POTD: Green spaces and violence

Happy Friday!

 

As previously mentioned, public health is a passion of mine, and this is one of my favorite public health topics to talk about. Today, we're talking about green spaces and their impact on violent crime. 

 

Green spaces (parks, community gardens, tree-covered sidewalks) have been shown to have a multitude of healthy benefits, such as reduced stress and anxiety, improving access to physical activity, social connection, and environmental benefits. However, a lesser-known benefit of green spaces is its association with reduced violence

 

Multiple studies as cited below have shown that neighborhoods with higher green space coverage are associated with lower rate of homicide, assault, and robbery. Several theories have been proposed to explain this association. Some are listed above (benefits of neighborhood green spaces), others include improved perceived quality of life, increased perceived order, and improvement in enfranchisement of residents in the community. Shepley et al. made a nice diagram with the theorized variables here:


However, as with many public health topics, this cannot be tested via a randomized controlled trial and only observational studies have been done, thus we only have data for correlation and not causation. Additionally, many studies do not account for confounding factors that may also affect rates of violent crime. The couple of studies I did find that accounted for confounding factors (Sanciangco et al, 2021 and Ogletree et al, 2022) still found that green spaces were correlated with reduced rates of violent crime. 

 

So, the data is not perfect, but there are a decent amount of observational studies on this topic. Anyways, I hope some of you guys found this interesting!

 

 

References

Sanciangco, J. C., Breetzke, G. D., Lin, Z., Wang, Y., Clevenger, K. A., and Pearson, A. L. (2021). The Relationship Between City “Greenness” and Homicide in the US: Evidence Over a 30-Year Period. Environment and Behavior. Advanced online publication. https://doi.org/10.1177/00139165211045095

Shepley M, Sachs N, Sadatsafavi H, Fournier C, Peditto K. The Impact of Green Space on Violent Crime in Urban Environments: An Evidence Synthesis. Int J Environ Res Public Health. 2019;16(24):5119. Published 2019 Dec 14. doi:10.3390/ijerph16245119

Venter ZS, Shackleton C, Faull A, Lancaster L, Breetzke G, Edelstein I. Is green space associated with reduced crime? A national-scale study from the Global South. Sci Total Environ. 2022;825:154005. doi:10.1016/j.scitotenv.2022.154005

Kim YJ, Kim EJ. Neighborhood Greenery as a Predictor of Outdoor Crimes between Low and High-Income Neighborhoods. Int J Environ Res Public Health. 2020;17(5):1470. Published 2020 Feb 25. doi:10.3390/ijerph17051470

University of Virginia Health System. "How green space can reduce violent crime." ScienceDaily. ScienceDaily, 27 February 2020. <www.sciencedaily.com/releases/2020/02/200227144253.htm>.

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POTD: C-Collars

Hellooo and welcome to Trauma Tuesday. Today we're going to be discussing c-collars, something that we very frequently see on our patients and very frequently place on our patients.

 

What is the evidence for it? Are we using c-collars correctly?

 

C-collars have been recommended by multiple academic societies (surgical, trauma, prehospital, neurological) to be placed pre-hospital if there is a suspected c-spine injury. This recommendation has been in place for ~30 years and has not really changed throughout that time. 

 

This recommendation has come into question in the past few years given that there aren't many high-quality RCTs truly showing he benefit of c-collars on c-spine injuries and subsequent spinal cord injuries. 

 

Additionally, conservative estimates show that at least 50-100 patients have c-collars placed on them for every patient that actually has a confirmed c-spine injury - and c-collars are not without harm.

 

C-collars have been shown to:

  • Increase intracranial pressure via jugular venous compression

  • Increase difficulty for airway management

  • Lead to pressure ulcers when used for an extended period of time

  • Lead to patient discomfort

  • Lead to increased CT imaging that may not have been necessary per our current evidence

 

Additionally, there is no evidence that small movements of the spine cause worsening c-spine injury. It's large, forceful impacts against the neck that lead to injury, and if the patient has a c-spine injury, they are unlikely to actively move their neck to a degree that will worsen their injury. 

 

However, given that c-collars are still standard of practice for anyone with a suspected (or confirmed) c-spine injury, we should still follow standard of practice and hospital protocols. Also, it's understandable that we, as EM providers, want to prevent the worst case scenario of a spinal cord injury. 

 

But I hope this POTD makes us all think harder about how many c-collars we're placing on our patients and the need for better evidence to support (or not support) this practice. 

 

References

Booth, K, Helman, A. Backboard and Collar Nightmares from Emergency Medicine Update Conference. Emergency Medicine Cases. May, 2015. https://emergencymedicinecases.com/backboard-and-collar-nightmares-emergency-medicine-update-conference/. Accessed October 7, 2024.

Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31(6):531-540. doi:10.1089/neu.2013.3094

Maschmann, C., Jeppesen, E., Rubin, M.A. et al. New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based. Scand J Trauma Resusc Emerg Med 27, 77 (2019). https://doi.org/10.1186/s13049-019-0655-x

Plumb, James O.M.Morris, Craig G. et al. Cervical Collars: Probably Useless; Definitely Cause Harm! Journal of Emergency Medicine, Volume 44, Issue 1, e143

https://www.jems.com/patient-care/why-ems-should-limit-use-rigid-cervical/

https://epmonthly.com/article/collar-care/

https://www.emdocs.net/cervical-collars-for-c-spine-trauma-the-facts/

https://www.emra.org/emresident/article/cervical-collar

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VOTW: Mass-ive Fever

This weeks’ VOTW was brought to you by Drs. Hannah Blakely, Patricia Camino, and the ultrasound team that was scanning that day!

HPI: 6 year old female with PMH of atrioventricular canal defect s/p repair, recent strep throat infection presenting for fever x 14 days.

Bedside POCUS showed:

Evaluating for endocarditis on POCUS:

B mode: look for masses, usually on the lower flow side of the valves (ex: mitral valve- endocarditis is more likely to be found on atrial side).

Color flow: you can usually find associated regurgitation of the affected valve

Possible mimics:

  • Thrombus

  • Papillary muscle rupture/flail leaflet

  • Intracardiac tumor

  • Artifact

Remember that a valve vegetation is one of the major diagnostic criteria for endocarditis. In the right clinical scenario this POCUS finding can highly increase your suspicion for endocarditis.

Case conclusion: CTAP significant for possible splenic and renal infarcts. Patient was admitted for suspected endocarditis. Blood cultures were +MSSA. Pediatric cardiology ECHO was consistent with mitral valve vegetation consistent with endocarditis and septic emboli.

Resources for more info:


Happy scanning!

  • The US Team