Violence in England and Wales in 2017: An Accident and Emergency perspective

Executive Summary • Serious violence levels and trends in England and Wales were studied based on data from a structured sample of 94 Emergency Departments (EDs), Minor Injury Units (MIUs) and Walk-in Centres. All are certified members of the National Violence Surveillance Network (NVSN). • Overall, an estimated 190,747 people attended EDs in England and Wales for treatment following violence in 2017, 1942 more than in 2016; a 1% increase. Falls or no change in overall violence levels in England and Wales according to this public health measure over the past decade were maintained in 2017. • In 2017, males (4.6 per 1,000 residents) were more than twice as likely as females (1.9 per 1,000 residents) to be treated in EDs following injury in violence. • Increases in violent injury among those aged 0-10 years (11%), 31-50 years (4.6%) and those aged 51 years and over (2.1%) were offset by the 1.8% decrease in violence among those aged 18-30 years. Due to small numbers, NVSN is unable to provide reliable violence trends for those aged 0-10 years. • Implementation of the new Emergency Care Data Set (ECDS) in Type 1 EDs in England led to increases in violence recording in the three months, October to December 2017. • Those most at risk of violence-related injury were males and those aged 18 to 30. Violence-related ED attendance was most frequent on Saturdays and Sundays

All-Wales licensed premises intervention (AWLPI): a randomised controlled trial to reduce alcohol-related violence

Background: Alcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom’s (UK) health services. Robust interventions targeted at licensed premises are therefore required to reduce the costs of alcohol-related harm. Previous evaluations of interventions in licensed premises have a number of methodological limitations and none have been conducted in the UK. The aim of the trial was to determine the effectiveness of the Safety Management in Licensed Environments intervention designed to reduce alcohol-related violence in licensed premises, delivered by Environmental Health Officers, under their statutory authority to intervene in cases of violence in the workplace.<p></p> Methods/Design: A national randomised controlled trial, with licensed premises as the unit of allocation. Premises were identified from all 22 Local Authorities in Wales. Eligible premises were those with identifiable violent incidents on premises, using police recorded violence data. Premises were allocated to intervention or control by optimally balancing by Environmental Health Officer capacity in each Local Authority, number of violent incidents in the 12 months leading up to the start of the project and opening hours. The primary outcome measure is the difference in frequency of violence between intervention and control premises over a 12 month follow-up period, based on a recurrent event model. The trial incorporates an embedded process evaluation to assess intervention implementation, fidelity, reach and reception, and to interpret outcome effects, as well as investigate its economic impact.<p></p> Discussion: The results of the trial will be applicable to all statutory authorities directly involved with managing violence in the night time economy and will provide the first formal test of Health and Safety policy in this environment. If successful, opportunities for replication and generalisation will be considered.<p></p&gt

Preventing violence-related injuries in England and Wales: A panel study examining the impact of on-trade and off-trade alcohol prices

Objective To examine the influence of real on-trade and off-trade alcohol prices and socioeconomic and environmental factors on rates of violence-related emergency department (ED) attendances in England and Wales over an 8-year period. Methods Anonymised injury data which included attendance date, age and gender of patients aged over 18 years who reported injury in violence were collected from a structured sample of 100 EDs across England and Wales between 1 January 2005 and 31 December 2012. Alcohol prices and socioeconomic measures were obtained from the UK Office for National Statistics. Panel techniques were used to derive a statistical model. Results Real on-trade (β=−0.661, p<0.01) and off-trade (β=−0.277, p<0.05) alcohol prices were negatively related with rates of violence-related ED attendance among the adult population of England and Wales, after accounting for the effects of regional poverty, income inequality, youth spending power and seasonal effects. It is estimated that over 6000 fewer violence-related ED attendances per year in England and Wales would result from a 1% increase in both on-trade and off-trade alcohol prices above inflation. Of the variables studied, changes in regional poverty and income inequality had the greatest effect on violence-related ED attendances in England and Wales. Conclusions Small increases in the price of alcohol, above inflation, in both markets, would substantially reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales. Reforming the current alcohol taxation system may be more effective at reducing violence-related injury than minimum unit pricing

Violence-related ambulance call-outs in the North West of England: a cross-sectional analysis of nature, extent and relationships to temporal, celebratory and sporting events.

OBJECTIVE: The aim of this study was to explore the potential of ambulance call-out data in understanding violence to inform about prevention activity. METHOD: This cross-sectional (2013-2015) study examined the nature, extent and characteristics of violence-related ambulance call-outs (n=15 687) across North West England and relationships with temporal, celebratory and sporting events. RESULTS: The majority of call-outs were for men, with a mean age of 33 years. Most call-outs were to deprived (64.4%) and urban (65.4%) areas and occurred at night (18:00-5:59; 75.2%). Three-quarters (77.3%) were recorded as assault/sexual assault and 22.7% stab/gunshot/penetrating trauma. Significant differences in call-out characteristics were identified between the two violence types. Generalised linear modelling found that call-outs significantly increased on weekends, New Year's Eve and weekday bank holiday eves (except for stab/gunshot/penetrating trauma). No significant associations between all violence call-outs, the two violence categories and sporting or celebration events were identified. Two-thirds (66.1%) of the call-outs were transferred to another health service for further assessment and/or treatment. The odds of being transferred were significantly higher among men (adjusted OR (AOR) 1.5, 95%CI 1.4 to 1.6), those aged 13-24 years (AOR 1.2, 95%CI 1.0 to 1.4), call-outs for stab/gunshot/penetrating trauma (AOR 1.4, 95%CI 1.3 to 1.5) and call-outs on Fridays/Saturdays (AOR 1.1, 95%CI 1.0 to 1.2) and lower for call-outs on New Year's Eve (AOR 0.6, 95%CI 0.4 to 0.9). CONCLUSION: Ambulance call-out data can provide a wealth of information to understand violence and subsequently inform about violence prevention and response activity. Ambulance services and staff could play a key role in preventing violence through sharing data and identifying and supporting victims

An evaluation of alcohol attendances to an inner city emergency department before and after the introduction of the UK Licensing Act 2003

Background: The Licensing Act 2003 (The Act) was implemented on the 24th November 2005 across England and Wales. The Act allowed more flexible and longer opening hours for licensed premises. We investigated the effect of The Act on alcohol related attendances to an inner city emergency department in Birmingham, UK. \ud \ud Methods: We compared the proportion and time of alcohol related emergency department attendances in one week periods in January 2005 and 2006, before and after the implementation of The Licensing Act 2003. An alcohol related attendance was defined as any attendance where there was any documentation of the patient having consumed alcohol before presenting to the emergency department, if they appeared intoxicated on examination, or if alcohol attributed to their final diagnosis. \ud \ud Results: The total weekly attendances increased slightly from 1,912 in 2005 to 2,146 in 2006. There was non-significant reduction in the proportion of alcohol related attendances between 2005 (3.6%) and 2006 (2.9%). A significantly greater proportion of attendances occurred at the weekend between 18.00 and 23.59 in 2005 (61.4%) than in 2006 (17.2%). There was a corresponding significant increase in the weekend proportion of attendances occurring between 03.00 to 05.59 in 2006. \ud \ud Conclusion: Our findings show that there was a change in the pattern of alcohol related attendances to the emergency department around the time of implementation of the Licensing Act 2003, which has implications for delivery of emergency department services

Immunology of choriodecidua and onset of labour

Introduction: Labour is a well-orchestrated process associated with inflammation; its onset is a poorly understood retrospective diagnosis. Immunology of pregnancy and labour is an area of wide interest; however, knowledge is lacking in what occurs at the maternal-fetal interface, the decidua. The aim of this thesis was to better understand the role of decidual immune cells in preterm birth and term labour while associating metabolites with immune cells that may be pivotal in labour. Methodology: Multiple cytokine assays were used to quantify cytokines/chemokines in choriodecidua/placenta. Flow cytometry was used to identify immune cells in decidua, placenta, maternal and cord blood. Mass spectrometry was used to quantify urinary metabolites. Results: Study one showed that choriodecidua was the most inflammatory gestational tissue analysed. Cytokines/chemokines indicated that NK cells, monocytes, T cells and neutrophils may play a significant role in preterm birth. Increased IL-8 in choriodecidua was associated with worse neonatal outcomes. Study two revealed a shift from predominantly CD56bright NK cells to a predominant subset of CD56+CD16+ NK cells with onset of term labour in decidua. Decidual NKbright cells and Tregs work together to maintain uterine quiescence at term, which is lost with labour. CD4+ Tregs and CD8+ Tregs were significantly higher in decidua than placenta/blood at term. Decidual monocytes, T cells and neutrophils did not alter with the onset of labour. Study three did not identify a signature urinary metabolic profile that is associated with the onset of labour. It highlighted that factors such as diet and lifestyle may cause inter-personal variability. Conclusions: This thesis highlights that the tolerant immune cells and their interaction with cytokines/chemokines maintain an immunological equilibrium in the decidua. This is altered with the onset of labour. Urinary metabolites inconsistently altered with the onset of labour, there was no signature urinary metabolic profile associated with labour.Open Acces

Denying humanness to victims: How gang members justify violent behavior

The high prevalence of violent offending amongst gang-involved youth has been established in the literature. Yet the underlying psychological mechanisms that enable youth to engage in such acts of violence remain unclear. 189 young people were recruited from areas in London, UK, known for their gang activity. We found that gang members, in comparison to non-gang youth, described the groups they belong to as having recognized leaders, specific rules and codes, initiation rituals, and special clothing. Gang members were also more likely than non-gang youth to engage in violent behavior and endorse moral disengagement strategies (i.e., moral justification, euphemistic language, advantageous comparison, displacement of responsibility, attribution of blame, and dehumanization). Finally, we found that dehumanizing victims partially mediated the relationship between gang membership and violent behavior. These findings highlight the effects of groups at the individual level and an underlying psychological mechanism that explains, in part, how gang members engage in violence