Híjar MC, Lozano R, Valdez R, Blanco J

Language: Spanish
References: 29
Page: 35-42
PDF size: 108.12 Kb.

ABSTRACT

Introduction: Mexico City enters this century as one of the most populated cities in the world, where difficulties in living together multiply and become deeper, and living conditions have greatly deteriorated. Also, poverty has become more severe and this creates an environment where different expressions of violence propagate.
From the health perspective, the topic of violence as a public health problem is relatively recent and has led some international organizations to call attention to the social and economic cost and to the overload which injuries caused by violence are producing in the already saturated health systems.
Objective: To identify the causes for the demand of attention at the emergency health care of public hospitals in Mexico City due to intentional injuries produced by different types of violent acts.
Methods: A cross-sectional design was used, where the observational and analytical units were those individuals who due to intentional injuries demanded medical care at the hospital emergency services located in different areas of Mexico City.
Information was obtained through a questionnaire applied to individuals who had been intentionally injured, and collected by previously trained interviewers who covered the 24 hours of the day during the study period. The studied variables of the injured individuals were: age, sex, scholastic level, activity, alcohol intake before the event, pre-hospital care, type of injury and external cause, categorized according to the International Diseases Classification , as well as to the injury severity.
With respect to perpetrators, we were only able to obtain information on the relationship between the perpetrator and the injured, and the motivations. Based on this information, we categorized the type of violence as follows: a) Assault or robbery: when the injury was caused by strangers with the intention of stealing independently of the site of the event; b) Interpersonal violence: when the injury was caused by strangers or individuals known by the injured, at sites outside the home; c) Domestic violence: when the injury was inflicted by spouses or relatives, independently of the site and the level of kinship; d) Self-inflicted injuries: suicides and suicidal attempts were included in this category.
We carried out a descriptive analysis of data through calculations of simple frequencies for each one of the variables. Later on, through the statistical chi square, the proportional differences between the variables included in the study were figured according to the type of violence. We used the Stata 5 statistical package.
Results: The total number of the studied cases was 598, distributed as follows: 46% due to interpersonal violence, followed by assaultive injuries, which amounted to 28.6% of the total sample. In both types of violence, males were significantly more affected (p <0.0001), as well as young people between ages 15 and 24. The public thoroughfare was the most frequent site of events. Domestic violence reached 19.6% of the total sample. Females between ages 25 and 34 were significantly more affected (p <0.0001), their sexual partner was the perpetrator and the home was the site of the event in most cases. It is important to mention that this was the most frequent type of violence in all females of the sample, and the cause of the injury in 67% of all treated cases in this group, while in men, this was the cause in only 7.6% of the cases. Selfinflicted injuries reached a lesser percentage, with only 28 cases similarly distributed among men and women; the home was the main site of the event.
Self-inflicted injuries in women were due to the use of some kind of medicament, while in half of the men cutting or piercing instruments were involved, and in the other half, poisonous substances. The type of violence which caused the greatest number of severe cases were intentional injuries in a fight, firearms, or cutting or piercing instruments. It is important to mention that in the self-inflicted injuries the external cause which provoke the greatest number of severe cases was poisoning by solid or liquid substances since 64% of the total number of cases recorded in this category required hospitalization or died.
Conclusions: The categorization of different types of violence proposed in this work allows gaining insight into the weight of each type of violence requiring emergency hospital services, as well as of its impact on the severity, need of hospital care and cause of death in those who were injured and managed to reach a medical facility.
Generally, we observed that in cases of interpersonal violence and assaultive injuries, the perpetrators were mostly men and, at the same time, they were also more likely to be victims, especially among youngsters.
In spite of the fact that this study found that injuries caused by domestic violence are a less frequent reason for the demand of hospital services than injuries caused by other types of violence, it is important to keep in mind that probably the cases included in the study correspond to those perceived as being the most serious, and that it is easier to report an act caused by a stranger or an acquaintance than one perpetrated by a relative, above all if he is a spouse or sexual partner.
The complexity of the studied problem requires a clear definition of the type of cause on which one wishes to have an effect, as well as of the target population. We believe this study provides two analytical levels: on the one hand, the level closest to the violent event which is the cause of the injury (fight, robbery, etc.), and on the other hand, the method used to cause the injury (blows, firearm, etc.). Both levels may be analyzed based on the characteristics of the injured and the perpetrator.
Contributions and limitations: This study only includes the population demanding medical care at public hospitals in Mexico City and it portrays a type of violence which is fundamentally urban. This defines the specific population groups and the context where the demand for care due to intentional injuries is probably different from what is found at private hospitals or in rural settings. In spite of the fact that this limits the possibility of defining a model to explain the problem from an epidemiological point of view, this study provides valuable information on the motives for the aggression and the relationship between the injured and the perpetrators, on which there are no previously published studies in our country.

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