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ORIGINAL ARTICLE - RETROSPECTIVE STUDY
Year : 2021  |  Volume : 11  |  Issue : 1  |  Page : 103-107

Head and face injuries in Brazilian homicide victims – A retrospective study


Departament of Dentistry, School of Dentistry, State University of Paraíba, Campina Grande, PB, Brazil

Date of Submission05-May-2020
Date of Decision01-Feb-2021
Date of Acceptance08-Feb-2021
Date of Web Publication24-Jul-2021

Correspondence Address:
Prof. Alessandro Leite Cavalcanti
State University of Paraiba, School of Dentistry, Rua das Baraunas, 351, Bodocongo, Campina Grande, PB
Brazil
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DOI: 10.4103/ams.ams_158_20

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  Abstract 

Introduction: Violence is a serious problem in view of its magnitude and impact on the health of the population in several countries. The aim of the study was to evaluate the occurrence of head and face injuries among homicide victims in a municipality in the Northeastern region of Brazil. Materials and Methods: A cross-sectional study carried out at the Police Station for Crimes against Persons of the Civil Police, which evaluated 168 police inquiries of homicide victims notified from January 2015 to December 2018. Variables analyzed were related to the Victim's sociodemographic profile, homicide characteristics and body region involved. Descriptive data analysis and Pearson's Chi-square test (P < 0.05) were performed. Results: There was greater involvement of men (92.9%) aged 20–29 years (36.3%), drug users (70.7%) and with a criminal record (65.9%). There was a predominance of simple homicides (92.3%), with greater occurrence on Sundays (16.7%), in the night shift (40.1%), revenge was the main reason for the crime (32%), and firearms as the main means used (89.2%). Regarding the number of body regions affected, victims were more frequently affected in 2 regions (36.5%). Head injuries were identified in 68.3% of victims, while face injuries represented 35.3%. There was an association between the presence of head injuries and number of injuries (P < 0.05). Discussion: The prevalence of head and face injuries resulting from homicide was high and victims are predominantly young men, drug users and those with a criminal record. The association was found between the presence of head injuries and number of injuries.

Keywords: Epidemiologic studies, homicide, maxillofacial injuries


How to cite this article:
Cavalcanti AL, de Sousa FJ, Laureano IC, Cavalcanti AF. Head and face injuries in Brazilian homicide victims – A retrospective study. Ann Maxillofac Surg 2021;11:103-7

How to cite this URL:
Cavalcanti AL, de Sousa FJ, Laureano IC, Cavalcanti AF. Head and face injuries in Brazilian homicide victims – A retrospective study. Ann Maxillofac Surg [serial online] 2021 [cited 2021 Dec 5];11:103-7. Available from: https://www.amsjournal.com/text.asp?2021/11/1/103/322234


  Introduction Top


Violence is a worldwide phenomenon that contributes to deaths, diseases, disability, and several other social and health consequences.[1] In 2015, the estimate of homicide victims was approximately 470,000 people worldwide, with a global rate of 6.4/100,000 inhabitants, with almost 60.0% of cases involving males aged 15–44 years.[2] The region of the Americas has the highest homicide rate, 18.6/100,000 inhabitants, with almost 65,000 deaths occurring in Brazil.[2] Worldwide, more than one in seven homicide victims are young men aged 15–29 years living in the Americas.[3] High homicide rates put pressure on public health services, particularly in developing countries, where resources are scarce.[3]

The International Classification of Crime for Statistical Purposes, developed by the United Nations Office on Drugs and Crime, defines homicide as the “unlawful death inflicted on a person with the intention of causing death or serious injury.”[4] In Brazil, homicide is part of crimes against life of the Brazilian Penal Code, being the first typified crime.[5] The criminal investigation in the country is carried out by police agencies and gains materiality within the police inquiry instrument.[6] In all cases of violent deaths, forensic medical autopsy is mandatory. The reports generated contain details on the mechanisms of deaths, injuries present and the results of alcohol and toxicological tests, which are essential for understanding the dynamics of events and the risk factors involved.[7]

Studies carried out in hospital and forensic medical services in Brazil have demonstrated that violence has been one of the main etiological factors of injuries in the head and face region,[8],[9],[10] as well as in studies carried out in New Zealand,[11] in Burkina Faso,[12] the United States of America,[13] and Taiwan.[14] Injuries in this region aim to disqualify the victim's identity, act as a factor of intimidation, and in cases of violence with a firearm, there is an indisputable attempt to cause the death of victims due to the lethality and the power of destruction of face injuries.[15]

Sociocultural factors, level of economic development, unsatisfactory management and infrastructure, alcohol and drug use, organized crime, increased life expectancy, and unemployment change the pattern of homicides in countries[3] and consequently, of head and face injuries. Thus, violence prevention is the most effective method to avoid morbidity and mortality from these injuries. Epidemiological studies seek to understand the multifactorial aspects related to head and face injuries with the aim of determining the factors involved and the needs of developing effective health measures.[16]

In this context, this research aimed to assess the occurrence of head and face injuries among homicide victims in a municipality in the Northeastern region of Brazil.


  Materials and Methods Top


Study design and location

This is a retrospective, cross-sectional study that evaluated police inquiries of homicide victims opened at the Police Station for Crimes Against the Person of the Civil Police in the municipality of Campina Grande, Paraíba, Brazil.

Data collection

About 168 police inquiries of homicide victims were systematic randomly selected from January 2015 to December 2018 were evaluated. A minimum sample of 40 police inquiries per year of registration was established. Therefore, for every 3 police inquiries, one was assessed up to a maximum of 40 inquiries. The exclusion criterion was the absence of information >10%.[17]

Data collection was carried out between August and September 2019 by three trained researchers. The data collection instrument consisted of a questionnaire elaborated from information contained in the police inquiry based on the following documents: investigation form of the police station, police report (PR) and medical reports of the Forensic Science Institute of the State of Paraíba.

Variables analyzed were related to the victim's sociodemographic profile (year of occurrence, sex, age group, involvement with drugs and criminal history), homicide characteristics (type of homicide, day of the week, time of occurrence, homicide motivation, means used, number of projectiles, number of lesions), and body region involved (number of body regions involved and body location affected).

Data analysis

Data were tabulated into Microsoft Excel 2016 for Windows (Microsoft Press, Redmond, WA, USA) and later transferred to the IBM SPSS for Windows software, version 20.0 (IBM Corp., Armonk, NY, USA). Initially, descriptive statistical analysis was performed, which corresponded to the calculation of absolute and relative frequencies. Then, bivariate analysis was used, using Pearson's Chi-square test, considering the value for rejection of the null hypothesis of P < 0.05.

Ethical considerations

This research followed rules established in Resolution No. 466/12 of the Brazilian National Health Council and was approved by the Ethics Research Committee of the State University of Paraíba (CAAE: 0719.0.133.000-11).


  Results Top


Regarding the characterization of victims, it was verified that there was greater involvement of men (92.9%) aged 20–29 years (36.3%), involvement with drugs (70.7%) and presence criminal record (65.9%) [Table 1]. The male-to-female ratio was 13:1.
Table 1: Distribution of homicide victims according to years, sex, age group, involvement with drugs and criminal history

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There was predominance of simple homicides (92.3%), with greater occurrence on Sundays (16.7%), in the night shift (40.1%), revenge being the main reason for the crime (32%), firearms being the main means used (89.2%), and most of victims were affected by 5 or more projectiles (27.0%). Regarding the number of body injuries, there was a more significant number of multiple injuries (77.8%) [Table 2].
Table 2: Distribution of victims according to homicide characteristics

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Regarding the number of body regions affected, victims were more frequently affected in 2 regions (36.5%). Head injuries were identified in 68.3% of victims, while face injuries represented 35.3% [Table 3].
Table 3: Distribution of victims according to body regions involved

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There was an association between the presence of head injuries and number of body injuries (P < 0.05) [Table 4].
Table 4: Distribution of head injuries according to victim and homicide characteristics

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  Discussion Top


Violence is recognized as a worldwide public health problem.[1] In addition to interrupting life, homicide causes adverse effects among victims' relatives, as well as in society, generating a feeling of insecurity and contributing to impairing the socioeconomic development of countries.[3]

In the present study, male gender was predominant among homicide victims. This finding is in agreement with data from the World Health Organization, for the six regions of the world,[2] and from previous studies carried out by researchers in Brazil,[8] in India,[18] and in Taiwan.[14] A possible explanation for this result would be the greater exposure of male victims to outdoor activities, this way becoming more exposed to stress, frustrations, and violence.[19] However, women are more likely of becoming victims of domestic homicides due to the physical disadvantages of offering resistance to violence.[19]

According to the global study on homicide,[3] in some countries in Asia and Europe, homicide rates are approximately equal between sexes. Homicides involving males can be considered to be influenced by unstable factors, such as socio-political development and trafficking, which cause rate peaks. In contrast, female homicides are affected by long-term issues such as social roles, social norms, and the situation of women in society, making female homicide rates more stable.[3]

In this research, the occurrence of homicides was higher among young adult individuals, similar to the worldwide trend.[2] Young adults are the main victims of homicides, mainly due to social inequalities, school exclusion, lack of employment, and future perspectives.[20] Another factor may be related to family conflicts, capable of taking young people to the world of drugs, being an environment that encourages criminal practices.[21] In the region of the Americas, homicides involve gangs and organized crime in most cases with firearm injuries, and these factors are favorable to the prevalence of young people as victims and perpetrators of homicides.[3] Although women generally face much lower risk of homicide than men, the age profile of women follows the pattern of male victims.[3]

Involvement with drugs and criminal record was high, revealing a relationship with homicides in the region. Drugs are related to crime through three mechanisms, psychopharmacological, which refers to the propensity of individuals to commit violent crimes under the influence of psychoactive substances; economic-compulsive, through the motivation of financing their habits; and systemic, linked to the activities of traffickers.[3] A study carried out in a municipality in the southeastern region of Brazil found that almost one-third of homicide victims consumed alcohol and drugs, being more frequent among men, young people, blacks and those with low schooling.[22] The involvement with drugs can represent an opportunity for young Brazilians, because difficulties of life, limited access to education and job market, as well as social exclusion, make these individuals to lose interest in studies and work and begin to attribute significance to the visibility and immediate recognition that trafficking provides.[22] Measures that provide adequate treatment for drug users are beneficial both for their health and for reducing the risk of involvement in crimes, reflecting on positive effects on their lives and society.[3]

It was also observed that the majority of homicides occurred due to revenge, with the predominance of simple homicides occurring in the night shift and during weekends. The higher frequency of violence during the night shift and weekends corroborates other findings.[15],[18] This can probably be explained by the fact that, during this period, people go out to places in search for fun and leisure, with large concentrations of people and frequent exposure to alcohol and drugs.[23]

The means used in the vast majority of cases were firearm and this predominance is in agreement with a previous study.[8] In 2017, over half of homicides were carried out with weapons worldwide, with the region of Americas accounting for three-quarters of homicides with firearms.[3] In Brazil, from 1996 to 2018, of the total death notifications registered by assaults in the mortality information system (SIM) (n = 1,168,880), 69.7% of Brazilians were killed by firearms, with an increase of almost 80.0% in the period.[24] This increase may indicate that public disarmament policies have not been consistent over time and that there have been no effective strategies to reverse this process and minimize the impacts of firearm violence on the population's health.[23]

It was observed that countries with high homicide rates by firearms tend to have a higher number of homicides, which may indicate an association between firearms and high levels of violence.[3] The wide availability of firearms in the Americas, together with the proliferation of gangs and organized crime, may explain why many countries in the region suffer from higher number of homicides than expected from their level of development.[3]

The head region was affected in more than half of cases, while face injuries reached more than one-third of the total affected areas. Silva et al. highlighted that the face is the locus of uniqueness and identity of the human person, reporting that several factors can explain the pattern found in their study, such as subjective issues in the construction of identity, the place of men and women in contemporary society and the risk behaviors observed in adolescents, youth, or adults.[15]

The etiologic agent of head and face injuries varies among countries and even within the same country.[25] This variability depends on socioeconomic, cultural and environmental factors, awareness measures, and traffic education, becoming a matter of discussion among researchers.[26] Despite the vast consequence of homicides, nonfatal interpersonal violence is more common[1] and recognized as one of the main etiological factors of head and face injuries.[9],[10],[11],[12],[13],[14] A study carried out in a forensic medical service in the same municipality of this research identified that the prevalence of head and face injuries due to physical violence against older adults was 42.9% and there was a predominance of soft-tissue injuries that affected more than one region of the face.[27] In the study by Cavalcanti et al. in victims of car accidents, the pattern of head and face injuries differed, being higher on the face (17.4%) than on the head (7.8%).[28] The increasingly important role of violence as an etiological factor for head and face injuries may be related to the reduction of injuries related to traffic accidents due to current safety measures.[29] However, in view of the global growth of injuries from external causes, there is need to improve current policies and adopt more efficient preventive measures to reduce these rates.[30]

There was association between the presence of head injury and number of injuries. This fact may be related to the explicit desire to kill the victim through greater number of firearm shots in the head region.

As study limitations, it is possible to observe the impossibility of investigating the cause and effect relationship, since this study has a cross-sectional design, the use of convenience sampling and possible data incompleteness and inconsistencies in the definition of the basic cause of deaths. However, despite these aspects, data described here are extremely relevant, as they not only characterize the victims and the profile of injuries, but can be used by managers for the implementation of security measures aimed at reducing the occurrence of homicides.


  Conclusion Top


The prevalence of head and face injuries resulting from homicide was high, with a predominance of young men, drug users and those with criminal record as victims. There was an association between presence of head injuries and number of injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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World Health Organization. Global Status Report on Violence Prevention 2014. Geneva: World Health Organization; 2014. Available from: https://www.who.int/violence_injury_prevention/violence/status_report/2014/report/report/en/. [Last accessed on 2020 Apr 10].  Back to cited text no. 1
    
2.
Global Health Estimates 2015: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2015. Geneva: World Health Organization; 2016.  Back to cited text no. 2
    
3.
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4.
United Nations Office on Drugs and Crime. International Classification of Crime for Statistical Purposes (ICCS), Version 1.0. Vienna: United Nations Office on Drugs and Crime; 2015. Available from: https://www.unodc.org/unodc/en/data-and-analysis/statistics/iccs.html. [Last accessed on 2020 Apr 12].  Back to cited text no. 4
    
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Brasil. Presidência da República. Decreto-Lei n° 2.848, de 7 de Dezembro de 1940. Código Penal. Available from: http://www.planalto.gov.br/ccivil_03/Decreto-Lei/Del2848.htm. [Last accessed on 2020 Apr 10].  Back to cited text no. 5
    
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Brasil. Presidência da República. Decreto Lei n° 3.689 de 03 de Outubro de 1941. Código de Processo Penal. Available from: http://www.planalto.gov.br/ccivil_03/decreto-lei/del3689.htm. [Last accessed on 2020 Apr 10].  Back to cited text no. 6
    
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Hercules HC. Causa Jurídica da Morte. In: Hercules HC, editor. Medicina Legal – Texto e Atlas. 2nd ed. São Paulo: Editora Atheneu; 2014. p. 123-43.  Back to cited text no. 7
    
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Villalobos MI, Dos Santos AS, Horta MC, Miranda GE, Bastos JV, Côrtes MI. Prevalence of traumatic orofacial and dental injury in unidentified bodies-Data from a forensic medicine institute in Brazil. Dent Traumatol 2020;36:161-6.  Back to cited text no. 8
    
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Zamboni RA, Wagner JCB, Volkweis MR, Gerhardt EL, Buchmann EM, Bavaresco CS. Epidemiological study of facial fractures at the Oral and Maxillofacial Surgery Service, Santa Casa de Misericordia Hospital Complex, Porto Alegre - RS - Brazil. Rev Col Bras Cir 2017;44:491-7.  Back to cited text no. 9
    
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Conceição LD, da Silveira IA, Nascimento GG, Lund RG, da Silva RH, Leite FR. Epidemiology and risk factors of maxillofacial injuries in Brazil, a 5-year retrospective study. J Maxillofac Oral Surg 2018;17:169-74.  Back to cited text no. 10
    
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York BS, Sent-Doux KN, Heo J, Barnett M, Marsh RW, Mackinnon CA, et al. Interpersonal violence and maxillofacial fractures. Ann Maxillofac Surg 2019;9:315-8.  Back to cited text no. 11
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Silva CJ, Ferreira RC, de Paula LP, Haddad JP, Moura AC, Naves MD, et al. Maxillofacial injuries as markers of urban violence: A comparative analysis between the genders. Cien Saude Colet 2014;19:127-36.  Back to cited text no. 15
    
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20.
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Oliveira AL, Luna CF, Quinino LR, Magalhães MA, Santana VC. Spatial analysis of intentional homicides in João Pessoa, Paraíba, Brazil, 2011-2016. Epidemiol Serv Saude 2019;28:e2018184.  Back to cited text no. 21
    
22.
Drumond EF, Souza HN, Hang-Costa TA. Homicides, alcohol and drugs in Belo Horizonte, Minas Gerais State, Brazil, 2000-2009. Epidemiol Serv Saúde 2015;24:607-16.  Back to cited text no. 22
    
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de Macedo Bernardino Í, Santos LM, Ferreira AV, de Almeida Lima TLM, da Nóbrega LM, d'Avila S. Multiple correspondence analysis as a strategy to explore the association between categories of qualitative variables related to oral-maxillofacial trauma and violent crimes at the community level. Int J Oral Maxillofac Surg 2018;47:339-44.  Back to cited text no. 23
    
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Ramisetty S, Gaddipati R, Vura N, Pokala S, Kapse S. Maxillofacial injuries in women: A retrospective study of 10 years. J Maxillofac Oral Surg 2017;16:438-44.  Back to cited text no. 25
    
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27.
Sousa RI, Bernardino IM, Castro RD, Cavalcanti AL, Bento PM, d'Avila S. Maxillofacial trauma resulting from physical violence against older adults: A 4-year study in a Brazilian forensic service. Braz Res Pediatr Dent Integr Clin 2016;16:313-22.  Back to cited text no. 27
    
28.
Cavalcanti AF, Lucena BM, Oliveira TB, Cavalcanti CL, d'Avila S, Cavalcanti AL. Head and face injuries in automobile accidents and associated factors in a city in northeastern Brazil. Pesqui Bras Odontoped Clin Integr 2017;17:e3753.  Back to cited text no. 28
    
29.
Boffano P, Roccia F, Zavattero E, Dediol E, Uglešić V, Kovačič Ž, et al. European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study. J Craniomaxillofac Surg 2015;43:62-70.  Back to cited text no. 29
    
30.
Costa RC, Nóbrega JB, Dantas EL, Damascena LC, Protásio AP, Valença AM. Profile of hospitalizations and deaths from craniofacial fractures in Brazilian children and adolescents: An ecological study. Braz Res Pediatr Dent Integr Clin 2016;16:99-111.  Back to cited text no. 30
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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