarh) andthree riot-free (Lucknow, Calicut, Surat).His focus on India’s urban centers is not without reason. Only 4% ofcommunal violence-related deaths have occurred in rural areas, where67% of the Indian population lives. Eight cities (whose total populationis only 5% of the country’s total population) account for 45% of deaths incommunal violence. Varshney seems overly eager to correct the notionthat Hindu-Muslim violence is a pan-Indian experience.His book highlights some important divisions that contribute to interreligiousdiscord. In chapter 5, for example, he notes that Aligarh MuslimUniversity (AMU), once an educational center for both Muslims andHindus, is now largely a university exclusively attended by Muslims.Such divisions at the higher academic levels lead to inevitable cleavagesin society. Varshney concludes that “local patterns of violence underlinehow important associational ties across communities are for peace inmulti-ethnic societies” (p. 11).It is tempting to agree with Varshney. His book suggests the basicpremise that if Muslims and Hindus work together, they will not resort tocommunal violence. One can understand why his ideas have gained supportfrom government officials, apologetic Indian scholars, and ...

Elder abuse and neglect: social problems revealed from 15 autopsy cases

This study examined the elder abuse cases that occurred in Gifu Prefecture, Japan between 1990 and 2000. We conducted a retrospective study of all the cases in which the victim was 65 years or older and autopsied in the Department of Legal Medicine, Gifu University School of Medicine. Fifteen victims were classified as elder abuse victims: five men and ten women. The victims ranged in age from 66 to 87 years (mean age, 74.5 years). The types of abuse were as follows: physical abuse, 13 cases; emotional abuse, five cases; neglect, four cases; and financial abuse, three cases. In eight cases, the victims were subjected to two or more types of abuse. The cause of death of the victims varied with the type of abuse. In the physical abuse cases, subdural hemorrhage was the most common cause, followed by other violence-related deaths and hypothermia. In the neglect cases, the victims died of either starvation or suffocation after the aspiration of food into the airway. In the domestic abuse cases, one of the victim's sons was the most common perpetrator, and little or no income was considered to be a risk factor for perpetrators. In the neglect cases, dementia and difficulty in performing activities of daily living were considered to be risk factors for victims, in addition to living in social isolation.