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K Tardiff

Publications and source records attributed to K Tardiff.

At least 37 records · Page 2Linked to original sources
PubMed1994

Homicide in New York City. Cocaine use and firearms.

OBJECTIVE: To determine differences between racial/ethnic groups in overall rates of death by homicide, proportion of firearm homicides, and the use of cocaine prior to death. DESIGN: Descriptive epidemiologic survey of a complete 2-year sample of homicides. SETTING: New York City, NY (population 7,322,564). SUBJECTS: All residents (N = 4298) of New York City who were victims of homicide during 1990 and 1991. MAIN OUTCOME MEASURES: Using medical examiner data, age- and gender-specific rates of homicide were calculated for African Americans, Latinos, and whites. Separate logistic regression analyses were conducted to examine the association between demographic variables and both recent cocaine use and firearm-related homicides. RESULTS: Young African-American and Latino men were more likely to be victims of homicide than all other demographic groups. Approximately three fourths of all homicides involved firearms. In the subset of homicide victims dying within 48 hours (n = 3890), 31.0% were positive for cocaine metabolites. African Americans (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2 to 2.1), Latinos (OR, 1.4; 95% CI, 1.1 to 1.9), and victims 25 through 34 years of age (OR, 2.9; 95% CI, 2.5 to 3.5) and 35 through 44 years of age (OR, 2.7; 95% CI, 2.2 to 3.4) were more likely to be positive for cocaine metabolites than other groups. Young males and females were equally likely to have used cocaine before death. Victims 15 through 24 years of age were more likely than other age groups to be killed by a firearm. African Americans (OR, 1.7; 95% CI, 1.3 to 2.3), Latinos (OR, 1.5; 95% CI, 1.2 to 2.0), and Asians (OR, 2.2; 95% CI, 1.4 to 3.6) were more likely than whites to be killed by a firearm. Men (OR, 4.8; 95% CI, 4.0 to 5.9) were more likely than women to be killed by a firearm. There was no association between having used cocaine before death and being killed by a firearm. CONCLUSIONS: The high rates of death by homicide among young African Americans and Latinos may be due to the increased involvement with both cocaine use and firearms. New efforts must be made to decrease cocaine use and firearm availability.

Adolescent↗
PubMed1994

Increase in fatal suicidal poisonings and suffocations in the year Final Exit was published: a national study.

Final Exit was a best-selling book that recommended poisoning and suffocation by plastic bag as lethal means of suicide for those with terminal medical illnesses. The authors sought to determine whether the number of suicides involving these methods increased in the United States in 1991, the year the book was published, compared with 1990. Suicidal asphyxiations involving a plastic bag increased 30.8%, from 334 to 437, and poisonings increased 5.4%, from 3,143 to 3,314. There was no change in the number of suicides involving each of the other methods or in the total number of suicides between 1990 and 1991. These ecological data support, but cannot conclusively prove, the hypothesis that Final Exit influenced the choice of lethal means of suicidal individuals.

Asphyxia↗
PubMed1992

The epidemiology of murder-suicide.

OBJECTIVE: To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence. DATA SOURCES: Data were obtained from English-language articles based on searches using MEDLINE (from 1966), PsychINFO (from 1967), and EMBASE (from 1974) programs. In addition, relevant articles, books, and monographs identified from the reference list of retrieved articles were reviewed. STUDY SELECTION: Case-control studies, descriptive epidemiologic surveys, and case series were chosen for review. DATA EXTRACTION: Because of the limited scope of the pertinent research literature, all data relevant to the incidence, demographics, circumstances, and precipitants of murder-suicide were summarized by the authors. DATA SYNTHESIS: Murder-suicide occurs with an annual incidence of 0.2 to 0.3 per 100,000 person-years and accounts for approximately 1000 to 1500 deaths yearly in the United States. The annual incidence of these events is relatively constant across industrialized nations and has not significantly changed over several decades. The principal perpetrators are young males with intense sexual jealousy, depressed mothers, or despairing elderly men with ailing spouses. The principal victims are female sexual partners or consanguineous relatives, usually young children. Clinical depression, specific motivations such as male sexual proprietariness or maternal salvation fantasies, and a history of previous suicide attempts are important in explaining underlying psychopathological mechanisms. CONCLUSIONS: Murder-suicide occupies a distinct epidemiological domain that overlaps with suicide, domestic homicide, and mass murder. These events may be categorized into one of only several phenomenologic typologies that share similar demographics, motivations, and circumstances. Despite the disruption of families and communities caused by murder-suicide, there are no standardized operational definitions, validated taxonomic systems, or national surveillance networks for these events, all of which are needed to develop prevention strategies.

Case-Control Studies↗
PubMed1992

Cocaine use, risk taking, and fatal Russian roulette.

OBJECTIVE: To examine the association between recent cocaine use and risk taking, particularly in the form of playing Russian roulette, a paradigm for extreme risk-taking behavior. DESIGN: A case-control study. CASES AND CONTROLS: The prevalence of cocaine use among all Russian roulette fatalities (N = 14) was compared with a demographically similar, randomly selected sample (N = 54) of all suicides by handgun during a contemporaneous 4-year period in New York City, NY. RESULTS: Recent use of cocaine, the most common drug found at autopsy, was detected in 64% of Russian roulette fatalities and in 35% of the control group (P less than .05). All Russian roulette fatalities were male and usually young and unemployed. Blacks and Hispanics accounted for 80% of all cases and were overrepresented compared with their numbers in the general population. CONCLUSION: In some populations cocaine may be associated with life-threatening risk-taking behaviors.

Adolescent↗
PubMed1992

The effect of access to lethal methods of injury on suicide rates.

The relationship between the availability of lethal methods of injury and suicide rates is an important, but unresolved question. We investigated this relationship by prospectively classifying lethal methods according to their accessibility in the five counties of New York City. These counties have both similarities and differences in the proportion of their populations with access to specific lethal means. We then compared the age- and gender-adjusted method-specific suicide rates of these counties. There were marked differences in overall crude suicide rates among the five counties. The counties had similar suicide rates involving methods that were equally accessible to all persons in each county (eg, hanging, laceration, suffocation, and burns) as well as methods that were accessible to a smaller, but similar proportion of the population in each county (eg, firearms and drowning in waterways). Virtually all of the differences in overall suicide risk among counties were explained by differences in rates involving methods that were differentially available in the counties, principally fall from height, overdose of prescription medications, and carbon monoxide poisoning. We conclude that differences in suicide rates between communities are, in large part, due to differences in accessibility to lethal methods of injury. Therefore, systematic studies should evaluate the effect of reducing accessibility to specific lethal means on suicide rates.

Age Factors↗
PubMed1992

The current state of psychiatry in the treatment of violent patients.

During the past 2 decades psychiatry has made great progress in describing patterns of violence by psychiatric patients and developing standards for the evaluation and treatment of these patients. Studies have found that roughly 10% of patients were violent toward other persons just prior to psychiatric hospitalization. Young male patients and patients in certain diagnostic groups had higher rates of violence. This report describes the proper evaluation of violent patients and proposes a model for the short-term potential of violent behavior. Psychiatry has developed guidelines for the acute treatment of violent patients using verbal intervention, physical restraint, and emergency medication. Long-term treatment relies on medication for the underlying disorder. Beyond their traditional indications, carbamazepine, propranolol hydrochloride, and lithium carbonate may be effective in diminishing violence. Some violent patients respond to long-term psychotherapy.

Female↗
PubMed1992

Prevalence of cocaine use among residents of New York City who committed suicide during a one-year period.

OBJECTIVE: In the mid-1980s the form of cocaine called "crack" became widely available in New York City. The authors sought to determine the prevalence of cocaine metabolites detected at autopsy in persons who committed suicide in New York City during this period. METHOD: Individual reviews of the autopsy and toxicological records of all persons under the age of 61 who had committed suicide in the city during a 1-year period were conducted to determine demographic characteristics, suicide methods, and cocaine and alcohol use at the time of death. RESULTS: In one of every five cases studied, the person who committed suicide had used cocaine within days of his or her death. The prevalence of cocaine use among young Hispanic males who committed suicide was 45%. Persons who were young, black, or Hispanic and who had used alcohol immediately before the fatal injury were most likely to have been recent cocaine users. After controlling for demographic variables and ethanol use, the investigators found that individuals who committed suicide with firearms were twice as likely to have used cocaine as those who used other methods. CONCLUSIONS: In contrast to the results of regional and household surveys during this period, which suggested that the current prevalence of cocaine use in New York City was 3%-5%, these results suggest a high prevalence of cocaine use in the days immediately preceding death by young persons who commit suicide. Additional studies are needed to determine how cocaine may act as a risk factor for suicide.

Adolescent↗
PubMed1992

Mentally abnormal offenders. Evaluation and management of violence.

Over the past two decades, much has been learned about the evaluation and management of violent patients. This has been translated into clinical guidelines for the evaluation and management of violent persons with psychiatric disorders. New research on neurotransmitters and the use of technology that can explore neurophysiologic and chemical activity in the brain promises continued advances in this area of psychiatry.

Adolescent↗
PubMed1990

Prevalence of recent cocaine use among motor vehicle fatalities in New York City.

We determined the prevalence of recent cocaine and alcohol use among motor vehicle fatalities occurring in New York, NY, from 1984 through 1987. Recent cocaine use was detected at autopsy in 18.2% of the sample and no significant difference between drivers (20.0%) and passengers (13.9%) was found. Both alcohol and cocaine metabolites were found in 10.0% of cases tested. The prevalence of cocaine metabolites or alcohol detected in driver fatalities aged 16 through 45 years did not change significantly when the period prior to the widespread availability of "crack" cocaine (1984 through 1985) was compared with the period immediately following the introduction of crack cocaine (1986 through 1987). Additional studies are needed both to elucidate the association between cocaine use and these fatalities and to determine the value of screening persons seriously injured in traffic accidents in areas where such drug use is endemic.

Accidents, Traffic↗
PubMed1989

Analysis of cocaine-positive fatalities.

A review of all autopsy and toxicology reports for persons dying in New York City in an 11-month period found 935 persons dying with cocaine in their bodies. Cocaine-positive fatalities were more likely in the young black and Hispanic and male population. In addition to cocaine and its metabolites, heroin and other opiates were found in 39% of persons and ethanol in 33% and barbiturates and minor tranquilizers in only 2% of the deceased. Cocaine overdose was responsible for 4% of the deaths and overdose with heroin and cocaine for 12% of the deaths. Violence was often the cause of death. Thirty-eight percent died of homicide, seven percent of suicide, and eight percent from accidents. Of particular interest were 6 persons who died of acute cardiac events directly related to cocaine as well as 4 cases of ruptured dissections of the ascending aorta, and 9 cases of cerebral hemorrhage. Autopsy findings for these individuals are described, and possible mechanisms of death are discussed.

Adolescent↗
PubMed1988

Increased risk of suicide in persons with AIDS.

The rate of suicide has been reported to be higher in persons with chronic and life-threatening illnesses (eg, cancer, Huntington's disease, and renal failure). We studied the rate of suicide in 1985 in New York City residents diagnosed with the acquired immunodeficiency syndrome (AIDS). There were 668 suicides in New York City residents in 1985, yielding a rate of 9.29 per 100,000 person-years. In men aged 20 to 59 years without a known diagnosis of AIDS, the rate was 18.75 per 100,000 person-years. There were 3828 individuals who lived with the diagnosis of AIDS for some part, or all, of 1985. There were 12 suicides in men aged 20 to 59 years from this group who lived 1763.25 person-years with a diagnosis of AIDS. This yields a suicide rate of 680.56 per 100,000 person-years. Thus, the relative risk of suicide in men with AIDS aged 20 to 59 years was 36.30 times (95% confidence limits, 20.45 to 64.42) that of men aged 20 to 59 years without this diagnosis, and 66.15 times (95% confidence limits, 37.38 to 117.06) that of the general population. We conclude that AIDS represents a significant risk factor for suicide.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Management of the violent patient in an emergency situation.

The management of an acute episode of violence by a psychiatric patient is probably one of the most demanding actions in psychiatry in terms of clinical competence and emotional impact on the clinician. In such situations, consideration of the safety of staff and other patients is paramount. Interventions available to the clinician in the management of acute violence include verbal intervention, restraint, seclusion and medication. This article offers guidelines for how to communicate with the patient. Issues of countertransference and emotional reactions to patients are addressed. The author has worked to develop national guidelines for the psychiatric use of seclusion and restraint in terms of indications, contraindications, implementation, review by the physician and the monitoring and care of the patient by staff.

Emergencies↗
PubMed1986

Selection and change of specialties by medical school graduates.

Previous studies of reasons for choosing medical specialties have been restricted to one specialty or to surveys of medical students. Since some students change their specialties after medical school, the present authors surveyed the graduates of a medical college's classes of 1971 through 1982 in regard to their selection of a number of different specialties. Overall, factors related to the content of the specialty and to contact with patients were rated as the most important in choosing a specialty; the quality of the medical college educational program was rated as of intermediate importance and life-style and personal factors as of least importance. Thirteen percent of those surveyed made major changes in specialties after graduation, with more of them leaving than entering internal medicine, pediatrics, and family practice and more of them entering than leaving the hospital service specialties (such as radiology and pathology) and psychiatry. The reasons for these changes involved financial and life-style considerations, for example, working hours, location, and financial rewards of practice.

Career Choice↗
PubMed1986

A study of homicides in Manhattan, 1981.

There were 573 persons murdered in Manhattan (New York) during 1981 for an overall rate of 40.5 per 100,000 population. The male, young, and Black or Latino populations were at higher risk of being homicide victims. For male victims, the homicides were the result of disputes in 37.6 per cent of the cases, drug-related activities in 37.6 per cent, and robbery and other criminal activities in 24.8 per cent of cases. For female victims, homicides resulted from disputes in 62.2 per cent of cases, drug-related activities in 13.8 per cent, and robberies in 20.0 per cent of cases. The observed proportion of homicides related to drug and other criminal activities was higher than has been reported previously in the United States. The role of alcohol continued to be important in homicides related to disputes. The authors stress the importance of differentiating drug-related homicides from those associated with other criminal activities.

Adolescent↗