An Examination of the Effectiveness of Child Endangerment Laws in Preventing Child Fatalities in Alcohol-Involved Motor Vehicle Crashes.

PubMed

Kelley-Baker, Tara; Romano, Eduardo

2016-09-01

The aim of this study was to assess the impact of U.S. child-endangerment laws on the prevalence of child passengers fatally injured in motor vehicle crashes in which the adult driver was drinking. We used data from the 2002-2012 Fatality Analysis Reporting System. We conducted both bivariate and multivariate analyses using Heckman selection models. After adjusting for several cofactors, including driver demographics and blood alcohol concentration, child seat positioning, and seat belt laws, we found that passing a DUI child-endangerment law may have no impact at all on the likelihood of finding impaired drivers among those driving with children. There are a number of reasons why DUI child-endangerment laws have not been effective in saving the lives of young passengers who are driven by adult drinking drivers. These reasons include lack of publicity and education, as well as issues related to enforcement. Potential solutions are suggested that include examining sanctions and strengthening of DUI child endangerment laws.

Measles Case Fatality Rate in Bihar, India, 2011–12

PubMed Central

Murhekar, Manoj V.; Ahmad, Mohammad; Shukla, Hemant; Abhishek, Kunwar; Perry, Robert T.; Bose, Anindya S.; Shimpi, Rahul; Kumar, Arun; Kaliaperumal, Kanagasabai; Sethi, Raman; Selvaraj, Vadivoo; Kamaraj, Pattabi; Routray, Satyabrata; Das, Vidya Nand; Menabde, Nata; Bahl, Sunil

2014-01-01

Background Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage. Methods We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. Results The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths. Conclusions Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases. PMID:24824641

Multiscale Characterization of PM2.5 in Southern Taiwan based on Noise-assisted Multivariate Empirical Mode Decomposition and Time-dependent Intrinsic Correlation

NASA Astrophysics Data System (ADS)

Hsiao, Y. R.; Tsai, C.

2017-12-01

As the WHO Air Quality Guideline indicates, ambient air pollution exposes world populations under threat of fatal symptoms (e.g. heart disease, lung cancer, asthma etc.), raising concerns of air pollution sources and relative factors. This study presents a novel approach to investigating the multiscale variations of PM2.5 in southern Taiwan over the past decade, with four meteorological influencing factors (Temperature, relative humidity, precipitation and wind speed),based on Noise-assisted Multivariate Empirical Mode Decomposition(NAMEMD) algorithm, Hilbert Spectral Analysis(HSA) and Time-dependent Intrinsic Correlation(TDIC) method. NAMEMD algorithm is a fully data-driven approach designed for nonlinear and nonstationary multivariate signals, and is performed to decompose multivariate signals into a collection of channels of Intrinsic Mode Functions (IMFs). TDIC method is an EMD-based method using a set of sliding window sizes to quantify localized correlation coefficients for multiscale signals. With the alignment property and quasi-dyadic filter bank of NAMEMD algorithm, one is able to produce same number of IMFs for all variables and estimates the cross correlation in a more accurate way. The performance of spectral representation of NAMEMD-HSA method is compared with Complementary Empirical Mode Decomposition/ Hilbert Spectral Analysis (CEEMD-HSA) and Wavelet Analysis. The nature of NAMAMD-based TDICC analysis is then compared with CEEMD-based TDIC analysis and the traditional correlation analysis.

The impact of ART on TB case fatality stratified by CD4 count for HIV-positive TB patients in Cape Town, South Africa (2009–2011)

PubMed Central

Kaplan, Richard; Caldwell, Judy; Middelkoop, Keren; Bekker, Linda-Gail; MMed, Robin Wood

2014-01-01

Objective To identify determinants of TB case fatality including the impact of antiretroviral therapy (ART) at different CD4 thresholds for HIV-positive adult and adolescent TB patients. Methods Through a retrospective analysis of the electronic TB database, we identified the HIV status of newly registered patients ≥15 yrs. Multivariable Cox proportional hazard models were used to determine risk factors for TB case fatality in these patients. Results In 2009, 2010 and 2011, 25,841, 26,104 and 25,554 newly registered adult TB patients were treated in primary health care clinics in Cape Town, of whom 49.7%, 50.4% and 50.9% were HIV-positive. ART uptake increased over the three years from 43% to 64.9% and case fatality of the HIV-positive patients decreased from 7.0% to 5.8% (p<0.001). Female gender, increasing age, retreatment TB, low CD4 counts and extrapulmonary TB (EPTB) were associated with increased case fatality while patients on ART had a substantial decrease in case fatality. The difference in case fatality between patients on ART and not on ART was most pronounced at low CD4 counts with the positive influence of ART noted up to a CD4 count threshold of 350 cells/mm3 (p<0.001). Despite improvements in ART uptake, in 2011, 21% of patients with CD4 counts <350 cells/mm3 did not start ART during TB treatment. Conclusion This study showed a relatively poor uptake of ART among severely immune-compromised TB patients. Patients with CD4 counts <350 cells/mm3 were shown to clearly benefit from ART during TB treatment and ART initiation should be prioritised for this category of patients. PMID:24820105

Impact of ART on TB case fatality stratified by CD4 count for HIV-positive TB patients in Cape Town, South Africa (2009-2011).

PubMed

Kaplan, Richard; Caldwell, Judy; Middelkoop, Keren; Bekker, Linda-Gail; Wood, Robin

2014-08-15

To identify determinants of tuberculosis (TB) case fatality including the impact of antiretroviral therapy (ART) at different CD4 thresholds for HIV-positive adult and adolescent TB patients. Through a retrospective analysis of the electronic TB database, we identified the HIV status of newly registered patients aged ≥15 years. Multivariable Cox proportional hazard models were used to determine the risk factors for TB case fatality in these patients. In 2009, 2010, and 2011, 25,841, 26,104, and 25,554 newly registered adult TB patients were treated in primary health care clinics in Cape Town, of whom 49.7%, 50.4%, and 50.9% were HIV positive. ART uptake increased over 3 years from 43% to 64.9%, and case fatality of the HIV-positive patients decreased from 7.0% to 5.8% (P < 0.001). Female gender, increasing age, retreatment TB, low CD4 counts, and extrapulmonary TB were associated with increased case fatality, whereas patients on ART had a substantial decrease in case fatality. The difference in case fatality between patients on ART and not on ART was most pronounced at low CD4 counts with the positive influence of ART noted up to a CD4 count threshold of 350 cells per cubic millimeter (P < 0.001). Despite improvements in ART uptake, in 2011, 21% of the patients with CD4 counts <350 cells per cubic millimeter did not start ART during TB treatment. This study showed a relatively poor uptake of ART among severely immune-compromised TB patients. Patients with CD4 counts <350 cells per cubic millimeter were shown to clearly benefit from ART during TB treatment, and ART initiation should be prioritized for this category of patients.

An Examination of the Effectiveness of Child Endangerment Laws in Preventing Child Fatalities in Alcohol-Involved Motor Vehicle Crashes

PubMed Central

Kelley-Baker, Tara; Romano, Eduardo

2016-01-01

Objective: The aim of this study was to assess the impact of U.S. child-endangerment laws on the prevalence of child passengers fatally injured in motor vehicle crashes in which the adult driver was drinking. Method: We used data from the 2002–2012 Fatality Analysis Reporting System. We conducted both bivariate and multivariate analyses using Heckman selection models. Results: After adjusting for several cofactors, including driver demographics and blood alcohol concentration, child seat positioning, and seat belt laws, we found that passing a DUI child-endangerment law may have no impact at all on the likelihood of finding impaired drivers among those driving with children. Conclusions: There are a number of reasons why DUI child-endangerment laws have not been effective in saving the lives of young passengers who are driven by adult drinking drivers. These reasons include lack of publicity and education, as well as issues related to enforcement. Potential solutions are suggested that include examining sanctions and strengthening of DUI child endangerment laws. PMID:27588542

Correlates of pilot fatality in general aviation crashes.

PubMed

Li, G; Baker, S P

1999-04-01

General aviation accounts for the majority of aviation crashes and casualties in the United States, and general aviation safety has not improved in the past decade. This study identifies factors associated with pilot fatality in general aviation crashes. We analyzed the National Transportation Safety Board's Factual Reports for all airplane and helicopter crashes of general aviation flights that occurred in North Carolina and Maryland during 1985 through 1994. Surviving pilots were compared with fatally injured pilots in relation to crash circumstances, and pilot and aircraft characteristics, at bivariate level and multivariate level. A total of 667 crashes resulted in 276 deaths and 368 injuries during the 10-yr period in the two states. Of the pilots-in-command involved in these crashes, 146 (22%) died. The case fatality rate for pilots was significantly higher in crashes that occurred between 6 p.m. and 5 a.m. (34%), away from airports (36%), with aircraft fire (69%), or in instrument meteorological weather conditions (IMC) (71%). Multivariate logistic regression revealed that the significant correlates of pilot fatality were aircraft fire [odds ratio (OR) 13.7, 95% confidence interval (CI) 6.9-27.2], off-airport location (OR 9.9, 95% CI 5.0-19.6), IMC (OR 9.1, 95% CI 4.3-19.6), nighttime (OR 2.2, 95% CI 1.3-3.7), and pilot age > or = 50 yr (OR 1.7, 95% CI 1.0-3.0). Pilot gender, flight experience, principal profession, and type of aircraft (airplane vs. helicopter) were not significantly associated with the likelihood of survival. The most important correlates of pilot fatality are variables likely related to increased impact forces. Better occupant protection equipment, such as air bag and crashworthy fuel system, are needed for general aviation aircraft.

Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis.

PubMed

Wolf, Lindsey L; Chowdhury, Ritam; Tweed, Jefferson; Vinson, Lori; Losina, Elena; Haider, Adil H; Qureshi, Faisal G

2017-08-01

To examine geographic variation in motor vehicle crash (MVC)-related pediatric mortality and identify state-level predictors of mortality. Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers <15 years of age involved in fatal MVCs, defined as crashes on US public roads with ≥1 death (adult or pediatric) within 30 days. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100 000 children and percentage of children who died of those in fatal MVCs. Unit of analysis was US state. We used multivariable linear regression to define state characteristics associated with higher levels of each outcome. Of 18 116 children in fatal MVCs, 15.9% died. The age-adjusted, MVC-related mortality rate per 100 000 children varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate of 0.94). Predictors of greater age-adjusted, MVC-related mortality rate per 100 000 children included greater percentage of children who were unrestrained or inappropriately restrained (P < .001) and greater percentage of crashes on rural roads (P = .016). Additionally, greater percentages of children died in states without red light camera legislation (P < .001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1100 pediatric deaths averted over 5 years. MVC-related pediatric mortality varied by state and was associated with restraint nonuse or misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

No association between HIV status and risk of non-fatal overdose among people who inject drugs in Vancouver, Canada

PubMed Central

Escudero, Daniel J; Marshall, Brandon DL; Kerr, Thomas; Hayashi, Kanna; Feng, Cindy; Guillemi, Silvia A; Hogg, Robert S; Montaner, Julio; Wood, Evan; Milloy, M-J

2016-01-01

Background The evidence to date on whether HIV infection increases the risk of accidental drug overdose among people who inject drugs (PWID) is equivocal. Thus, we sought to estimate the effect of HIV infection on risk of non-fatal overdose among two parallel cohorts of HIV-positive and –negative PWID. Methods Data were collected from a prospective cohort of PWID in Vancouver, Canada between 2006 and 2013. During biannual follow-up assessments, non-fatal overdose within the previous 6 months was assessed. Bivariable and multivariable generalized mixed-effects regression models were used to determine the unadjusted and adjusted associations between HIV status, plasma HIV-1 RNA viral load, and likelihood of non-fatal overdose. Results A total of 1,760 eligible participants (67% male, median age = 42, and 42% HIV-positive at baseline) were included. Among 15,070 unique observations, 649 (4.3%) included a report of a non-fatal overdose within the previous 6 months (4.4% among seropositive and 4.3% among seronegative individuals). We did not observe a difference in the likelihood of overdose by HIV serostatus in crude (odds ratio [OR]: 1.05, p=0.853) analyses or analyses adjusted for known overdose risk factors (adjusted OR [AOR]: 1.19, p=0.474). In a secondary analysis, among HIV-positive PWID, we did not observe an association between having a detectable viral load and overdose (AOR: 1.03, p=0.862). Conclusions Despite the evidence that HIV infection is a risk factor for fatal overdose, we found no evidence for a relationship between HIV disease and non-fatal overdose. However, overdose remains high among PWID, indicating the need for ongoing policy addressing this problem, and research into understanding modifiable risk factors that predict non-fatal overdose. PMID:27082262

A decade of road traffic fatalities among the elderly in north-West Iran.

PubMed

Sadeghi-Bazargani, Homayoun; Samadirad, Bahram; Moslemi, Farnaz

2018-01-08

Iran has a uniquely catastrophic status for road traffic injury incidence and fatality. The elderly account for a substantial number of the hospitalizations and fatalities due to traffic injuries. The aim of this study was to investigate the crash mechanisms and medical outcomes of traffic fatalities among the elderly in East Azerbaijan province of Iran during the period 2006-2016. A total of 9435 fatalities registered in East Azerbaijan forensic medicine database, Iran, during 2006-2016, were investigated. Of these, 1357 were elderly persons (age > 65). Both victim- and crash-related variables were compared for the elderly and other age groups. Bivariate and multivariate analysis methods were applied using Stata statistical software package version 13. Of the 9435 fatalities, 1357 victims (14.4%) were elderly persons. The mean age of the elderly traffic fatalities was 75.3(SD = 6.2) years. About 78% of the elderly versus 80% of those in other age groups were males. A decreasing trend of fatal traffic accidents was observed over the study period both for the elderly and other age groups. The elderly were nearly seven times more likely to die as a pedestrian compared to other age groups. By exclusively analyzing pedestrians, it was found that motorcycles were responsible for pedestrian deaths in 9.1% of the fatalities while this figure was 5.5% for pedestrians in other age groups killed in a traffic accident (P < 0.05). About 56% (N = 761) of the elderly died in hospital which was higher than the proportion for other age groups (39%). Ambulance was the main vehicle for transferring the injured victims in four-fifths of the cases both for the elderly and other age groups. Although, in the present study, head injuries were the most common type of injury regardless of the age group, the elderly had a lower percentage of head injuries and a higher percentage of injuries to the torso, pelvis and limbs compared to younger victims. Pedestrian inner-city crashes in East Azerbaijan province of Iran are a major cause of road injury fatalities among the elderly and should be considered as a priority in road safety interventions.

Hepcidin-25 is related to cardiovascular events in chronic haemodialysis patients.

PubMed

van der Weerd, Neelke C; Grooteman, Muriel P C; Bots, Michiel L; van den Dorpel, Marinus A; den Hoedt, Claire H; Mazairac, Albert H A; Nubé, Menso J; Penne, E Lars; Wetzels, Jack F M; Wiegerinck, Erwin T; Swinkels, Dorine W; Blankestijn, Peter J; Ter Wee, Piet M

2013-12-01

The development of atherosclerosis may be enhanced by iron accumulation in macrophages. Hepcidin-25 is a key regulator of iron homeostasis, which downregulates the cellular iron exporter ferroportin. In haemodialysis (HD) patients, hepcidin-25 levels are increased. Therefore, it is conceivable that hepcidin-25 is associated with all-cause mortality and/or fatal and non-fatal cardiovascular (CV) events in this patient group. The aim of the current analysis was to study the relationship between hepcidin-25 and all-cause mortality and both fatal and non-fatal CV events in chronic HD patients. Data from 405 chronic HD patients included in the CONvective TRAnsport STudy (NCT00205556) were studied (62% men, age 63.7 ± 13.9 years [mean ± SD]). The median (range) follow-up was 3.0 (0.8-6.6) years. Hepcidin-25 was measured with mass spectrometry. The relationship between hepcidin-25 and all-cause mortality or fatal and non-fatal CV events was investigated with multivariate Cox proportional hazard models. Median (interquartile range) hepcidin-25 level was 13.8 (6.6-22.5) nmol/L. During follow-up, 158 (39%) patients died from any cause and 131 (32%) had a CV event. Hepcidin-25 was associated with all-cause mortality in an unadjusted model [hazard ratio (HR) 1.14 per 10 nmol/L, 95% CI 1.03-1.26; P = 0.01], but not after adjustment for all confounders including high-sensitive C-reactive protein (HR 1.02 per 10 nmol/L, 95% CI 0.87-1.20; P = 0.80). At the same time, hepcidin-25 was significantly related to fatal and non-fatal CV events in a fully adjusted model (HR 1.24 per 10 nmol/L, 95% CI 1.05-1.46, P = 0.01). Hepcidin-25 was associated with fatal and non-fatal CV events, even after adjustment for inflammation. Furthermore, inflammation appears to be a significant confounder in the relation between hepcidin-25 and all-cause mortality. These findings suggest that hepcidin-25 might be a novel determinant of CV disease in chronic HD patients.

Fatal and non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone.

PubMed

Kelty, Erin; Hulse, Gary

2017-08-01

Illicit opioid use is associated with high rates of fatal and non-fatal opioid overdose. This study aims to compare rates of fatal and serious but non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone, and to identify risk factors for fatal opioid overdose. Opioid dependent patients treated with methadone (n=3515), buprenorphine (n=3250) or implant naltrexone (n=1461) in Western Australia for the first time between 2001 and 2010, were matched against state mortality and hospital data. Rates of fatal and non-fatal serious opioid overdoses were calculated and compared for the three treatments. Risk factors associated with fatal opioid overdose were examined using multivariate cox proportional hazard models. No significant difference was observed between the three groups in terms of crude rates of fatal or non-fatal opioid overdoses. During the first 28days of treatment, rates of non-fatal opioid overdose were high in all three groups, as were fatal opioid overdoses in patients treated with methadone. However, no fatal opioid overdoses were observed in buprenorphine or naltrexone patients during this period. Following the first 28 days, buprenorphine was shown to be protective, particularly in terms of non-fatal opioid overdoses. After the cessation of treatment, rates of fatal and non-fatal opioid overdoses were similar between the groups, with the exception of lower rates of non-fatal opioid overdose in the naltrexone treated patients compared with the methadone treated patients. After the commencement of treatment, gender, and hospitalisations with a diagnosis of opioid poisoning, cardiovascular or mental health problems were significant predictors of subsequent fatal opioid overdose. Rates of fatal and non-fatal opioid overdose were not significantly different in patients treated with methadone, buprenorphine or implant naltrexone. Gender and prior cause-specific hospitalisations can be used to identify patients at a high risk of fatal opioid overdose. Copyright © 2017 Elsevier B.V. All rights reserved.

History of kidney stones and risk of coronary heart disease

PubMed Central

Ferraro, Pietro Manuel; Taylor, Eric N; Eisner, Brian H; Gambaro, Giovanni; Rimm, Eric B; Mukamal, Kenneth J; Curhan, Gary C

2014-01-01

Importance Kidney stone disease is common and may be associated with an increased risk of coronary heart disease (CHD). However, previous studies of the association between kidney stones and CHD have often not controlled for important risk factors, and the results have been inconsistent. Objective We examined the association between a history of kidney stones and the risk of CHD in three large prospective cohorts. Design, setting, and participants Prospective study of 45,748 men and 196,357 women in the United States without a history of CHD at baseline who were participants in the Health Professionals Follow-Up Study (HPFS, 51,529 men aged 40–75 years followed since 1986), Nurses’ Health Study (NHS) I (121,700 women aged 30–55 years followed since 1976) and II (116,430 women aged 25–42 years followed since 1989). The diagnoses of kidney stones and CHD were updated biennially during follow-up. Main outcome measure CHD was defined as fatal or non-fatal myocardial infarction (MI) or coronary revascularization. The outcome was identified by biennial questionnaires and confirmed through review of medical records (fatal and non-fatal MI). Results Out of a total of 242,105 participants, 19,678 reported a history of kidney stones. After up to 24 years of follow-up in men and 18 years in women, 16,838 incident cases of CHD occurred. After adjusting for potential confounders, among women, those with a reported history of kidney stones compared with those without had an increased risk of CHD in NHS I (incidence rate (IR) 754 vs 514/100,000 person-years; multivariate HR 1.18, 95% CI 1.08 to 1.28) and NHS II (IR 144 vs 55/100,000 person-years; multivariate HR 1.48, 95% CI 1.23 to 1.78); there was no significant association in men (IR 1,355 vs 1,022/100,000 person-years; multivariate HR 1.06, 95% CI 0.99 to 1.13). Similar results were found when analyzing the individual end-points (fatal and non-fatal MI, revascularization). Conclusions Among two cohorts of women, a history of kidney stones was associated with a modest but statistically significant increased risk of CHD; there was no significant association in a separate cohort of men. Further research is needed to determine whether the association is sex-specific. PMID:23917291

Acute gouty arthritis complicated with acute ST elevation myocardial infarction is independently associated with short- and long-term adverse non-fatal cardiac events.

PubMed

Liu, Kuan-Liang; Lee, Hsin-Fu; Chou, Shing-Hsien; Lin, Yen-Chen; Lin, Chia-Pin; Wang, Chun-Li; Chang, Chi-Jen; Hsu, Lung-An

2014-01-01

Large epidemiologic studies have associated gouty arthritis with the risk of coronary heart disease. However, there has been a lack of information regarding the outcomes for patients who have gout attacks during hospitalization for acute myocardial infarction. We reviewed the data of 444 consecutive patients who were admitted to our hospital between 2005 and 2008 due to acute ST elevation myocardial infarction (STEMI). The clinical outcomes were compared between patients with gout attack and those without. Of the 444, 48 patients with acute STEMI developed acute gouty arthritis during hospitalization. The multivariate analysis identified prior history of gout and estimated glomerular filtration rate as independent risk factors of gout attack for patients with acute STEMI (odds ratio (OR) 21.02, 95 % CI 2.96-149.26, p = 0.002; OR 0.92, 95 % CI 0.86-0.99, p = 0.035, respectively). The in-hospital mortality and duration of hospital stay did not differ significantly between the gouty group and the non-gouty group (controls). During a mean follow-up of 49 ± 28 months, all-cause mortality and stroke were similar for both groups. Multivariate Cox regression showed that gout attack was independently associated with short- and long-term adverse non-fatal cardiac events (hazard ratio (HR) 1.88, 95 % CI 1.09-3.24, p = 0.024; HR 1.82, 95 % CI 1.09-3.03, p = 0.022, respectively). Gout attack among patients hospitalized due to acute STEMI was independently associated with short-term and long-term rates of adverse non-fatal cardiac events.

The Role of Plasma Triglyceride/High-Density Lipoprotein Cholesterol Ratio to Predict New Cardiovascular Events in Essential Hypertensive Patients.

PubMed

Turak, Osman; Afşar, Barış; Ozcan, Fırat; Öksüz, Fatih; Mendi, Mehmet Ali; Yayla, Çagrı; Covic, Adrian; Bertelsen, Nathan; Kanbay, Mehmet

2016-08-01

Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been suggested as a simple method to identify unfavorable cardiovascular outcomes in the general population. The effect of the TG/HDL-C ratio on essential hypertensive patients is unclear. About 900 consecutive essential hypertensive patients (mean age 52.9±12.6 years, 54.2% male) who visited our outpatient hypertension clinic were analyzed. Participants were divided into quartiles based on baseline TG/HDL-C ratio and medical records were obtained periodically for the occurrence of fatal events and composite major adverse cardiovascular events (MACEs) including transient ischemic attack, stroke, aortic dissection, acute coronary syndrome, and death. Participants were followed for a median of 40 months (interquartile range, 35-44 months). Overall, a higher quartile of TG/HDL-C ratio at baseline was significantly linked with higher incidence of fatal and nonfatal cardiovascular events. Using multivariate Cox regression analysis, plasma TG/HDL-C ratio was independently associated with increased risk of fatal events (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.13-1.37; P≤.001] and MACEs (HR, 1.13; 95% CI, 1.06-1.21; P≤.001). Increased plasma TG/HDL-C ratio was associated with more fatal events and MACEs in essential hypertensive patients. © 2015 Wiley Periodicals, Inc.

[Methods of the multivariate statistical analysis of so-called polyetiological diseases using the example of coronary heart disease].

PubMed

Lifshits, A M

1979-01-01

General characteristics of the multivariate statistical analysis (MSA) is given. Methodical premises and criteria for the selection of an adequate MSA method applicable to pathoanatomic investigations of the epidemiology of multicausal diseases are presented. The experience of using MSA with computors and standard computing programs in studies of coronary arteries aterosclerosis on the materials of 2060 autopsies is described. The combined use of 4 MSA methods: sequential, correlational, regressional, and discriminant permitted to quantitate the contribution of each of the 8 examined risk factors in the development of aterosclerosis. The most important factors were found to be the age, arterial hypertension, and heredity. Occupational hypodynamia and increased fatness were more important in men, whereas diabetes melitus--in women. The registration of this combination of risk factors by MSA methods provides for more reliable prognosis of the likelihood of coronary heart disease with a fatal outcome than prognosis of the degree of coronary aterosclerosis.

Association between vascular calcification assessed by simple radiography and non-fatal cardiovascular events in hemodialysis patients.

PubMed

Petrauskiene, Vaida; Vaiciuniene, Ruta; Bumblyte, Inga Arune; Kuzminskis, Vytautas; Ziginskiene, Edita; Grazulis, Saulius; Jonaitiene, Egle

2016-12-01

Vascular calcification (VC) is one of the factors associated with cardiovascular mortality in hemodialysis (HD) patients. Recommendations concerning screening for VC differ. Possible ability to prevent and reversibility of VC are major subjects on debate whether screening for VC could improve outcomes of renal patients. The objective of the study was to evaluate the significance of simple vascular calcification score (SVCS) based on plane radiographic films and to test its association with non-fatal cardiovascular events in patients on chronic HD. A study population consisted of 95 prevalent HD patients in the HD unit of Hospital of Lithuanian University of Health sciences Kaunas Clinics. Clinical data and laboratory tests information were collected from medical records. SVCS was evaluated as it is described by Adragao et al. After measurement of VC, HD patients were observed for novel non-fatal cardiovascular events. Patients were divided into two groups: SVCS≥3 (57 patients [60%]) and <3 (38 patients [40%]). The Kaplan-Meier survival curves show a significant difference in non-fatal cardiovascular events in the group with SVCS≥3 vs. <3 group (26.3% vs. 7.8%; log rank 5,49; P=0.018). Multivariate Cox regression analysis confirmed a negative impact of VC, hyperphosphatemia, and lower ejection fraction on cardiovascular events. No statistically significant differences were observed comparing parameters of Ca-P metabolism disorders between groups with different SVCS. On separate analysis, the presence of VC in hands was also associated with higher rate of novel cardiovascular events (score 0 goup-5 events [10.6%] vs. score≥1 group-13 events [27%], log rank P=0.035). VC assessed by simple and inexpensive radiological method was an independent predictor of novel non-fatal cardiovascular events in HD patients. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Graduated driver license nighttime compliance in U.S. teen drivers involved in fatal motor vehicle crashes.

PubMed

Carpenter, Dustin; Pressley, Joyce C

2013-07-01

Examination of teen driver compliance with graduated driver licensing (GDL) laws could be instrumental in identifying factors associated with persistently high motor vehicle mortality rates. Fatality analysis reporting system (FARS) data from the years 2006 to 2009 were used in this nation-wide cross-sectional study of drivers covered by a state nighttime GDL law (n=3492). A new definition of weekend, based on the school night in relation to the teenage social landscape, redefined Friday night as a weekend night and Sunday night as a weekday/school night and compared it to previous weekend definitions. Multiple logistic regression was used to examine independent effects of demographic, behavioral, environmental, contextual, and other factors on compliance with nighttime GDL laws. All analyses were performed in Stata version 11. Given coverage under nighttime GDL laws, drivers aged 15-17 years were non-compliant in 14.9% of the fatal MVCs in which they were involved, and nearly one-fifth (18.8%) of all fatalities aged 15-17 years were associated with non-compliance. Mortality risk was 10% higher using a revised social (school night) versus traditional (Sat-Sun) weekend definitions. In multivariable analysis, drivers non-compliant with nighttime GDL laws were more likely to be drinking (OR=4.97, 3.85-6.40), unbelted (OR=1.58, 1.25-1.99), driving on the weekend (OR=1.82, 1.47-2.24), and killed (OR=1.31, 1.04-1.65). GDL non-compliance contributes to teen motor vehicle mortality. Legislative and enforcement efforts targeting non-school night driving, seatbelt nonuse and alcohol have potential to further reduce teen driving mortality. Copyright © 2012 Elsevier Ltd. All rights reserved.

Screening and analysis of aconitum alkaloids and their metabolites in rat urine after oral administration of aconite roots extract using LC-TOFMS-based metabolomics.

PubMed

Tan, Guangguo; Lou, Ziyang; Jing, Jing; Li, Wuhong; Zhu, Zhenyu; Zhao, Liang; Zhang, Guoqing; Chai, Yifeng

2011-12-01

Aconite roots are popularly used in herbal medicines in China. Many cases of accidental and intentional intoxication with this plant have been reported; some of these are fatal because the toxicity of aconitum is very high. It is thus important to detect and identify aconitum alkaloids in biofluids. In this work, an improved method employing LC-TOFMS with multivariate data analysis was developed for screening and analysis of major aconitum alkaloids and their metabolites in rat urine following oral administration of aconite roots extract. Thirty-four signals highlighted by multivariate statistical analyses including 24 parent components and 10 metabolites were screened out and further identified by adjustment of the fragmentor voltage to produce structure-relevant fragment ions. It is helpful for studying aconite roots in toxicology, pharmacology and forensic medicine. This work also confirmed that the metabolomic approach provides effective tools for screening multiple absorbed and metabolic components of Chinese herbal medicines in vivo. Copyright © 2011 John Wiley & Sons, Ltd.

The effects of driving age, driver education, and curfew laws on traffic fatalities of 15-17 year olds.

PubMed

Levy, D T

1988-12-01

This study examines the effect of state driving age, learning permit, driver's education, and curfew laws on 15-17-year-old driver fatality rates. A multivariate regression model is estimated for 47 states and nine years. The minimum legal driving age and curfew laws are found to be important determinants of fatalities. Driver's education and learning permits have smaller effects. The relationship between rates of licensure and driving age, education, and curfew laws is also examined. In each case, a more restrictive policy is found to reduce licensure of 15-17 year olds. The results suggest that the imposition of curfew laws and higher minimum driving ages are particularly effective traffic safety policies.

Cirrus Airframe Parachute System and Odds of a Fatal Accident in Cirrus Aircraft Crashes.

PubMed

Alaziz, Mustafa; Stolfi, Adrienne; Olson, Dean M

2017-06-01

General aviation (GA) accidents have continued to demonstrate high fatality rates. Recently, ballistic parachute recovery systems (BPRS) have been introduced as a safety feature in some GA aircraft. This study evaluates the effectiveness and associated factors of the Cirrus Airframe Parachute System (CAPS) at reducing the odds of a fatal accident in Cirrus aircraft crashes. Publicly available Cirrus aircraft crash reports were obtained from the National Transportation Safety Board (NTSB) database for the period of January 1, 2001-December 31, 2016. Accident metrics were evaluated through univariate and multivariate analyses regarding odds of a fatal accident and use of the parachute system. Included in the study were 268 accidents. For CAPS nondeployed accidents, 82 of 211 (38.9%) were fatal as compared to 8 of 57 (14.0%) for CAPS deployed accidents. After controlling for all other factors, the adjusted odds ratio for a fatal accident when CAPS was not deployed was 13.1. The substantial increased odds of a fatal accident when CAPS was not deployed demonstrated the effectiveness of CAPS at providing protection of occupants during an accident. Injuries were shifted from fatal to serious or minor with the use of CAPS and postcrash fires were significantly reduced. These results suggest that BPRS could play a significant role in the next major advance in improving GA accident survival.Alaziz M, Stolfi A, Olson DM. Cirrus Airframe Parachute System and odds of a fatal accident in Cirrus aircraft crashes. Aerosp Med Hum Perform. 2017; 88(6):556-564.

Associations between unprocessed red and processed meat, poultry, seafood and egg intake and the risk of prostate cancer: A pooled analysis of 15 prospective cohort studies.

PubMed

Wu, Kana; Spiegelman, Donna; Hou, Tao; Albanes, Demetrius; Allen, Naomi E; Berndt, Sonja I; van den Brandt, Piet A; Giles, Graham G; Giovannucci, Edward; Alexandra Goldbohm, R; Goodman, Gary G; Goodman, Phyllis J; Håkansson, Niclas; Inoue, Manami; Key, Timothy J; Kolonel, Laurence N; Männistö, Satu; McCullough, Marjorie L; Neuhouser, Marian L; Park, Yikyung; Platz, Elizabeth A; Schenk, Jeannette M; Sinha, Rashmi; Stampfer, Meir J; Stevens, Victoria L; Tsugane, Shoichiro; Visvanathan, Kala; Wilkens, Lynne R; Wolk, Alicja; Ziegler, Regina G; Smith-Warner, Stephanie A

2016-05-15

Reports relating meat intake to prostate cancer risk are inconsistent. Associations between these dietary factors and prostate cancer were examined in a consortium of 15 cohort studies. During follow-up, 52,683 incident prostate cancer cases, including 4,924 advanced cases, were identified among 842,149 men. Cox proportional hazard models were used to calculate study-specific relative risks (RR) and then pooled using random effects models. Results do not support a substantial effect of total red, unprocessed red and processed meat for all prostate cancer outcomes, except for a modest positive association for tumors identified as advanced stage at diagnosis (advanced(r)). For seafood, no substantial effect was observed for prostate cancer regardless of stage or grade. Poultry intake was inversely associated with risk of advanced and fatal cancers (pooled multivariable RR [MVRR], 95% confidence interval, comparing ≥ 45 vs. <5 g/day: advanced 0.83, 0.70-0.99; trend test p value 0.29), fatal, 0.69, 0.59-0.82, trend test p value 0.16). Participants who ate ≥ 25 versus <5 g/day of eggs (1 egg ∼ 50 g) had a significant 14% increased risk of advanced and fatal cancers (advanced 1.14, 1.01-1.28, trend test p value 0.01; fatal 1.14, 1.00-1.30, trend test p value 0.01). When associations were analyzed separately by geographical region (North America vs. other continents), positive associations between unprocessed red meat and egg intake, and inverse associations between poultry intake and advanced, advanced(r) and fatal cancers were limited to North American studies. However, differences were only statistically significant for eggs. Observed differences in associations by geographical region warrant further investigation. © 2015 UICC.

Dietary and Plasma Magnesium and Risk of Coronary Heart Disease Among Women

PubMed Central

Chiuve, Stephanie E.; Sun, Qi; Curhan, Gary C.; Taylor, Eric N.; Spiegelman, Donna; Willett, Walter C.; Manson, JoAnn E.; Rexrode, Kathryn M.; Albert, Christine M.

2013-01-01

Background Magnesium is associated with lower risk of sudden cardiac death, possibly through antiarrhythmic mechanisms. Magnesium influences endothelial function, inflammation, blood pressure, and diabetes, but a direct relation with coronary heart disease (CHD) risk has not been established. Methods and Results We prospectively examined the association between dietary and plasma magnesium and risk of CHD among women in the Nurses' Health Study. The association for magnesium intake was examined among 86 323 women free of disease in 1980. Information on magnesium intake and lifestyle factors was ascertained every 2 to 4 years through questionnaires. Through 2008, 3614 cases of CHD (2511 nonfatal/1103 fatal) were documented. For plasma magnesium, we conducted a nested case–control analysis, with 458 cases of incident CHD (400 nonfatal/58 fatal) matched to controls (1:1) on age, smoking, fasting status, and date of blood sampling. Higher magnesium intake was not associated with lower risk of total CHD (P‐linear trend=0.12) or nonfatal CHD (P‐linear trend=0.88) in multivariable models. However, magnesium intake was inversely associated with risk of fatal CHD. The RR comparing quintile 5 to quintile 1 of magnesium intake was 0.61 (95% CI, 0.45 to 0.84; P‐linear trend=0.003). The association between magnesium intake and risk of fatal CHD appeared to be mediated partially by hypertension. Plasma magnesium levels above 2.0 mg/dL were associated with lower risk of CHD, although not independent of other cardiovascular biomarkers (RR, 0.67; 95% CI, 0.44 to 1.04). Conclusions Dietary and plasma magnesium were not associated with total CHD incidence in this population of women. Dietary magnesium intake was inversely associated with fatal CHD, which may be mediated in part by hypertension. PMID:23537810

n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes

PubMed Central

Kromhout, Daan; Geleijnse, Johanna M.; de Goede, Janette; Oude Griep, Linda M.; Mulder, Barbara J.M.; de Boer, Menko-Jan; Deckers, Jaap W.; Boersma, Eric; Zock, Peter L.; Giltay, Erik J.

2011-01-01

OBJECTIVE We carried out a secondary analysis in high-risk patients with a previous myocardial infarction (MI) and diabetes in the Alpha Omega Trial. We tested the hypothesis that in these patients an increased intake of the n-3 fatty acids eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and α-linolenic acid (ALA) will reduce the incidence of ventricular arrhythmias and fatal MI. RESEARCH DESIGN AND METHODS A subgroup of 1,014 post-MI patients with diabetes aged 60–80 years was randomly allocated to receive one of four trial margarines, three with an additional amount of n-3 fatty acids and one placebo for 40 months. The end points were ventricular arrhythmia–related events and fatal MI. The data were analyzed according to the intention-to-treat principle, using multivariable Cox proportional hazards models. RESULTS The patients consumed on average 18.6 g of margarine per day, which resulted in an additional intake of 223 mg EPA plus 149 mg DHA and/or 1.9 g ALA in the active treatment groups. During follow-up, 29 patients developed a ventricular arrhythmia–related events and 27 had a fatal MI. Compared with placebo patients, the EPA-DHA plus ALA group experienced less ventricular arrhythmia–related events (hazard ratio 0.16; 95% CI 0.04–0.69). These n-3 fatty acids also reduced the combined end-point ventricular arrhythmia–related events and fatal MI (0.28; 0.11–0.71). CONCLUSIONS Our results suggest that low-dose supplementation of n-3 fatty acids exerts a protective effect against ventricular arrhythmia–related events in post-MI patients with diabetes. PMID:22110169

Epidemiology of Road Traffic Incidents in Peru 1973–2008: Incidence, Mortality, and Fatality

PubMed Central

Miranda, J. Jaime; López-Rivera, Luis A.; Quistberg, D. Alex; Rosales-Mayor, Edmundo; Gianella, Camila; Paca-Palao, Ada; Luna, Diego; Huicho, Luis; Paca, Ada; Luis, López; Luna, Diego; Rosales, Edmundo; Best, Pablo; Best, Pablo; Egúsquiza, Miriam; Gianella, Camila; Lema, Claudia; Ludeña, Esperanza; Miranda, J. Jaime; Huicho, Luis

2014-01-01

Background The epidemiological profile and trends of road traffic injuries (RTIs) in Peru have not been well-defined, though this is a necessary step to address this significant public health problem in Peru. The objective of this study was to determine trends of incidence, mortality, and fatality of RTIs in Peru during 1973–2008, as well as their relationship to population trends such as economic growth. Methods and Findings Secondary aggregated databases were used to estimate incidence, mortality and fatality rate ratios (IRRs) of RTIs. These estimates were standardized to age groups and sex of the 2008 Peruvian population. Negative binomial regression and cubic spline curves were used for multivariable analysis. During the 35-year period there were 952,668 road traffic victims, injured or killed. The adjusted yearly incidence of RTIs increased by 3.59 (95% CI 2.43–5.31) on average. We did not observe any significant trends in the yearly mortality rate. The total adjusted yearly fatality rate decreased by 0.26 (95% CI 0.15–0.43), while among adults the fatality rate increased by 1.25 (95% CI 1.09–1.43). Models fitted with splines suggest that the incidence follows a bimodal curve and closely followed trends in the gross domestic product (GDP) per capita Conclusions The significant increasing incidence of RTIs in Peru affirms their growing threat to public health. A substantial improvement of information systems for RTIs is needed to create a more accurate epidemiologic profile of RTIs in Peru. This approach can be of use in other similar low and middle-income settings to inform about the local challenges posed by RTIs. PMID:24927195

Epidemiology of road traffic incidents in Peru 1973-2008: incidence, mortality, and fatality.

PubMed

Miranda, J Jaime; López-Rivera, Luis A; Quistberg, D Alex; Rosales-Mayor, Edmundo; Gianella, Camila; Paca-Palao, Ada; Luna, Diego; Huicho, Luis; Paca, Ada

2014-01-01

The epidemiological profile and trends of road traffic injuries (RTIs) in Peru have not been well-defined, though this is a necessary step to address this significant public health problem in Peru. The objective of this study was to determine trends of incidence, mortality, and fatality of RTIs in Peru during 1973-2008, as well as their relationship to population trends such as economic growth. Secondary aggregated databases were used to estimate incidence, mortality and fatality rate ratios (IRRs) of RTIs. These estimates were standardized to age groups and sex of the 2008 Peruvian population. Negative binomial regression and cubic spline curves were used for multivariable analysis. During the 35-year period there were 952,668 road traffic victims, injured or killed. The adjusted yearly incidence of RTIs increased by 3.59 (95% CI 2.43-5.31) on average. We did not observe any significant trends in the yearly mortality rate. The total adjusted yearly fatality rate decreased by 0.26 (95% CI 0.15-0.43), while among adults the fatality rate increased by 1.25 (95% CI 1.09-1.43). Models fitted with splines suggest that the incidence follows a bimodal curve and closely followed trends in the gross domestic product (GDP) per capita. The significant increasing incidence of RTIs in Peru affirms their growing threat to public health. A substantial improvement of information systems for RTIs is needed to create a more accurate epidemiologic profile of RTIs in Peru. This approach can be of use in other similar low and middle-income settings to inform about the local challenges posed by RTIs.

Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure and mortality: A cohort study

PubMed Central

Muntner, Paul; Whittle, Jeff; Lynch, Amy I.; Colantonio, Lisandro D.; Simpson, Lara M.; Einhorn, Paula T.; Levitan, Emily B.; Whelton, Paul K; Cushman, William C.; Louis, Gail T.; Davis, Barry R.; Oparil, Suzanne

2016-01-01

Background Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient’s underlying BP. Objective: Examine the association between visit-to-visit variability (VVV) of systolic and diastolic BP (SBP and DBP) on cardiovascular disease and mortality outcomes. Design Prospective cohort study Setting Post-hoc analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Participants 25,814 ALLHAT participants. Measurements VVV of SBP was defined as the standard deviation (SD) across BP measurements obtained at 7 visits conducted from 6 to 28 months following ALLHAT enrollment. Participants free of cardiovascular disease events during the first 28 months of follow-up were followed from the month 28 study visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease or non-fatal myocardial infarction, all-cause mortality, stroke and heart failure. Results There were 1194 cases of fatal CHD or non-fatal MI, 1948 deaths, 606 cases of stroke and 921 cases of heart failure during follow-up. After multivariable adjustment including mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mmHg versus <6.5 mmHg) was 1.30 (1.06–1.59) for fatal coronary heart disease or non-fatal myocardial infarction, 1.58 (1.32–1.90) for all-cause mortality, 1.46 (1.06–2.01) for stroke, and 1.25 (0.97–1.61) for heart failure. Higher VVV of DBP was also associated with cardiovascular disease events and mortality. Limitations Long-term outcomes were not available. Conclusions Higher VVV of SBP is associated with increased cardiovascular disease and mortality risk. Future studies should examine whether reducing VVV of BP lowers this risk. Primary funding source National Institutes of Health PMID:26215765

Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh.

PubMed

Alfonso, Natalia Y; Alonge, Olakunle; Hoque, Dewan Md Emdadul; Baset, Kamran Ul; Hyder, Adnan A; Bishai, David

2017-04-29

This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims' perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8-$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $$355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.

Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh

PubMed Central

Alfonso, Yira Natalia; Alonge, Olakunle; Hoque, Dewan Md Emdadul; Ul Baset, Md Kamran; Hyder, Adnan A.; Bishai, David

2017-01-01

This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims’ perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8–$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment. PMID:28468240

Trichomonas vaginalis infection and risk of advanced prostate cancer.

PubMed

Shui, Irene M; Kolb, Suzanne; Hanson, Christi; Sutcliffe, Siobhan; Rider, Jennifer R; Stanford, Janet L

2016-05-01

The epidemiologic evidence for an association of Trichomonas vaginalis (Tv) with overall prostate cancer is mixed, but some studies suggest Tv may increase risk of more aggressive disease. The aim of this study was to assess whether Tv serostatus is associated with advanced or fatal prostate cancer. A total of 146 men with advanced (metastatic or fatal) prostate cancer and 181 age-matched controls were selected from two prior population-based, case-control studies. Tv serostatus was determined with the same laboratory methods used in previous epidemiologic studies. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression to compare Tv serostatus in prostate cancer cases and controls adjusted for potential confounders. The seroprevalence of Tv in controls was 23%. Tv serostatus was not associated with an increased risk of metastatic or fatal prostate cancer (ORs < 1). Our study does not support an increased risk of advanced or fatal prostate cancer in men seropositive for Tv. © 2016 Wiley Periodicals, Inc.

Influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism.

PubMed

Trujillo-Santos, Javier; Gussoni, Gualberto; Gadelha, Telma; Sänchez Muñoz-Torrero, Juan Francisco; Barron, Manuel; Lopez, Luciano; Ruiz-Ruiz, Justo; Fernandez-Capitan, Carmen; Lorente, Manuel; Monreal, Manuel

2014-05-01

The influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism (VTE) has not been thoroughly studied. We used the RIETE Registry data to compare the 3-month mortality rate in cancer patients with VTE, with patients categorized according to the presence of recent immobilization, surgery or neither. The major outcomes were fatal pulmonary embolism (PE) and fatal bleeding within the first 3 months. Of 6,746 patients with active cancer and acute VTE, 1,224 (18%) had recent immobilization, 1,055 (16%) recent surgery, and 4,467 (66%) had neither. The all-cause mortality was 23.4% (95% CI: 22.4-24.5), and the PE-related mortality: 2.5% (95% CI: 2.1-2.9). Four in every ten patients dying of PE had recent immobilization (37%) or surgery (5.4%). Only 28% of patients with immobilization had received prophylaxis, as compared with 67% of the surgical. Fatal PE was more common in patients with recent immobilization (5.0%; 95% CI: 3.9-6.3) than in those with surgery (0.8%; 95% CI: 0.4-1.6) or neither (2.2%; 95% CI: 1.8-2.6). On multivariate analysis, patients with immobilization were at an increased risk for fatal PE (odds ratio: 1.8; 95% CI: 1.2-2.5). One in every three cancer patients dying of PE had recent immobilization for ≥ 4 days. Many of these deaths could have been prevented with adequate thromboprophylaxis. Copyright © 2014 Elsevier Ltd. All rights reserved.

Ethnicity and alcohol-related fatalities : 1990 to 1994

DOT National Transportation Integrated Search

2000-07-01

Author's abstract: This paper contains a preliminary analysis of just under 200,000 records of fatally injured road users drawn from the 1990 to 1994 Fatality Analysis Reporting System (FARS). The analysis of ethnic factors in fatal crashes was made ...

Preliminary analysis of the National Crash Severity Study : factors in fatal accidents

DOT National Transportation Integrated Search

1979-06-01

This study investigates the fatalities on the National Crash Severity Study (NCSS) of towaway, passenger car accidents. The analysis is in three stages. First, NCSS fatalities are compared to the fatally-injured occupants reported on the Fatal Accide...

Lower Performance in Orientation to Time and Place Associates with Greater Risk of Cardiovascular Events and Mortality in the Oldest Old: Leiden 85-Plus Study.

PubMed

Rostamian, Somayeh; van Buchem, Mark A; Jukema, J Wouter; Gussekloo, Jacobijn; Poortvliet, Rosalinde K E; de Cren, Anton J M; Sabayan, Behnam

2017-01-01

Background: Impairment in orientation to time and place is commonly observed in community-dwelling older individuals. Nevertheless, the clinical significance of this has been not fully explored. In this study, we investigated the link between performance in orientation domains and future risk of cardiovascular events and mortality in a non-hospital setting of the oldest old adults. Methods: We included 528 subjects free of myocardial infarction (Group A), 477 individuals free of stroke/transient ischemic attack (Group B), and 432 subjects free of both myocardial infarction and stroke/transient ischemic attack (Group C) at baseline from the population-based Leiden 85-plus cohort study. Participants were asked to answer five questions related to orientation to time and five questions related to orientation to place. 5-year risks of first-time fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, as well as cardiovascular and non-cardiovascular mortality, were estimated using the multivariate Cox regression analysis. Results: In the multivariable analyses, adjusted for sociodemographic characteristics and cardiovascular risk factors, each point lower performance in "orientation to time" was significantly associated with higher risk of first-time myocardial infarction (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.09-1.67, P = 0.007), first-time stroke (HR 1.35, 95% CI 1.12-1.64, P = 0.002), cardiovascular mortality (HR 1.28, 95% CI 1.06-1.54, P = 0.009) and non-cardiovascular mortality (HR 1.37, 95% CI 1.20-1.56, P < 0.001). Similarly, each point lower performance in "orientation to place" was significantly associated with higher risk of first-time myocardial infarction (HR 1.67, 95% CI 1.25-2.22, P = 0.001), first-time stroke (HR 1.39, 95% CI 1.05-1.82, P = 0.016), cardiovascular mortality (HR 1.35, 95% CI 1.00-1.82, P = 0.054) and non-cardiovascular mortality (HR 1.45, 95% CI 1.20-1.77, P < 0.001). Conclusions: Lower performance in orientation to time and place in advanced age is independently related to higher risk of myocardial infarction, stroke and mortality. Impaired orientation might be an early sign of covert vascular injuries, putting subjects at greater risk of cardiovascular events and mortality.

Determinants of mortality and prolonged hospital stay among dengue patients attending tertiary care hospital: a cross-sectional retrospective analysis

PubMed Central

Khan, Amer Hayat; Sarriff, Azmi; Adnan, Azreen Syazril; Khan, Yusra Habib

2017-01-01

Objectives Dengue imposes substantial economic, societal and personal burden in terms of hospital stay, morbidity and mortality. Early identification of dengue cases with high propensity of increased hospital stay and death could be of value in isolating patients in need of early interventions. The current study was aimed to determine the significant factors associated with dengue-related prolonged hospitalisation and death. Design Cross-sectional retrospective study. Setting Tertiary care teaching hospital. Participants Patients with confirmed dengue diagnosis were stratified into two categories on the basis of prolonged hospitalisation (≤3 days and >3 days) and mortality (fatal cases and non-fatal cases). Clinico-laboratory characteristics between these categories were compared by using appropriate statistical methods. Results Of 667 patients enrolled, 328 (49.2%) had prolonged hospitalisation. The mean hospital stay was 4.88±2.74 days. Multivariate analysis showed that dengue haemorrhagic fever (OR 2.3), elevated alkaline phosphatase (ALP) (OR 2.3), prolonged prothrombin time (PT) (OR 1.7), activated partial thromboplastin time (aPTT) (OR 1.9) and multiple-organ dysfunctions (OR 2.1) were independently associated with prolonged hospitalisation. Overall case fatality rate was 1.1%. Factors associated with dengue mortality were age >40 years (p=0.004), secondary infection (p=0.040), comorbidities (p<0.05), acute kidney injury (p<0.001), prolonged PT (p=0.022), multiple-organ dysfunctions (p<0.001), haematocrit >20% (p=0.001), rhabdomyolosis (p<0.001) and respiratory failure (p=0.007). Approximately half of the fatal cases in our study had prolonged hospital stay of greater than three days. Conclusions The results underscore the high proportion of dengue patients with prolonged hospital stay. Early identification of factors relating to prolonged hospitalisation and death will have obvious advantages in terms of appropriate decisions about treatment and management in high dependency units. PMID:28698348

A national cohort study of parental socioeconomic status and non-fatal suicidal behaviour-the mediating role of school performance

PubMed Central

2012-01-01

Background A link between low parental socioeconomic status and mental health problems in offspring is well established in previous research. The mechanisms that explain this link are largely unknown. The present study investigated whether school performance was a mediating and/or moderating factor in the path between parental socioeconomic status and the risk of hospital admission for non-fatal suicidal behaviour. Methods A national cohort of 447 929 children born during 1973-1977 was followed prospectively in the National Patient Discharge Register from the end of their ninth and final year of compulsory school until 2001. Multivariate Cox proportional hazards and linear regression analyses were performed to test whether the association between parental socioeconomic status and non-fatal suicidal behaviour was mediated or moderated by school performance. Results The results of a series of multiple regression analyses, adjusted for demographic variables, revealed that school performance was as an important mediator in the relationship between parental socioeconomic status and risk of non-fatal suicidal behaviour, accounting for 60% of the variance. The hypothesized moderation of parental socioeconomic status-non-fatal suicidal behaviour relationship by school performance was not supported. Conclusions School performance is an important mediator through which parental socioeconomic status translates into a risk for non-fatal suicidal behaviour. Prevention efforts aimed to reduce socioeconomic inequalities in non-fatal suicidal behaviour among young people will need to consider socioeconomic inequalities in school performance. PMID:22230577

Perceptions of Prostate Cancer Fatalism and Screening Behavior Between United States-Born and Caribbean-Born Black Males

PubMed Central

Cobran, Ewan K.; Wutoh, Anthony K.; Lee, Euni; Odedina, Folakemi T.; Ragin, Camille; Aiken, William; Godley, Paul A.

2013-01-01

Cancer fatalism is believed to be a major barrier for cancer screening in Black males. Therefore, the purpose of this study was to compare perceptions of prostate cancer (CaP) fatalism and predictors of CaP screening with Prostate Specific Antigen (PSA) testing between U.S.-born and Caribbean-born Black males. The Powe Fatalism Inventory and the Personal Integrative Model of CaP Disparity Survey were used to collect the following data from males in South Florida. Multivariate logistic regression models were constructed to examine the statistically significant predictors of CaP screening. A total of 211 U.S.-born and Caribbean-born Black males between ages 39–75 were recruited. Nativity was not a significant predictor of CaP screening with PSA testing within the last year (Odds ratio [OR] = 0.80, 95 % confidence interval [CI] = 0.26, 2.48, p = 0.70). Overall, higher levels of CaP fatalism were not a significant predictor of CaP screening with PSA testing within the last year (OR = 1.37, 95 % CI = 0.48, 3.91, p = 0.56). The study results suggest that nativity did not influence CaP screening with PSA testing. However, further studies are needed to evaluate the association between CaP screening behavior and levels of CaP fatalism. PMID:23576029

How did the economic recession (2008-2010) influence traffic fatalities in OECD-countries?

PubMed

Wegman, Fred; Allsop, Richard; Antoniou, Constantinos; Bergel-Hayat, Ruth; Elvik, Rune; Lassarre, Sylvain; Lloyd, Daryl; Wijnen, Wim

2017-05-01

This paper presents analyses of how the economic recession that started in 2008 has influenced the number of traffic fatalities in OECD countries. Previous studies of the relationship between economic recessions and changes in the number of traffic fatalities are reviewed. Based on these studies, a causal diagram of the relationship between changes of the business cycle and changes in the number of traffic fatalities is proposed. This causal model is tested empirically by means of multivariate analyses and analyses of accident statistics for Great Britain and Sweden. Economic recession, as indicated both by slower growth of, or decline of gross national product, and by increased unemployment is associated with an accelerated decline in the number of traffic fatalities, i.e. a larger decline than the long-term trend that is normal in OECD countries. The principal mechanisms bringing this about are a disproportionate reduction of driving among high-risk drivers, in particular young drivers and a reduction of fatality rate per kilometre of travel, probably attributable to changes in road user behaviour that are only partly observable. The total number of vehicle kilometres of travel did not change very much as a result of the recession. The paper is based on an ITF-report that presents the analyses in greater detail. Copyright © 2017 Elsevier Ltd. All rights reserved.

Self-rated health and standard risk factors for myocardial infarction: a cohort study.

PubMed

Waller, Göran; Janlert, Urban; Norberg, Margareta; Lundqvist, Robert; Forssén, Annika

2015-02-13

To investigate the relationship between self-rated health, adjusted for standard risk factors, and myocardial infarction. Population-based prospective cohort study. Enrolment took place between 1990 and 2004 in Västerbotten County, Sweden Every year, persons in the total population, aged 40, 50 or 60 were invited. Participation rate was 60%. The cohort consisted of 75 386 men and women. After exclusion for stroke or myocardial infarction before, or within 12 months after enrolment or death within 12 months after enrolment, 72 530 persons remained for analysis. Mean follow-up time was 13.2 years. Cox regression analysis was used to estimate HRs for the end point of first non-fatal or fatal myocardial infarction. HR were adjusted for age, sex, systolic blood pressure, total cholesterol, smoking, diabetes, body mass index, education, physical activity and self-rated health in the categories very good; pretty good; somewhat good; pretty poor or poor. In the cohort, 2062 persons were diagnosed with fatal or non-fatal myocardial infarction. Poor self-rated health adjusted for sex and age was associated with the outcome with HR 2.03 (95% CI 1.45 to 2.84). All categories of self-rated health worse than very good were statistically significant and showed a dose-response relationship. In a multivariable analysis with standard risk factors (not including physical activity and education) HR was attenuated to 1.61 (95% CI 1.13 to 2.31) for poor self-rated health. All categories of self-rated health remained statistically significant. We found no interaction between self-rated health and standard risk factors except for poor self-rated health and diabetes. This study supports the use of self-rated health as a standard risk factor among others for myocardial infarction. It remains to demonstrate whether self-rated health adds predictive value for myocardial infarction in combined algorithms with standard risk factors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Analysis of Ejection in Fatal Crashes

DOT National Transportation Integrated Search

1997-11-01

Data from NHTSA's Fatality Analysis Reporting System (FARS) show that the : ejection rate among fatally injured passenger vehicle occupants has remained at : over 20 percent since the early 1980's. Because the risk of fatality in a crash : is over th...

Switching operations fatality analysis : findings and recommendations of the SOFA working group

DOT National Transportation Integrated Search

1999-10-01

On February 1998, a Switching Operations Fatality Analysis (SOFA) Working Group (WG) was formed at the request of the Federal Railroad Administration (FRA) to review recent fatal incidents and develop recommendations for reducing fatalities in switch...

Resting heart rate is a risk factor for mortality in chronic obstructive pulmonary disease, but not for exacerbations or pneumonia.

PubMed

Warnier, Miriam J; Rutten, Frans H; de Boer, Anthonius; Hoes, Arno W; De Bruin, Marie L

2014-01-01

Although it is known that patients with chronic obstructive pulmonary disease (COPD) generally do have an increased heart rate, the effects on both mortality and non-fatal pulmonary complications are unclear. We assessed whether heart rate is associated with all-cause mortality, and non-fatal pulmonary endpoints. A prospective cohort study of 405 elderly patients with COPD was performed. All patients underwent extensive investigations, including electrocardiography. Follow-up data on mortality were obtained by linking the cohort to the Dutch National Cause of Death Register and information on complications (exacerbation of COPD or pneumonia) by scrutinizing patient files of general practitioners. Multivariable cox regression analysis was performed. During the follow-up 132 (33%) patients died. The overall mortality rate was 50/1000 py (42-59). The major causes of death were cardiovascular and respiratory. The relative risk of all-cause mortality increased with 21% for every 10 beats/minute increase in heart rate (adjusted HR: 1.21 [1.07-1.36], p = 0.002). The incidence of major non-fatal pulmonary events was 145/1000 py (120-168). The risk of a non-fatal pulmonary complication increased non-significantly with 7% for every 10 beats/minute increase in resting heart rate (adjusted HR: 1.07 [0.96-1.18], p = 0.208). Increased resting heart rate is a strong and independent risk factor for all-cause mortality in elderly patients with COPD. An increased resting heart rate did not result in an increased risk of exacerbations or pneumonia. This may indicate that the increased mortality risk of COPD is related to non-pulmonary causes. Future randomized controlled trials are needed to investigate whether heart-rate lowering agents are worthwhile for COPD patients.

Predictive value of night-time heart rate for cardiovascular events in hypertension. The ABP-International study.

PubMed

Palatini, Paolo; Reboldi, Gianpaolo; Beilin, Lawrence J; Eguchi, Kazuo; Imai, Yutaka; Kario, Kazuomi; Ohkubo, Takayoshi; Pierdomenico, Sante D; Saladini, Francesca; Schwartz, Joseph E; Wing, Lindon; Verdecchia, Paolo

2013-09-30

Data from prospective cohort studies regarding the association between ambulatory heart rate (HR) and cardiovascular events (CVE) are conflicting. To investigate whether ambulatory HR predicts CVE in hypertension, we performed 24-hour ambulatory blood pressure and HR monitoring in 7600 hypertensive patients aged 52 ± 16 years from Italy, U.S.A., Japan, and Australia, included in the 'ABP-International' registry. All were untreated at baseline examination. Standardized hazard ratios for ambulatory HRs were computed, stratifying for cohort, and adjusting for age, gender, blood pressure, smoking, diabetes, serum total cholesterol and serum creatinine. During a median follow-up of 5.0 years there were 639 fatal and nonfatal CVE. In a multivariable Cox model, night-time HR predicted fatal combined with nonfatal CVE more closely than 24h HR (p=0.007 and =0.03, respectively). Daytime HR and the night:day HR ratio were not associated with CVE (p=0.07 and =0.18, respectively). The hazard ratio of the fatal combined with nonfatal CVE for a 10-beats/min increment of the night-time HR was 1.13 (95% CI, 1.04-1.22). This relationship remained significant when subjects taking beta-blockers during the follow-up (hazard ratio, 1.15; 95% CI, 1.05-1.25) or subjects who had an event within 5 years after enrollment (hazard ratio, 1.23; 95% CI, 1.05-1.45) were excluded from analysis. At variance with previous data obtained from general populations, ambulatory HR added to the risk stratification for fatal combined with nonfatal CVE in the hypertensive patients from the ABP-International study. Night-time HR was a better predictor of CVE than daytime HR. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Analysis of fatal crashes due to signal and stop sign violations

DOT National Transportation Integrated Search

2004-09-01

The 1999 and 2000 Fatality Analysis Reporting System databases were analyzed to gain a better understanding of fatal crashes involving light vehicles that violated traffic signals or stop signs. A total of 9,951 vehicles were involved in fatal crashe...

The effect of verified pediatric trauma centers, state laws and crash characteristics on time trends in adolescent motor vehicle fatalities, 1999-2015.

PubMed

Notrica, David M; Sayrs, Lois W; Krishna, Nidhi

2018-05-15

Motor vehicle crashes (MVCs) are a leading cause of adolescent death from trauma. A recent study found ACS verified pediatric trauma centers (vPTC) were inversely correlated with pediatric mortality, but the analysis was limited to a single year. This study assesses the contribution of vPTCs, crash characteristics, and state driver laws on 15 to 17 years old MVC mortality for all 50 states from 1999-2015. Prospective data on motor vehicle fatalities, crash characteristics, state driving laws, and ACS verified trauma centers were collected from publically available sources for 50 U.S. states from 1999-2015. A mixed fixed/random effects multivariate regression model was fitted to assess the relative contribution of crash characteristics, state laws and vPTCs while controlling for state variation and time trends. The final regression model included driver and crash characteristics, verified trauma centers, and state laws. Camera laws ([B=-0.57[P<0.001]) were associated with a 57% decrease in the rate of change in adolescent crude fatalities. The lagged Level 1 vPTC crude rate (B=-0.12[P<.001]) was protective and contributed independently to a 12% decline in the rate of change in teen fatalities over the time period. Seat belt laws (B=-0.15[P<0.001]), GDL passenger restrictions (B=-0.07[P<0.001]), GDL learner permit period (B=-0.04[P<0.002]), non-deployed airbag (B=-0.003[P<0.001]), Hispanic heritage (B=-0.003[P<0.05]), were protective. Increased risk of fatality was associated with mini-van (B=0.01[P<0.001]), speed>90mph (B=0.004[P<0.001]), rural roads (B=0.002[P<0.002], unknown seat belt compliance (B=0.004[P<0.001]) and dry road surface (B=0.005[P<0.001]). State camera laws during the study time frame are associated with a 57% decrease in the rate of change in adolescent crude fatalities; vPTCs during the study time period reduced overall rate of change in the crude fatality rate by 12%. State laws, restrictions on teenage passengers and longer learner's permit periods, and seat belt laws are associated with significant decreases the crude teen mortality rate. Level III, Prospective.

DRUG USE PATTERNS PREDICT RISK OF NON-FATAL OVERDOSE AMONG STREET-INVOLVED YOUTH IN A CANADIAN SETTING

PubMed Central

Mitra, Goldis; Wood, Evan; Nguyen, Paul; Kerr, Thomas; DeBeck, Kora

2015-01-01

Background Non-fatal drug overdose is a major cause of morbidity among people who use drugs, although few studies have examined this risk among street-involved youth. We sought to determine the risk factors associated with non-fatal overdose among Canadian street-involved youth who reported illicit drug use. Methods Using data from a prospective cohort of street-involved youth in Vancouver, Canada, we identified youth without a history of overdose and employed Cox regression analyses to determine factors associated with time to non-fatal overdose between September 2005 and May 2012. Results Among 615 participants, 98 (15.9%) reported a non-fatal overdose event during follow-up, resulting in an incidence density of 7.67 cases per 100 person-years. In multivariate Cox regression analyses, binge drug use (adjusted hazard ratio [AHR] = 1.85; 95% confidence interval [CI] = 1.20 – 2.84), non-injection crystal methamphetamine use (AHR = 1.70; 95% CI = 1.12 – 2.58), non-injection prescription opiate use (AHR = 2.56; 95% CI = 1.36 – 4.82), injection prescription opiate use (AHR = 2.49; 95% CI = 1.40 – 4.45) and injection heroin use (AHR = 1.85; 95% CI = 1.14 – 3.00) were positively associated with time to non-fatal overdose. Social, behavioural and demographic factors were not significantly associated with time to non-fatal overdose event. Conclusions Rates of non-fatal overdose were high among street-involved youth. Drug use patterns, in particular prescription opiate use, were associated with overdose. These findings underscore the importance of addiction treatment and prevention efforts aimed at reducing the risk of overdose among youth. PMID:26096535

Early morning awakening and nonrestorative sleep are associated with increased minor non-fatal accidents during work and leisure time.

PubMed

Chiu, Hsiao-Yean; Wang, Mei-Yeh; Chang, Cheng-Kuei; Chen, Ching-Min; Chou, Kuei-Ru; Tsai, Jen-Chen; Tsai, Pei-Shan

2014-10-01

The relationship between a composite measure of insomnia and occupational or fatal accidents has been investigated previously; however, little is known regarding the effect of various insomnia symptoms on minor non-fatal accidents during work and leisure time. We investigated the predicting role of insomnia symptoms on minor non-fatal accidents during work and leisure time. Data from the 2005 Taiwan Social Development Trend Survey of 36,473 Taiwanese aged ≥18 years were analyzed in 2013. Insomnia symptoms, including difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS) were investigated. A minor non-fatal accident was defined as any mishap such as forgetting to turn off the gas or faucets, accidental falls, and abrasions or cuts occurring during work and leisure time in the past month that do not require immediate medical attention. Multivariable logistic regression was performed to assess the odds ratios (ORs) and associated 95% confidence interval (CI) of minor non-fatal accidents (as a binary variable) for each insomnia symptom compared with those of people presenting no symptoms, while controlling for possible confounders. EMA and NRS increased the odds of minor non-fatal accidents occurring during work and leisure time (adjusted OR=1.19, 95% CI=1.08-1.32 and adjusted OR=1.27, 95% CI=1.17-1.37, respectively). EMA and NRS are two symptoms that are significantly associated with an increased likelihood of minor non-fatal accidents during work and leisure time after adjusting for of a range of covariates. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cognitive impairment and risk of future stroke: a systematic review and meta-analysis

PubMed Central

Lee, Meng; Saver, Jeffrey L.; Hong, Keun-Sik; Wu, Yi-Ling; Liu, Hsing-Cheng; Rao, Neal M.; Ovbiagele, Bruce

2014-01-01

Background: Several studies have assessed the link between cognitive impairment and risk of future stroke, but results have been inconsistent. We conducted a systematic review and meta-analysis of cohort studies to determine the association between cognitive impairment and risk of future stroke. Methods: We searched MEDLINE and Embase (1966 to November 2013) and conducted a manual search of bibliographies of relevant retrieved articles and reviews. We included cohort studies that reported multivariable adjusted relative risks and 95% confidence intervals or standard errors for stroke with respect to baseline cognitive impairment. Results: We identified 18 cohort studies (total 121 879 participants) and 7799 stroke events. Pooled analysis of results from all studies showed that stroke risk increased among patients with cognitive impairment at baseline (relative risk [RR] 1.39, 95% confidence interval [CI] 1.24–1.56). The results were similar when we restricted the analysis to studies that used a widely adopted definition of cognitive impairment (i.e., Mini-Mental State Examination score < 25 or nearest equivalent) (RR 1.64, 95% CI 1.46–1.84). Cognitive impairment at baseline was also associated with an increased risk of fatal stroke (RR 1.68, 95% CI 1.21–2.33) and ischemic stroke (RR 1.65, 95% CI 1.41–1.93). Interpretation: Baseline cognitive impairment was associated with a significantly higher risk of future stroke, especially ischemic and fatal stroke. PMID:25157064

Colorectal Cancer Screening among Latinos in Three Communities on the Texas-Mexico Border

ERIC Educational Resources Information Center

Fernández, María E.; Savas, Lara S.; Wilson, Katherine M.; Byrd, Theresa L.; Atkinson, John; Torres-Vigil, Isabel; Vernon, Sally W.

2015-01-01

Objective: To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. Method: Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older).…

Is systematic training in opioid overdose prevention effective?

PubMed

Espelt, Albert; Bosque-Prous, Marina; Folch, Cinta; Sarasa-Renedo, Ana; Majó, Xavier; Casabona, Jordi; Brugal, M Teresa

2017-01-01

The objectives were to analyze the knowledge about overdose prevention, the use of naloxone, and the number of fatal overdoses after the implementation of Systematic Training in Overdose Prevention (STOOP) program. We conducted a quasi-experimental study, and held face-to-face interviews before (n = 725) and after (n = 722) implementation of systematic training in two different samples of people who injected opioids attending harm reduction centers. We asked participants to list the main causes of overdose and the main actions that should be taken when witnessing an overdose. We created two dependent variables, the number of (a) correct and (b) incorrect answers. The main independent variable was Study Group: Intervention Group (IG), Comparison Group (CG), Pre-Intervention Group With Sporadic Training in Overdose Prevention (PREIGS), or Pre-Intervention Group Without Training in Overdose Prevention (PREIGW). The relationship between the dependent and independent variables was assessed using a multivariate Poisson regression analysis. Finally, we conducted an interrupted time series analysis of monthly fatal overdoses before and after the implementation of systematic program during the period 2006-2015. Knowledge of overdose prevention increased after implementing systematic training program. Compared to the PREIGW, the IG gave more correct answers (IRR = 1.40;95%CI:1.33-1.47), and fewer incorrect answers (IRR = 0.33;95%CI:0.25-0.44). Forty percent of people who injected opioids who received a naloxone kit had used the kit in response to an overdose they witnessed. These courses increase knowledge of overdose prevention in people who use opioids, give them the necessary skills to use naloxone, and slightly diminish the number of fatal opioid overdoses in the city of Barcelona.

Is systematic training in opioid overdose prevention effective?

PubMed Central

Bosque-Prous, Marina; Folch, Cinta; Sarasa-Renedo, Ana; Majó, Xavier; Casabona, Jordi; Brugal, M. Teresa

2017-01-01

The objectives were to analyze the knowledge about overdose prevention, the use of naloxone, and the number of fatal overdoses after the implementation of Systematic Training in Overdose Prevention (STOOP) program. We conducted a quasi-experimental study, and held face-to-face interviews before (n = 725) and after (n = 722) implementation of systematic training in two different samples of people who injected opioids attending harm reduction centers. We asked participants to list the main causes of overdose and the main actions that should be taken when witnessing an overdose. We created two dependent variables, the number of (a) correct and (b) incorrect answers. The main independent variable was Study Group: Intervention Group (IG), Comparison Group (CG), Pre-Intervention Group With Sporadic Training in Overdose Prevention (PREIGS), or Pre-Intervention Group Without Training in Overdose Prevention (PREIGW). The relationship between the dependent and independent variables was assessed using a multivariate Poisson regression analysis. Finally, we conducted an interrupted time series analysis of monthly fatal overdoses before and after the implementation of systematic program during the period 2006–2015. Knowledge of overdose prevention increased after implementing systematic training program. Compared to the PREIGW, the IG gave more correct answers (IRR = 1.40;95%CI:1.33–1.47), and fewer incorrect answers (IRR = 0.33;95%CI:0.25–0.44). Forty percent of people who injected opioids who received a naloxone kit had used the kit in response to an overdose they witnessed. These courses increase knowledge of overdose prevention in people who use opioids, give them the necessary skills to use naloxone, and slightly diminish the number of fatal opioid overdoses in the city of Barcelona. PMID:29088247

78 FR 38096 - Fatality Analysis Reporting System Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-25

... Number NHTSA-2012-0168] Fatality Analysis Reporting System Information Collection AGENCY: National... comments on the following proposed collections of information: (1) Title: Fatal Analysis Reporting System... comment on proposed collection of information. SUMMARY: Before a Federal agency can collect certain...

Prevalence and trends of drugged driving in Canada.

PubMed

Robertson, Robyn D; Mainegra Hing, Marisela; Pashley, Charlotte R; Brown, Steve W; Vanlaar, Ward G M

2017-02-01

This study evaluates prevalence and trends in drugged driving in Canada based on multiple indicators collected from the Road Safety Monitor (RSM) and Canada's National Fatality Database maintained by the Traffic Injury Research Foundation (TIRF). The objective of this paper is to identify the state of drug-positive driving in Canada, as well as to make comparisons with data from previous years to determine whether changes have occurred. Available data from the RSM on self-reported drugged driving behaviours were collected and analyzed using multivariate techniques in various years spanning from 2002 to 2015. Data from TIRF's National Fatality Database from 2000 to 2012 were also analyzed to evaluate trends and prevalence of drugs in fatally injured drivers across Canada. Additionally, differences among drugged drivers with respect to gender and age were studied. Analyses of the RSM data and of the National Fatality Database showed that, as a whole, the prevalence of drugged driving has remained relatively stable over the past decade, with some changes noticed in specific years for some drug types. Specifically from the RSM, there was a 62.5% increase from the 1.6% of drivers reporting driving within two hours of using marijuana in 2013 to 2.6% in 2015. The analyses of the fatality data revealed a 16.9% increase in the percentage of fatally injured drivers testing positive for drugs between 2000 and 2012 (from 33.56% to 39.24%). Cocaine-positive fatally injured drivers increased from 3.6% in 2000 to 6.2% in 2012. Similarly, marijuana-positive fatally injured drivers increased from 12.8% in 2000 to 19.7% in 2012. Results showed varying characteristics with respect to gender and age among self-reported and fatally injured drugged drivers. Drugged driving behaviours remain prevalent among Canadian drivers and drugs continue to be found in over one-third of tested fatally injured drivers. Although self-reported behaviours have neither decreased nor increased overall in the past decade according to RSM data, with the exception of driving within two hours of using marijuana, data from fatally injured drivers reveal that small, but significant increases in some behaviours have occurred. Copyright © 2016 Elsevier Ltd. All rights reserved.

75 FR 52587 - 2009 Fatality Analysis Reporting System (FARS)/National Automotive Sampling System General...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-26

... DEPARTMENT OF TRANSPORTATION National Highway Traffic Safety Administration [U.S. DOT Docket Number NHTSA-2010-0122] 2009 Fatality Analysis Reporting System (FARS)/National Automotive Sampling... Administration (NHTSA)--2009 Fatality Analysis Reporting System (FARS) & National Automotive Sampling System...

Testing if Social Services Prevent Fatal Child Maltreatment Among a Sample of Children Previously Known to Child Protective Services.

PubMed

Douglas, Emily M

2016-08-01

The purpose of this article was to examine the potential impact of child welfare services on the risk for fatal child maltreatment. This was conducted using a subsample of children who were identified as "prior victims" in the National Child Abuse and Neglect Data System from 2008 to 2012. At the multivariate level, the analyses show that case management services act to protect children from death as do family support services, family preservation services, and foster care, but that the results vary by type of maltreatment experienced. The author recommends that before strong conclusions are drawn, additional research in this area is warranted. © The Author(s) 2016.

Oral pathology follow-up by means of micro-Raman spectroscopy on tissue and blood serum samples: an application of wavelet and multivariate data analysis

NASA Astrophysics Data System (ADS)

Delfino, I.; Camerlingo, C.; Zenone, F.; Perna, G.; Capozzi, V.; Cirillo, N.; Gaeta, G. M.; De Mol, E.; Lepore, M.

2009-02-01

Pemphigus vulgaris (PV) is a potentially fatal autoimmune disease that cause blistering of the skin and oral cavity. It is characterized by disruption of cell-cell adhesion within the suprabasal layers of epithelium, a phenomenon termed acantholysis Patients with PV develop IgG autoantibodies against normal constituents of the intercellular substance of keratinocytes. The mechanisms by which such autoantibodies induce blisters are not clearly understood. The qualitative analysis of such effects provides important clues in the search for a specific diagnosis, and the quantitative analysis of biochemical abnormalities is important in measuring the extent of the disease process, designing therapy and evaluating the efficacy of treatment. Improved diagnostic techniques could permit the recognition of more subtle forms of disease and reveal incipient lesions clinically unapparent, so that progression of potentially severe forms could be reversed with appropriate treatment. In this paper, we report the results of our micro-Raman spectroscopy study on tissue and blood serum samples from ill, recovered and under therapy PV patients. The complexity of the differences among their characteristic Raman spectra has required a specific strategy to obtain reliable information on the illness stage of the patients For this purpose, wavelet techniques and advanced multivariate analysis methods have been developed and applied to the experimental Raman spectra. Promising results have been obtained.

Ecological correlates of neglect in infants and toddlers.

PubMed

Connell-Carrick, Kelli; Scannapieco, Maria

2006-03-01

Infants and toddlers are more likely to be victims of neglect than any other form of maltreatment. Infants and toddlers are at highest risk of fatality because of maltreatment and experience behavioral, social, academic, medical, and cognitive consequences of neglect during their most formative years. Within an ecological framework, this study examines the correlates of the substantiation of neglect in children 0 to 36 months of age. Using an ex post facto design and a random sample of 148 child protective services cases, bivariate analysis revealed significant differences in families who were substantiated for neglect in the areas of child characteristics, home environment, social environment, caregiver, and maltreatment situations. Multivariate analysis found children who were substantiated for neglect were exposed to greater environmental dangers and had caregivers who had poor parenting skills. Implications for practice and future research are discussed.

Clinical profile and improving mortality trend of scrub typhus in South India.

PubMed

Varghese, George M; Trowbridge, Paul; Janardhanan, Jeshina; Thomas, Kurien; Peter, John V; Mathews, Prasad; Abraham, Ooriapadickal C; Kavitha, M L

2014-06-01

Scrub typhus, a bacterial zoonosis caused by Orientia tsutsugamushi, may cause multiorgan dysfunction syndrome (MODS) and is associated with significant mortality. This study was undertaken to document the clinical and laboratory manifestations and complications and to study time trends and factors associated with mortality in patients with scrub typhus infection. This retrospective study, done at a university teaching hospital, included 623 patients admitted between 2005 and 2010 with scrub typhus. The diagnosis was established by a positive IgM ELISA and/or pathognomonic eschar with PCR confirmation where feasible. The clinical and laboratory profile, course in hospital, and outcome were documented. Factors associated with mortality were analyzed using multivariate logistic regression analysis. The most common presenting symptoms were fever (100%), nausea/vomiting (54%), shortness of breath (49%), headache (46%), cough (38%), and altered sensorium (26%). An eschar was present in 43.5% of patients. Common laboratory findings included elevated transaminases (87%), thrombocytopenia (79%), and leukocytosis (46%). MODS was seen in 34% of patients. The overall case-fatality rate was 9.0%. Features of acute lung injury were observed in 33.7%, and 29.5% required ventilatory support. On multivariate analysis, shock requiring vasoactive agents (relative risk (RR) 10.5, 95% confidence interval (CI) 4.2-25.7, p<0.001), central nervous system (CNS) dysfunction (RR 5.1, 95% CI 2.4-10.7, p<0.001), and renal failure (RR 3.6, 95% CI 1.7-7.5, p=0.001) were independent predictors of mortality. Over 4 years, a decreasing trend was observed in the mortality rate. Scrub typhus can manifest with potentially life-threatening complications such as lung injury, shock, and meningoencephalitis. MODS occurred in a third of our patients. The overall case-fatality rate was 9%, with shock, renal failure, and CNS associated with a higher mortality. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Distance matters: Effect of geographic trauma system resource organization on fatal motor vehicle collisions.

PubMed

Brown, Joshua B; Rosengart, Matthew R; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2017-07-01

Trauma systems improve outcome; however, it is unclear how geographic organization of trauma system resources (TSR) affects outcome. Our objective was to evaluate the relationship of fatal motor vehicle collision (MVC) rates and the distance from individual MVC locations to the nearest TSR as a measure of the geographical organization of trauma systems, as well as how theoretical changes in the distribution of TSR may affect fatal MVC rates. All fatal MVC in Pennsylvania 2013-2014 were mapped from the Fatality Analysis Reporting System database. Deaths on scene were excluded. TSR including trauma centers and helicopter bases were mapped. Distance between each fatal MVC and nearest TSR was calculated. The primary outcome was fatal MVC rate per 100 million vehicle miles traveled (VMT). Empiric Bayes kriging and hot spot analysis were performed to evaluate geographic patterns in fatal MVC rates. Association between fatal MVC rate and distance to the nearest TSR was evaluated with linear regression. Spatial lag regression evaluated this association while controlling for MVC and county-level characteristics. We identified 886 fatalities from 863 fatal MVC. Median fatal MVC rate was 0.187 per 100 million VMT. Higher fatal MVC rates and fatality hot spots occur in locations farther from TSR. The fatal MVC rate increased 0.141 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). When controlling for confounders, the fatal MVC rate increased by 0.089 per 100 million VMT for every 10 miles farther from the nearest TSR (p < 0.01). If two helicopters stationed at trauma centers were relocated into the highest fatality regions, our model predicts a 12.3% relative reduction in the overall MVC fatality rate. Increasing distance to the nearest TSR is associated with increasing fatal MVC rate. The geographic organization of trauma systems may impact outcome, and geospatial analysis can allow data-driven changes to potentially improve outcome. Prognostic/Epidemiologic, level III; Case management, level III.

The strength of graduated drivers license programs and fatalities among teen drivers and passengers.

PubMed

Morrisey, Michael A; Grabowski, David C; Dee, Thomas S; Campbell, Christine

2006-01-01

The purpose of this study is to investigate the effects of differentially stringent graduated drivers license programs on teen driver fatalities, day-time and night-time teen driver fatalities, fatalities of teen drivers with passengers present, and fatalities among teen passengers. The study uses 1992-2002 data on motor vehicle fatalities among 15-17-year-old drivers from the Fatality Analysis Reporting System to identify the effects of "good", "fair", and "marginal" GDL programs based upon designations by the Insurance Institute for Highway Safety. Analysis is conducted using conditional negative binomial regressions with fixed effects. "Good" programs reduce total fatalities among young drivers by 19.4% (c.i. -33.0%, -5.9%). "Fair" programs reduce night-time young driver fatalities by 12.6% (c.i. -23.9%, -1.2%), but have no effect on day-time fatalities. "Marginal" programs had no statistically meaningful effect on driver fatalities. All three types of programs reduced teen passenger fatalities, but the effects of limitations on the number of passengers appear to have had only minimal effects in reducing fatalities among young drivers themselves. Stronger GDL programs are more effective than weaker programs in reducing teenage motor vehicle fatalities.

Hazards of Extreme Weather: Flood Fatalities in Texas

NASA Astrophysics Data System (ADS)

Sharif, H. O.; Jackson, T.; Bin-Shafique, S.

2009-12-01

The Federal Emergency Management Agency (FEMA) considers flooding “America’s Number One Natural Hazard”. Despite flood management efforts in many communities, U.S. flood damages remain high, due, in large part, to increasing population and property development in flood-prone areas. Floods are the leading cause of fatalities related to natural disasters in Texas. Texas leads the nation in flash flood fatalities. There are three times more fatalities in Texas (840) than the following state Pennsylvania (265). This study examined flood fatalities that occurred in Texas between 1960 and 2008. Flood fatality statistics were extracted from three sources: flood fatality databases from the National Climatic Data Center, the Spatial Hazard Event and Loss Database for the United States, and the Texas Department of State Health Services. The data collected for flood fatalities include the date, time, gender, age, location, and weather conditions. Inconsistencies among the three databases were identified and discussed. Analysis reveals that most fatalities result from driving into flood water (about 65%). Spatial analysis indicates that more fatalities occurred in counties containing major urban centers. Hydrologic analysis of a flood event that resulted in five fatalities was performed. A hydrologic model was able to simulate the water level at a location where a vehicle was swept away by flood water resulting in the death of the driver.

2003 railroad employee fatalities : case studies and analysis

DOT National Transportation Integrated Search

2006-03-01

2003 Railroad Employee Fatalities: Case Studies and Analysis is designed to promote and : enhance awareness of many unsafe behaviors and conditions that typically contribute to : railroad employee fatalities, this report is intended to assist r...

2006 railroad employee fatalities : case studies and analysis

DOT National Transportation Integrated Search

2008-02-01

This document, entitled 2006 Railroad Employee Fatalities: Case Studies and Analysis, was : developed to promote and enhance awareness of many unsafe behaviors and conditions that : typically contribute to railroad employee fatalities, and is i...

Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities.

PubMed

Ewing, Reid; Schieber, Richard A; Zegeer, Charles V

2003-09-01

We sought to determine the association between urban sprawl and traffic fatalities. We created a sprawl index by applying principal components analysis to data for 448 US counties in the largest 101 metropolitan areas. Regression analysis was used to determine associations between the index and traffic fatalities. For every 1% increase in the index (i.e., more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% (P <.001) and pedestrian fatality rates fell by 1.47% to 3.56%, after adjustment for pedestrian exposure (P <.001). Urban sprawl was directly related to traffic fatalities and pedestrian fatalities. Subsequent studies should investigate relationships at a finer geographic scale and should strive to improve on the measure of exposure used to adjust pedestrian fatality rates.

Extended investigation on road fatality in Brunei.

PubMed

Yusof, N B; Hoque, M A; Steele, M C; Yong, S Y

2018-06-08

Road fatality is one of the leading causes of death in Brunei with 79 deaths in 1993, the highest ever recorded. The Brunei government has been trying to reduce this by implementing new traffic measures and successfully reduced fatalities to 24 fatalities in 2014. Yearly road fatality has been fluctuating, but there has been a declining tendency overall. The aim of this study is to investigate road fatality in Brunei by extending the research. We developed a multiple regression model and carried out an analysis on road fatality in Brunei. Our analysis indicates that the road fatality appears to rise depending on the increase in the number of young drivers between 15 to 24 years and the number of unemployed people. Comparisons of Brunei road fatality rate per 10,000 vehicles are made with some other countries and we conclude that Brunei has approximately the same rate as Australia in 2014.

Quasi-likelihood generalized linear regression analysis of fatality risk data

DOT National Transportation Integrated Search

2009-01-01

Transportation-related fatality risks is a function of many interacting human, vehicle, and environmental factors. Statisitcally valid analysis of such data is challenged both by the complexity of plausable structural models relating fatality rates t...

Intratumor Heterogeneity of the Estrogen Receptor and the Long-term Risk of Fatal Breast Cancer.

PubMed

Lindström, Linda S; Yau, Christina; Czene, Kamila; Thompson, Carlie K; Hoadley, Katherine A; Van't Veer, Laura J; Balassanian, Ron; Bishop, John W; Carpenter, Philip M; Chen, Yunn-Yi; Datnow, Brian; Hasteh, Farnaz; Krings, Gregor; Lin, Fritz; Zhang, Yanhong; Nordenskjöld, Bo; Stål, Olle; Benz, Christopher C; Fornander, Tommy; Borowsky, Alexander D; Esserman, Laura J

2018-01-19

Breast cancer patients with estrogen receptor (ER)-positive disease have a continuous long-term risk for fatal breast cancer, but the biological factors influencing this risk are unknown. We aimed to determine whether high intratumor heterogeneity of ER predicts an increased long-term risk (25 years) of fatal breast cancer. The STO-3 trial enrolled 1780 postmenopausal lymph node-negative breast cancer patients randomly assigned to receive adjuvant tamoxifen vs not. The fraction of cancer cells for each ER intensity level was scored by breast cancer pathologists, and intratumor heterogeneity of ER was calculated using Rao's quadratic entropy and categorized into high and low heterogeneity using a predefined cutoff at the second tertile (67%). Long-term breast cancer-specific survival analyses by intra-tumor heterogeneity of ER were performed using Kaplan-Meier and multivariable Cox proportional hazard modeling adjusting for patient and tumor characteristics. A statistically significant difference in long-term survival by high vs low intratumor heterogeneity of ER was seen for all ER-positive patients (P < .001) and for patients with luminal A subtype tumors (P = .01). In multivariable analyses, patients with high intratumor heterogeneity of ER had a twofold increased long-term risk as compared with patients with low intratumor heterogeneity (ER-positive: hazard ratio [HR] = 1.98, 95% confidence interval [CI] = 1.31 to 3.00; luminal A subtype tumors: HR = 2.43, 95% CI = 1.18 to 4.99). Patients with high intratumor heterogeneity of ER had an increased long-term risk of fatal breast cancer. Interestingly, a similar long-term risk increase was seen in patients with luminal A subtype tumors. Our findings suggest that intratumor heterogeneity of ER is an independent long-term prognosticator with potential to change clinical management, especially for patients with luminal A tumors. © The Author(s) 2018. Published by Oxford University Press.

Exploratory spatial analysis of pilot fatality rates in general aviation crashes using geographic information systems.

PubMed

Grabowski, Jurek G; Curriero, Frank C; Baker, Susan P; Li, Guohua

2002-03-01

Geographic information systems and exploratory spatial analysis were used to describe the geographic characteristics of pilot fatality rates in 1983-1998 general aviation crashes within the continental United States. The authors plotted crash sites on a digital map; rates were computed at regular grid intersections and then interpolated by using geographic information systems. A test for significance was performed by using Monte Carlo simulations. Further analysis compared low-, medium-, and high-rate areas in relation to pilot characteristics, aircraft type, and crash circumstance. Of the 14,051 general aviation crashes studied, 31% were fatal. Seventy-four geographic areas were categorized as having low fatality rates and 53 as having high fatality rates. High-fatality-rate areas tended to be mountainous, such as the Rocky Mountains and the Appalachian region, whereas low-rate areas were relatively flat, such as the Great Plains. Further analysis comparing low-, medium-, and high-fatality-rate areas revealed that crashes in high-fatality-rate areas were more likely than crashes in other areas to have occurred under instrument meteorologic conditions and to involve aircraft fire. This study demonstrates that geographic information systems are a valuable tool for injury prevention and aviation safety research.

Cost-effectiveness analysis of applying the Cholesterol and Recurrent Events (CARE) study protocol in Hong Kong.

PubMed

Chau, J; Cheung, B M; McGhee, S M; Lauder, I J; Lau, C P; Kumana, C R

2001-12-01

To determine the cost-effectiveness of secondary prevention with pravastatin in Hong Kong patients with coronary heart disease and average cholesterol levels. Cost-effectiveness analysis based on published results of the CARE study. Men and women post-myocardial infarction with average cholesterol levels. Cost-effectiveness analysis: cost per life saved, cost per fatal or non-fatal coronary event prevented, cost per procedure prevented, and cost per fatal or non-fatal stroke prevented. Cost-utility analysis: gross cost and net cost per quality-adjusted life year gained calculated using two alternative models. Cost per life saved or death prevented was HK$4,442,350 (non-discounted); cost per fatal or non-fatal cardiac event prevented HK$1,146,413; cost per procedure prevented HK$732,759; and cost per fatal or non-fatal stroke prevented HK$2,961,566. Net cost per quality adjusted life year gained was HK$73,218 and HK$65,280 non-discounted, respectively using the two alternative models. The results of this study can assist in prioritising the use of health care resources in Hong Kong but should be considered alongside the benefits and costs of alternative interventions for coronary heart disease.

Symptoms associated with adverse dengue fever prognoses at the time of reporting in the 2015 dengue outbreak in Taiwan.

PubMed

Yeh, Chun-Yin; Chen, Po-Lin; Chuang, Kun-Ta; Shu, Yu-Chen; Chien, Yu-Wen; Perng, Guey Chuen; Ko, Wen-Chien; Ko, Nai-Ying

2017-12-01

Tainan experienced the most severe dengue epidemic in Taiwan in 2015. This study investigates the association between the signs and symptoms at the time of reporting with the adverse dengue prognoses. A descriptive study was conducted using secondary data from the Dengue Disease Reporting System in Tainan, Taiwan, between January 1 and December 31, 2015. A multivariate stepwise logistic regression was used to identify the risk factors for the adverse prognoses: ICU admissions and mortality. There were 22,777 laboratory-confirmed reported cases (mean age 45.6 ± 21.2 years), of which 3.7% were admitted to intensive care units (ICU), and 0.8% were fatal. The most common symptoms were fever (92.8%), myalgia (26.6%), and headache (22.4%). The prevalence of respiratory distress, altered consciousness, shock, bleeding, and thrombocytopenia increased with age. The multivariate analysis indicated that being in 65-89 years old age group [Adjusted Odds Ratio (aOR):4.95], or the 90 years old and above age group (aOR: 9.06), and presenting with shock (aOR: 8.90) and respiratory distress (aOR: 5.31) were significantly associated with the risk of ICU admission. While old age (aOR: 1.11), respiratory distress (aOR: 9.66), altered consciousness (aOR: 7.06), and thrombocytopenia (aOR: 2.55) were significantly associated with the risk of mortality. Dengue patients older than 65 and those with severe and non-specific signs and symptoms at the time of reporting were at a higher risk of ICU admission and mortality. First-line healthcare providers need to be aware of the varied presentations between the different age groups to allow early diagnosis and in-time management, which would prevent ICU admissions and fatalities in dengue patients.

One-year survival of demented stroke patients: data from the Dijon Stroke Registry, France (1985-2008).

PubMed

Béjot, Y; Jacquin, A; Rouaud, O; Durier, J; Aboa-Eboulé, C; Hervieu, M; Osseby, G-V; Giroud, M

2012-05-01

  Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post-stroke dementia was a predictor of 1-year case-fatality and to evaluate factors that could influence survival in demented stroke patients. From 1985 to 2008, all first-ever strokes were recorded in the population-based stroke registry of Dijon, France (150, 000 inhabitants). Dementia was diagnosed during the first month following stroke, according to DSM-III and DSM-IV criteria. Survival was evaluated at 1 year and multivariate analyses were performed using Cox proportional hazards to identify independent predictive factors.   We recorded 3948 first-ever strokes. Among these stroke patients, 3201 (81%) were testable, and of these, 653 (20.4%) had post-stroke dementia (337 women and 316 men). Demented patients had lower 1-year survival than patients without dementia (82.9% vs. 86.9%, P = 0.013). However, in multivariate analysis, dementia did not appear as an independent predictor of 1-year death. In demented stroke patients, age >80 years old, severe handicap at discharge, recurrent stroke within the first year and subarachnoid haemorrhage were associated with a higher risk of 1-year death, and the risk was lower in the study period 2003-2008.   Dementia after stroke is not independently associated with an increased risk of death at 1 year. In recent years, 1-year case-fatality decreased in demented as well as in and non-demented patients suggesting that improvements in the management of stroke also benefited the most fragile patients. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

The association between nut consumption and the risk of total and ischemic stroke in a German cohort study.

PubMed

di Giuseppe, R; Fjeld, M K; Dierkes, J; Theoflylaktopoulou, D; Arregui, M; Boeing, H; Weikert, C

2015-04-01

Nuts have beneficial effects on coronary heart disease and many cardiovascular risk factors. However, their effect on stroke is less established, and no studies on the topic are available in Northern and Central European populations. Therefore, we aimed at investigating the association between nut consumption and the risk of stroke in a German population. We used data from a prospective cohort of 26,285 participants of the European Prospective Investigation into the Cancer and Nutrition Potsdam Study. During a median follow-up time of 8.3 years (interquartile range: 7.5-9.2), 288 incident cases of stroke occurred. Nut consumption (standard portion size of 50 g) was assessed at baseline with a semiquantitative food-frequency questionnaire. The median nut intake was 0.82 g per day, interquartile range: 0.41-4.11. In the multivariable model, an increased risk of stroke was observed among participants who never consumed nuts (hazard ratio (HR): 1.56, 95% confidence interval: 1.17-2.08), compared with those consuming <½ portion/week. However, there was no evidence of a dose-response relationship between nut consumption and stroke. Compared with those who consumed <½ portion/week, the multivariable HR for total stroke was 1.06 (0.75-1.52) among those who consumed ½ to 1 portion/week and 1.37 (0.92-2.05) for those who consumed >1 portion/week. Similar nonsignificant associations were observed in stratified analysis for gender, or for fatal and nonfatal stroke. We could not observe an association between nut consumption and the risk of developing stroke (fatal/nonfatal) in a population with low habitual nut consumption.

Factors related to pilot survival in helicopter commuter and air taxi crashes.

PubMed

Krebs, M B; Li, G; Baker, S P

1995-02-01

We examined factors related to pilot survival in 167 consecutive helicopter commuter and air taxi crashes that occurred during 1983-88. Case fatality rates and adjusted odds ratios from multivariate logistic regression models were determined using data from the National Transportation Safety Board (NTSB). During this 6-year period, 29 pilots-in-command died in 167 helicopter commuter and air taxi crashes, a case fatality rate of 17.4%. Factors significantly associated with increased risk of pilot fatality were aircraft fire [odds ratio (OR) 20.0, 95% confidence interval (CI) 4.6-86.8], not using shoulder harnesses (OR 9.2, 95% CI 2.2-37.3), and aircraft with two engines (OR 4.8, 95% CI 1.3-17.4). In addition, we present data regarding success and failure of emergency flotation devices. The results suggest that the likelihood of pilot survival in helicopter crashes could be greatly improved by preventing crash associated fires and promoting the usage of shoulder restraints.

Characteristics of low-speed vehicle run-over events in children: an 11-year review.

PubMed

Griffin, Bronwyn R; Watt, Kerrianne; Shields, Linda E; Kimble, Roy M

2014-10-01

The purpose of this study was to investigate the characteristics associated with fatal and non-fatal low-speed vehicle run-over (LSVRO) events in relation to person, incident and injury characteristics, in order to identify appropriate points for intervention and injury prevention. Data on all known LSVRO events in Queensland, Australia, over 11 calendar years (1999-2009) were extracted from five different databases representing the continuum of care (prehospital to fatality) and manually linked. Descriptive and multivariate analyses were used to analyse the sample characteristics in relation to demographics, health service usage, outcomes, incident characteristics, and injury characteristics. Of the 1641 LSVRO incidents, 98.4% (n=1615) were non-fatal, and 1.6% were fatal (n=26). Over half the children required admission to hospital (56%, n=921); mean length of stay was 3.4 days. Younger children aged 0-4 years were more frequently injured, and experienced more serious injuries with worse outcomes. Patterns of injury (injury type and severity), injury characteristics (eg, time of injury, vehicle type, driver of vehicle, incident location), and demographic characteristics (such as socioeconomic status, indigenous status, remoteness), varied according to age group. Almost half (45.6%; n=737) the events occurred outside major cities, and approximately 10% of events involved indigenous children. Parents were most commonly the vehicle drivers in fatal incidents. While larger vehicles such as four-wheel drives (4WD) were most frequently involved in LSVRO events resulting in fatalities, cars were most frequently involved in non-fatal events. This is the first study, to the authors' knowledge, to analyse the characteristics of fatal and non-fatal LSVRO events in children aged 0-15 years on a state-wide basis. Characteristics of LSVRO events varied with age, thus age-specific interventions are required. Children living outside major cities, and indigenous children, were over-represented in these data. Further research is required to identify the burden of injury in these groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study

PubMed Central

Lazzerini, Marzia; Seward, Nadine; Lufesi, Norman; Banda, Rosina; Sinyeka, Sophie; Masache, Gibson; Nambiar, Bejoy; Makwenda, Charles; Costello, Anthony; McCollum, Eric D; Colbourn, Tim

2017-01-01

Summary Background Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012. Methods Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi’s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children’s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2–11 months of age, and 12–59 months of age using separate multivariable mixed effects logistic regression models. Findings Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92.7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6.6% (95% CI 6.4–6.7). The case fatality rate significantly decreased between 2001 (15.2% [13.4–17.1]) and 2012 (4.5% [4.1–4.9]; ptrend<0.0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2–11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11.8%), severe undernutrition (15.4%), severe acute malnutrition (34.8%), and symptom duration of more than 21 days (9.0%). Interpretation Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi. PMID:26718810

Prophylaxis of venous thromboembolism in elderly patients with multimorbidity.

PubMed

Marcucci, Maura; Iorio, Alfonso; Nobili, Alessandro; Tettamanti, Mauro; Pasina, Luca; Djade, Codjo Djignefa; Marengoni, Alessandra; Salerno, Francesco; Corrao, Salvatore; Mannucci, Pier Mannuccio

2013-09-01

Pharmacological thromboprophylaxis (TP) is known to reduce venous thromboembolism (VTE) in medical inpatients, but the criteria for risk-driven prescription, safety and impact on mortality are still debated. We analyze data on elderly patients with multimorbidities admitted in the year 2010 to the Italian internal medicine wards participating in the REPOSI registry to investigate the rate of TP during the hospital stay, and analyze the factors that are related to its prescription. Multivariate logistic regression, area under the ROC curve and CART analysis were performed to look for independent predictors of TP prescription. Association between TP and VTE, bleeding and death in hospital and during the 3-month post-discharge follow-up were explored by logistic regression and propensity score analysis. Among the 1,380 patients enrolled, 171 (15.2 %) were on TP during the hospital stay (162 on low molecular weight heparins, 9 on fondaparinux). The disability Barthel index was the main independent predictor of TP prescription. Rate of fatal and non-fatal VTE and bleeding during and after hospitalization did not differ between TP and non-TP patients. In-hospital and post-discharge mortality was significantly higher in patients on TP, that however was not an independent predictor of mortality. Among elderly medical patients there was a relatively low rate of TP, that was more frequently prescribed to patients with a higher degree of disability and who had an overall higher mortality.

[Factors associated with work-related accidents in the informal commercial sector].

PubMed

Rios, Marcela Andrade; Nery, Adriana Alves; Rios, Polianna Alves Andrade; Casotti, Cezar Augusto; Cardoso, Jefferson Paixão

2015-06-01

This study aimed to estimate the incidence of non-fatal work-related accidents in the informal commercial sector and analyze associated socio-demographic, occupational, workplace, and health factors, in a cross-sectional survey of 434 workers in the business district of Jequié, Bahia State, Brazil, in 2013. Logistic regression was used to assess factors associated with accidents. Incidence of accidents in the previous 12 months was estimated at 32.3%, and multivariate analysis showed higher odds of accidents in male sex workers (OR = 1.61), young individuals (OR = 4.62), meat or poultry workers (OR = 9.55), and workers performing heavy physical work (OR = 1.71). The results show the need for public policies to prevent accidents in the informal commercial sector.

Opportunities for reduction of fatalities in vehicle-guardrail collisions.

PubMed

Gabler, Hampton C; Gabauer, Douglas J

2007-01-01

In the United States in 2005, there were 1,189 fatal crashes and 35,000 injurious crashes into guardrails. Current efforts to reduce fatalities occurring in guardrail collisions have focused on frontal oblique collisions of cars and light trucks into guardrail. These crashes however represent a diminishing target population for fatality reduction. This paper examines the current opportunities for reducing fatalities in guardrail collisions in the United States. The analysis was based upon crash data from the Fatality Analysis Reporting System (FARS) and the National Automotive Sampling System General Estimates System (GES) for the years 2000-2005. The greatest opportunity for fatality reduction is the protection of motorcyclists, who now account for 32% of guardrail fatalities, and car and light truck occupants in side impact, who now comprise 14% of all guardrail fatalities. Together, protection of motorcycle riders and protection of car and light truck occupants in side impacts account for nearly half of all fatalities (46%) which occur in vehicle-guardrail collisions. Additional targets for fatality reduction include light truck rollover and collisions with guardrail ends.

Pedestrian and bicyclist fatalities in large truck crashes, 2013 : [analysis brief].

DOT National Transportation Integrated Search

2015-11-01

From 2006 to 2013, pedestrian fatalities as a : percentage of total fatalities in all motor vehicle : crashes rose from 11.2 percent to 14.5 percent, and : bicyclist fatalities as a percentage of total fatalities : rose from 1.8 percent to 2.3 percen...

Urban Sprawl as a Risk Factor in Motor Vehicle Occupant and Pedestrian Fatalities

PubMed Central

Ewing, Reid; Schieber, Richard A.; Zegeer, Charles V.

2003-01-01

Objectives. We sought to determine the association between urban sprawl and traffic fatalities. Methods. We created a sprawl index by applying principal components analysis to data for 448 US counties in the largest 101 metropolitan areas. Regression analysis was used to determine associations between the index and traffic fatalities. Results. For every 1% increase in the index (i.e., more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% (P < .001) and pedestrian fatality rates fell by 1.47% to 3.56%, after adjustment for pedestrian exposure (P < .001). Conclusions. Urban sprawl was directly related to traffic fatalities and pedestrian fatalities. Subsequent studies should investigate relationships at a finer geographic scale and should strive to improve on the measure of exposure used to adjust pedestrian fatality rates. PMID:12948977

An anthropometric study of Serbian metal industry workers.

PubMed

Omić, S; Brkić, V K Spasojevic; Golubović, T A; Brkić, A D; Klarin, M M

2017-01-01

There are recent studies using new industrial workers' anthropometric data in different countries, but for Serbia such data are not available. This study is the first anthropometric study of Serbian metal industry workers in the country, whose labor force is increasingly employed both on local and international markets. The metal industry is one of Serbia's most important economic sectors. To this end, we collected the basic static anthropometric dimensions of 122 industrial workers and used principal components analysis (PCA) to obtain multivariate anthropometric models. To confirm the results, the dimensions of an additional 50 workers were collected. The PCA methodology was also compared with the percentile method. Comparing both data samples, we found that 96% of the participants are within the tolerance ellipsoid. According to this study, multivariate modeling covers a larger extent of the intended population proportion compared to percentiles. The results of this research are useful for the designers of metal industry workstations. This information can be used in dimensioning the workplace, thus increasing job satisfaction, reducing the risk of injuries and fatalities, and consequently increasing productivity and safety.

Impact of Chronic Nitrate Therapy in Patients With Ischemic Heart Failure.

PubMed

Moreira-Silva, Sofia; Urbano, Joana; Nogueira-Silva, Luís; Bettencourt, Paulo; Pimenta, Joana

2016-09-01

There is a lack of knowledge on the effects of nitrates alone in heart failure (HF). We aimed to assess the impact of nitrates use in the occurrence of ischemic events in patients with ischemic HF attending an HF clinic. We performed a retrospective analysis of a cohort of 632 patients managed in an HF clinic between January 2000 and December 2011. Patients with ischemic etiology were selected (n = 290). Patients were classified according to chronic nitrates use (n = 83 nitrates users vs n = 194) and followed up for 5 years for the occurrence of fatal or nonfatal myocardial infarction or stroke. Nitrates users had more frequently diabetes, dyslipidemia, and higher body mass index but were less frequently treated with statins. Thirty adverse events were recorded (n = 16 in nitrates group). Variables significantly associated with the occurrence of the end point in univariate analysis were arterial hypertension, diabetes, and nitrates use. Male gender, beta-blockers, statin, and clopidogrel use had a protective effect on the occurrence of the end point. In multivariate analysis, nitrates use remained an independent predictor of adverse outcome when adjusted for each of the variables: arterial hypertension, gender, diabetes, beta-blocker, and clopidogrel use; however, when adjusted for statin use, nitrates were no longer associated with the outcome. Long-term nitrates use in patients with ischemic HF was associated with higher occurrence of ischemic events, defined as fatal or nonfatal myocardial infarction or stroke. Our results, although from a retrospective analysis, do not support a role for chronic nitrate use in HF. © The Author(s) 2016.

An Analysis of fatal traffic crashes in Kentucky and recommended countermeasures.

DOT National Transportation Integrated Search

2005-11-01

The objective of this study were analyze fatal traffic crashes in Kentucky to identify patterns and causes of these crashes and to recommend potential countermeasures. The study included the following areas of analysis: 1) trends in fatal collisions,...

Psychometric properties of the Arabic version of the 12-item diabetes fatalism scale

PubMed Central

Abi Kharma, Joelle

2018-01-01

Background There are widespread fatalistic beliefs in Arab countries, especially among individuals with diabetes. However, there is no tool to assess diabetes fatalism in this population. This study describes the processes used to create an Arabic version of the Diabetes Fatalism Scale (DFS) and examine its psychometric properties. Methods A descriptive correlational design was used with a convenience sample of Lebanese adults (N = 274) with type 2 diabetes recruited from a major hospital in Beirut, Lebanon and by snowball sampling. The 12- item Diabetes Fatalism Scale- Arabic (12-item DFS-Ar) was back-translated from the original version, pilot tested on 22 adults with type 2 diabetes and then administered to 274 patients to assess the validity and reliability of the scale. Confirmatory factor analysis (CFA) was used to test the hypothesized factor structure. Cronbach’s alpha was used to test for reliability. Results CFA supported the existence of the three factor hypothesis of the original DFS scale. The five items measuring “emotional distress” loaded under Factor 1, the four items measuring “spiritual coping” loaded under factor 2 and the last three items measuring “perceived self-efficacy” of the original scale loaded under Factor 3 (p <0.001 for all three subscales). Goodness of fit indices confirmed adequateness of the CFA model (CFI = 0.97, TLI = 0.96, RMSEA = 0.067 and pclose = 0.05). The 12-item DFS-Ar showed good reliability (Cronbach’s alpha of 0.86) and significantly predicted HbA1c (β = 0.20, p < 0.01). After adjusting for the demographic characteristics and the number of diabetes comorbid conditions, the 12-item DFS-Ar score was independently associated with HbA1c in a multivariable model (β = 0.16, p < 0.05). Conclusions The 12-item DFS-Ar demonstrated good psychometric properties that are comparable to the original scale. It is a valid and reliable measure of diabetes fatalism. Further testing with larger and non-Lebanese Arabic population is needed. PMID:29324827

Brazilian Road Traffic Fatalities: A Spatial and Environmental Analysis

PubMed Central

de Andrade, Luciano; Vissoci, João Ricardo Nickenig; Rodrigues, Clarissa Garcia; Finato, Karen; Carvalho, Elias; Pietrobon, Ricardo; de Souza, Eniuce Menezes; Nihei, Oscar Kenji; Lynch, Catherine; de Barros Carvalho, Maria Dalva

2014-01-01

Background Road traffic injuries (RTI) are a major public health epidemic killing thousands of people daily. Low and middle-income countries, such as Brazil, have the highest annual rates of road traffic fatalities. In order to improve road safety, this study mapped road traffic fatalities on a Brazilian highway to determine the main environmental factors affecting road traffic fatalities. Methods and Findings Four techniques were utilized to identify and analyze RTI hotspots. We used spatial analysis by points by applying kernel density estimator, and wavelet analysis to identify the main hot regions. Additionally, built environment analysis, and principal component analysis were conducted to verify patterns contributing to crash occurrence in the hotspots. Between 2007 and 2009, 379 crashes were notified, with 466 fatalities on BR277. Higher incidence of crashes occurred on sections of highway with double lanes (ratio 2∶1). The hotspot analysis demonstrated that both the eastern and western regions had higher incidences of crashes when compared to the central region. Through the built environment analysis, we have identified five different patterns, demonstrating that specific environmental characteristics are associated with different types of fatal crashes. Patterns 2 and 4 are constituted mainly by predominantly urban characteristics and have frequent fatal pedestrian crashes. Patterns 1, 3 and 5 display mainly rural characteristics and have higher prevalence of vehicular collisions. In the built environment analysis, the variables length of road in urban area, limited lighting, double lanes roadways, and less auxiliary lanes were associated with a higher incidence of fatal crashes. Conclusions By combining different techniques of analyses, we have identified numerous hotspots and environmental characteristics, which governmental or regulatory agencies could make use to plan strategies to reduce RTI and support life-saving policies. PMID:24498051

Epidemiologic patterns of influenza outbreaks in institutional settings.

PubMed

Šubelj, M

2018-02-01

Congregate environments facilitate spread of influenza viruses and could result in serious outcomes among residents. We reviewed the epidemiology and identified factors that affect outbreak outcomes, using descriptive statistics and generalized estimating equations (GEE) regression. Outbreak duration, attack rate, hospitalization rate, case fatality rate, and the proportion of laboratory tests performed among infected residents were calculated by viral etiology, time to notification, and facility type and size. Between January 2011 and May 2015, the median attack rate for the 41 influenza outbreaks was highest among children in kindergarten (34%) and lowest among patients, who acquired influenza during hospitalization (17%). The median number of cases in each outbreak was 37 (range: 6-158) and a median of 199 individuals (range: 25-574) was exposed to influenza. The outbreaks lasted 2-49 days (median: 13 days). The average case fatality rate among residents for outbreaks attributed to influenza A or B was 3.1/1000 and for outbreaks attributed to influenza B 6.7/1000. Median time to notification was 10 days after the index case. In multivariate analysis, influenza outbreaks reported sooner after onset in the primary case ended sooner (P = 0.027) and had lower case fatality rates (P < 0.001). Residing in larger facilities was associated with lower proportion of laboratory tests performed (P = 0.024). Understanding whether earlier notification is a measure of a better functioning and therefore safer facility is a potentially important measure of the quality of care. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Spectral Analysis of the Effects of Daylight Saving Time on Motor Vehicle Fatal Traffic Accidents

DOT National Transportation Integrated Search

1977-04-01

This report shows that Daylight Saving Time (DST) reduces the number of persons killed in motor vehicle fatal traffic accidents by about one percent. This estimate is based on a spectral (Fourier) analysis of these fatalities which utilizes a filteri...

Pandemic influenza A(H1)pdm09 in hospitals and intensive care units - results from a new hospital surveillance, Germany 2009/2010.

PubMed

Adlhoch, Cornelia; Wadl, Maria; Behnke, Michael; Peña Diaz, Luis Alberto; Clausmeyer, Jörg; Eckmanns, Tim

2012-11-01

The pandemic influenza A(H1)pdm09 (PI) was introduced to Germany in April 2009. The Robert Koch Institute (RKI) implemented a nationwide voluntary hospital sentinel surveillance for to assess the burden and severity of PI. Three modules were offered: a hospital module collected aggregated data from all hospital units on admissions and fatalities with and without PI; an intensive care module data on admissions, patient-days, and ventilated patient-days with and without PI; and a case-based module retrieved clinical patient data of PI cases. A in-patient with a PCR confirmation was defined as a PI case. Descriptive, trend, uni-, and multivariable analysis were performed. Between week 49/2009 and 13/2010, the hospitals reported 103 (0.07%) PI cases among 159181 admissions and 59/16728 (0.35%) PI-related admissions in intensive care units (ICUs). The weekly average incidence decreased in hospitals by 21.5% and in ICUs by 19.2%. In ICUs, 1848/85559 (2.2%) patient-days were PI-related, 94.8% of those with mechanical ventilation. Case-based data on 43 recovered and 16 fatal PI cases were reported. Among recovered, 61% were admitted to ICUs, 51% were mechanically ventilated, and 16% received extracorporeal membrane oxygenation (ECMO). All fatal cases were admitted to ICUs and received mechanical ventilation, 75% ECMO. Fatal outcome was rather associated with complications than with underlying medical conditions. The surveillance started shortly after the PI peak, which explains the small number of PI cases. The burden of PI disease was low, but higher in ICUs with a high proportion of severe cases needing ventilation and ECMO treatment. A continuous hospital surveillance system could be helpful to measure the burden of severe community-acquired infections. © 2012 Blackwell Publishing Ltd.

The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries

PubMed Central

Pollack, Craig Evan; Garza, Mary A.; Yeh, Hsin-Chieh; Markakis, Diane; Phelan-Emrick, Darcy F.; Wenzel, Jennifer; Shapiro, Gary R.; Bone, Lee; Johnson, Lawrence

2017-01-01

Purpose We examined the association between socioeconomic status (SES) and prostate-specific antigen (PSA) cancer screening among older African American men. Methods We analyzed baseline data from a sample of 485 community-dwelling African American men who participated in the Cancer Prevention and Treatment Demonstration Trial. The outcome was receipt of PSA screening within the past year. SES was measured using income and educational attainment. Sequential multivariate logistic regression models were performed to study whether health care access, patient–provider relationship, and cancer fatalism mediated the relationship between SES and PSA screening. Results Higher educational attainment was significantly associated with higher odds of PSA screening in the past year (odds ratio (OR) 2.08 for college graduate compared to less than high school graduate, 95 % confidence interval (CI) 1.03–4.24); income was not. Health care access and patient–provider communication did not alter the relationship between education and screening; however, beliefs regarding cancer fatalism partially mediated the observed relationship. Conclusion Rates of prostate cancer screening among African American men vary by level of educational attainment; beliefs concerning cancer fatalism help explain this gradient. Understanding the determinants of cancer fatalism is a critical next step in building interventions that seek to ensure equitable access to prostate cancer screening. PMID:26863336

The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries.

PubMed

Hararah, Mohammad Khalid; Pollack, Craig Evan; Garza, Mary A; Yeh, Hsin-Chieh; Markakis, Diane; Phelan-Emrick, Darcy F; Wenzel, Jennifer; Shapiro, Gary R; Bone, Lee; Johnson, Lawrence; Ford, Jean G

2015-06-01

We examined the association between socioeconomic status (SES) and prostate-specific antigen (PSA) cancer screening among older African American men. We analyzed baseline data from a sample of 485 community-dwelling African American men who participated in the Cancer Prevention and Treatment Demonstration Trial. The outcome was receipt of PSA screening within the past year. SES was measured using income and educational attainment. Sequential multivariate logistic regression models were performed to study whether health care access, patient-provider relationship, and cancer fatalism mediated the relationship between SES and PSA screening. Higher educational attainment was significantly associated with higher odds of PSA screening in the past year (odds ratio (OR) 2.08 for college graduate compared to less than high school graduate, 95 % confidence interval (CI) 1.03-4.24); income was not. Health care access and patient-provider communication did not alter the relationship between education and screening; however, beliefs regarding cancer fatalism partially mediated the observed relationship. Rates of prostate cancer screening among African American men vary by level of educational attainment; beliefs concerning cancer fatalism help explain this gradient. Understanding the determinants of cancer fatalism is a critical next step in building interventions that seek to ensure equitable access to prostate cancer screening.

Fatal crashes involving drivers recorded as asleep or fatigued, 2013 : analysis brief.

DOT National Transportation Integrated Search

2016-05-01

In 2013, 30,057 fatal crashes took place on our Nations roadways, with 11.8 percent (3,541) involving at least 1 large truck. This analysis reviews fatal crashes in which the large truck driver was recorded as being fatigued at the time of the cra...

Mortality among patients due to adverse drug reactions that lead to hospitalization: a meta-analysis.

PubMed

Patel, Tejas K; Patel, Parvati B

2018-06-01

The aim of this study was to estimate the prevalence of mortality among patients due to adverse drug reactions that lead to hospitalisation (fatal ADR Ad ), to explore the heterogeneity in its estimation through subgroup analysis of study characteristics, and to identify system-organ classes involved and causative drugs for fatal ADR Ad . We identified prospective ADR Ad -related studies via screening of the PubMed and Google Scholar databases with appropriate key terms. We estimated the prevalence of fatal ADR Ad using a double arcsine method and explored heterogeneity using the following study characteristics: age groups, wards, study region, ADR definitions, ADR identification methods, study duration and sample size. We examined patterns of fatal ADR Ad and causative drugs. Among 312 full-text articles assessed, 49 studies satisfied the selection criteria and were included in the analysis. The mean prevalence of fatal ADR Ad was 0.20% (95% CI: 0.13-0.27%; I 2  = 93%). The age groups and study wards were the important heterogeneity modifiers. The mean fatal ADR Ad prevalence varied from 0.01% in paediatric patients to 0.44% in the elderly. Subgroup analysis showed a higher prevalence of fatal ADR Ad in intensive care units, emergency departments, multispecialty wards and whole hospitals. Computer-based monitoring systems in combination with other methods detected higher mortality. Intracranial haemorrhage, renal failure and gastrointestinal bleeding accounted for more than 50% of fatal ADR Ad cases. Warfarin, aspirin, renin-angiotensin system (RAS) inhibitors and digoxin accounted for 60% of fatal ADR Ad . ADR Ad is an important cause of mortality. Strategies targeting the safer use of warfarin, aspirin, RAS inhibitors and digoxin could reduce the large number of fatal ADR Ad cases.

Estimating the rates of deaths by suicide among adults who attempt suicide in the United States.

PubMed

Han, Beth; Kott, Phillip S; Hughes, Art; McKeon, Richard; Blanco, Carlos; Compton, Wilson M

2016-06-01

In 2012, over 1.3 million U.S. adults reported that they attempted suicide in the past year, and 39,426 adults died by suicide. This study estimated national suicide case fatality rates among adult suicide attempters (fatal and nonfatal cases) and examined how they varied by sociodemographic characteristics. We pooled data on deaths by suicide (n = 147,427, fatal cases in the U.S.) from the 2008-2011 U S. mortality files and data on suicide attempters who survived (n = 2000 nonfatal cases) from the 2008-2012 National Surveys on Drug Use and Health. Descriptive analyses and multivariable logistic regression models were applied. Among adult suicide attempters in the U.S., the overall 12-month suicide case fatality rate was 3.2% (95% confidence interval (CI) = 2.9%-3.5%). It varied significantly by sociodemographic factors. For those aged 45 or older, the adjusted suicide case fatality rate was higher among men (7.6%) than among women (2.6%) (suicide case fatality rate ratio (SCFRR) = 3.0, 95% CI = 1.83-4.79), was higher among non-Hispanic whites (7.9%) than among non-white minorities (0.8-2.5%) (SCFRRs = 3.2-9.9), and was higher among those with less than high school education (16.0%) than among college graduates (1.8%) (SCFRR = 8.8, 95% CI = 3.83-20.16). Across male and female attempters, being aged 45 or older and non-Hispanic white and having less than secondary school were at a higher risk for death by suicide. Focusing on these demographic characteristics can help identify suicide attempters at higher risk for death by suicide, inform clinical assessments, and improve suicide prevention and intervention efforts by increasing high-risk suicide attempters' access to mental health treatment. Published by Elsevier Ltd.

US Traffic Fatalities, 1985–2014, and Their Relationship to Medical Marijuana Laws

PubMed Central

Mauro, Christine M.; Wall, Melanie M.; Kim, June H.; Cerdá, Magdalena; Keyes, Katherine M.; Hasin, Deborah S.; Galea, Sandro; Martins, Silvia S.

2017-01-01

Objectives. To determine the association of medical marijuana laws (MMLs) with traffic fatality rates. Methods. Using data from the 1985–2014 Fatality Analysis Reporting System, we examined the association between MMLs and traffic fatalities in multilevel regression models while controlling for contemporaneous secular trends. We examined this association separately for each state enacting MMLs. We also evaluated the association between marijuana dispensaries and traffic fatalities. Results. On average, MML states had lower traffic fatality rates than non-MML states. Medical marijuana laws were associated with immediate reductions in traffic fatalities in those aged 15 to 24 and 25 to 44 years, and with additional yearly gradual reductions in those aged 25 to 44 years. However, state-specific results showed that only 7 states experienced post-MML reductions. Dispensaries were also associated with traffic fatality reductions in those aged 25 to 44 years. Conclusions. Both MMLs and dispensaries were associated with reductions in traffic fatalities, especially among those aged 25 to 44 years. State-specific analysis showed heterogeneity of the MML–traffic fatalities association, suggesting moderation by other local factors. These findings could influence policy decisions on the enactment or repealing of MMLs and how they are implemented. PMID:27997245

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001-12: a retrospective observational study.

PubMed

Lazzerini, Marzia; Seward, Nadine; Lufesi, Norman; Banda, Rosina; Sinyeka, Sophie; Masache, Gibson; Nambiar, Bejoy; Makwenda, Charles; Costello, Anthony; McCollum, Eric D; Colbourn, Tim

2016-01-01

Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012. Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi's Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children's clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2-11 months of age, and 12-59 months of age using separate multivariable mixed effects logistic regression models. Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92·7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6·6% (95% CI 6·4-6·7). The case fatality rate significantly decreased between 2001 (15·2% [13·4-17·1]) and 2012 (4·5% [4·1-4·9]; ptrend<0·0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2-11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11·8%), severe undernutrition (15·4%), severe acute malnutrition (34·8%), and symptom duration of more than 21 days (9·0%). Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi. Bill & Melinda Gates Foundation. Copyright © 2016 Lazzerini et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Fatal falls in the US construction industry, 1990 to 1999.

PubMed

Derr, J; Forst, L; Chen, H Y; Conroy, L

2001-10-01

The Occupational Safety and Health Administration's (OSHA's) Integrated Management Information System (IMIS) database allows for the detailed analysis of risk factors surrounding fatal occupational events. This study used IMIS data to (1) perform a risk factor analysis of fatal construction falls, and (2) assess the impact of the February 1995 29 CFR Part 1926 Subpart M OSHA fall protection regulations for construction by calculating trends in fatal fall rates. In addition, IMIS data on fatal construction falls were compared with data from other occupational fatality surveillance systems. For falls in construction, the study identified several demographic factors that may indicate increased risk. A statistically significant downward trend in fatal falls was evident in all construction and within several construction categories during the decade. Although the study failed to show a statistically significant intervention effect from the new OSHA regulations, it may have lacked the power to do so.

Fatality Analysis Reporting System, General Estimates System: 2001 Data Summary.

ERIC Educational Resources Information Center

2003

The Fatality Analysis Reporting System (FARS), which became operational in 1975, contains data on a census of fatal traffic crashes within the 50 states, the District of Columbia, and Puerto Rico. The General Estimates System (GES), which began in 1988, provides data from a nationally representative probability sample selected from all…

The impact of non-fatal workplace injuries and illnesses on mortality.

PubMed

Boden, Leslie I; O'Leary, Paul K; Applebaum, Katie M; Tripodis, Yorghos

2016-12-01

Little research has examined the relationship between non-fatal workplace injuries and illnesses, and long-term mortality. We linked non-fatal injury cases reported to the New Mexico workers' compensation system for 1994-2000 with Social Security Administration data on individual earnings and mortality through 2014. We then derived sex-specific Kaplan-Meier curves to show time to death for workers with lost-time injuries (n = 36,377) and comparison workers (n = 70,951). We fit multivariable Cox survival models to estimate the hazard ratio separately for male and female workers with lost-time injuries. The estimated hazard ratio for lost-time injuries is 1.24 for women and 1.21 for men. Ninety-five percent confidence intervals were 1.15, 1.35 and 1.15, 1.27, respectively. Lost-time occupational injuries are associated with a substantially elevated mortality hazard. This implies an important formerly unmeasured cost of these injuries and a further reason to focus on preventing them. Am. J. Ind. Med. 59:1061-1069, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

25(OH)D deficiency is associated with fatal stroke among whites but not blacks: The NHANES-III linked mortality files

PubMed Central

Michos, Erin D.; Reis, Jared P.; Post, Wendy S.; Lutsey, Pamela L.; Gottesman, Rebecca F.; Mosley, Thomas H.; Sharrett, A. Richey; Melamed, Michal L.

2011-01-01

Objective Deficient 25-hydroxyvitamin D [25(OH)D] levels are associated with cardiovascular disease (CVD) events and mortality. Both 25(OH)D deficiency and stroke are more prevalent among blacks. We examined whether low 25(OH)D contributes to the excess risk of fatal stroke in blacks compared to whites. Research Methods and Procedures The Third National Health and Nutrition Examination Survey, a probability sample of US civilians, measured 25(OH)D levels and CVD risk factors between 1988–1994. Vital status through December 2006 was obtained via linkage with the National Death Index. Among white and black adults without CVD reported at baseline (n=7981), Cox regression models were fit to estimate hazard ratios (HR) for fatal stroke by 25(OH)D status and race. Results During a median of 14.1 years, there were 116 and 60 fatal strokes among whites and blacks respectively. The risk of fatal stroke was greater in blacks compared to whites in models adjusted for socio-economic status and CVD risk factors, [HR 1.60 (95% CI 1.01–2.53)]. Mean baseline 25(OH)D levels were significantly lower in blacks compared to whites (19.4 vs 30.8 ng/mL, respectively). In multivariable-adjusted models, deficient 25(OH)D levels <15 ng/mL were associated with fatal stroke among whites [HR 2.13 (1.01–4.50)] but not blacks [HR 0.93 (0.49–1.80)]. Conclusions Vitamin D deficiency was associated with increased risk of stroke death in whites but not blacks. Although blacks had a higher rate of fatal stroke compared to whites, the low 25(OH)D levels in blacks were unrelated to stroke incidence and therefore 25(OH)D levels did not explain this excess risk. PMID:22261577

Hantavirus pulmonary syndrome in a highly endemic area of Brazil.

PubMed

Oliveira, R C; Sant'ana, M M; Guterres, A; Fernandes, J; Hillesheim, N L F K; Lucini, C; Gomes, R; Lamas, C; Bochner, R; Zeccer, S; DE Lemos, E R S

2016-04-01

Hantavirus pulmonary syndrome (HPS) is the most frequently reported fatal rodent-borne disease in Brazil, with the majority of cases occurring in Santa Catarina. We analysed the clinical, laboratory and epidemiological data of the 251 confirmed cases of HPS in Santa Catarina in 1999-2011. The number of cases ranged from 10 to 47 per year, with the highest incidences in 2004-2006. Gastrointestinal tract manifestations were found in >60% of the cases, potentially confounding diagnosis and leading to inappropriate therapy. Dyspnoea, acute respiratory failure, renal failure, increased serum creatinine and urea levels, increased haematocrits and the presence of pulmonary interstitial infiltrate were significantly more common in HPS patients who died. In addition, we demonstrated that the six cases from the midwest region of the state were associated with Juquitiba virus genotype. The case-fatality rate in this region, 19·2%, was lower than that recorded for other mesoregions. In the multivariate analysis increase of serum creatinine and urea was associated with death by HPS. Our findings help elucidate the epidemiology of HPS in Brazil, where mast seeding of bamboo can trigger rodent population eruptions and subsequent human HPS outbreaks. We also emphasize the need for molecular confirmation of the hantavirus genotype of human cases for a better understanding of the mortality-related factors associated with HPS cases in Brazil.

Risk Factors for Mortality in Patients with Serratia marcescens Bacteremia

PubMed Central

Kim, Sun Bean; Jeon, Yong Duk; Kim, Jung Ho; Kim, Jae Kyoung; Ann, Hea Won; Choi, Heun; Kim, Min Hyung; Song, Je Eun; Ahn, Jin Young; Jeong, Su Jin; Han, Sang Hoon; Choi, Jun Yong; Song, Young Goo; Kim, June Myung

2015-01-01

Purpose Over the last 30 years, Serratia marcescens (S. marcescens) has emerged as an important pathogen, and a common cause of nosocomial infections. The aim of this study was to identify risk factors associated with mortality in patients with S. marcescens bacteremia. Materials and Methods We performed a retrospective cohort study of 98 patients who had one or more blood cultures positive for S. marcescens between January 2006 and December 2012 in a tertiary care hospital in Seoul, South Korea. Multiple risk factors were compared with association with 28-day all-cause mortality. Results The 28-day mortality was 22.4% (22/98 episodes). In a univariate analysis, the onset of bacteremia during the intensive care unit stay (p=0.020), serum albumin level (p=0.011), serum C-reactive protein level (p=0.041), presence of indwelling urinary catheter (p=0.023), and Sequential Oran Failure Assessment (SOFA) score at the onset of bacteremia (p<0.001) were significantly different between patients in the fatal and non-fatal groups. In a multivariate analysis, lower serum albumin level and an elevated SOFA score were independently associated with 28-day mortality [adjusted odds ratio (OR) 0.206, 95% confidential interval (CI) 0.044-0.960, p=0.040, and adjusted OR 1.474, 95% CI 1.200-1.810, p<0.001, respectively]. Conclusion Lower serum albumin level and an elevated SOFA score were significantly associated with adverse outcomes in patients with S. marcescens bacteremia. PMID:25683980

Risk factors for mortality in patients with Serratia marcescens bacteremia.

PubMed

Kim, Sun Bean; Jeon, Yong Duk; Kim, Jung Ho; Kim, Jae Kyoung; Ann, Hea Won; Choi, Heun; Kim, Min Hyung; Song, Je Eun; Ahn, Jin Young; Jeong, Su Jin; Ku, Nam Su; Han, Sang Hoon; Choi, Jun Yong; Song, Young Goo; Kim, June Myung

2015-03-01

Over the last 30 years, Serratia marcescens (S. marcescens) has emerged as an important pathogen, and a common cause of nosocomial infections. The aim of this study was to identify risk factors associated with mortality in patients with S. marcescens bacteremia. We performed a retrospective cohort study of 98 patients who had one or more blood cultures positive for S. marcescens between January 2006 and December 2012 in a tertiary care hospital in Seoul, South Korea. Multiple risk factors were compared with association with 28-day all-cause mortality. The 28-day mortality was 22.4% (22/98 episodes). In a univariate analysis, the onset of bacteremia during the intensive care unit stay (p=0.020), serum albumin level (p=0.011), serum C-reactive protein level (p=0.041), presence of indwelling urinary catheter (p=0.023), and Sequential Oran Failure Assessment (SOFA) score at the onset of bacteremia (p<0.001) were significantly different between patients in the fatal and non-fatal groups. In a multivariate analysis, lower serum albumin level and an elevated SOFA score were independently associated with 28-day mortality [adjusted odds ratio (OR) 0.206, 95% confidential interval (CI) 0.044-0.960, p=0.040, and adjusted OR 1.474, 95% CI 1.200-1.810, p<0.001, respectively]. Lower serum albumin level and an elevated SOFA score were significantly associated with adverse outcomes in patients with S. marcescens bacteremia.

[«All of a sudden…» preventability and priorities of construction fatalities: an experience in Piedmont].

PubMed

Pasqualini, Osvaldo; Libener, Marcello; Farina, Elena; Bena, Antonella

2011-01-01

To examine the usefulness for prevention of the National Surveillance System on occupational fatalities, which is based on the narrative description of the work accident collected by OSH inspectors and on the subsequent classification of the injury dynamics by means of a standardized model of analysis. The system ability of providing useful recommendations for prevention was evaluated on one hand by analyzing the effectiveness of inspections in preventing fatalities, on the other hand by identifying the most frequent accident mechanisms. Data analyzed consisted of investigation reports of construction fatalities occurred during 2002-2008 in the Piedmont Region, collected by surveillance system. The injury narrative description was used to assess whether the fatality would have been preventable by an inspection hypothetically conducted the day before the event; injuries were classified as probably preventable, probably not preventable, and uncertain. A standardized model of classification of injury dynamics was employed to identify mechanisms and circumstances related to the construction fatalities, and particularly those caused by falls from height. Among 122 construction fatalities occurred, 25%were considered probably preventable and 60%probably not preventable. Half of the construction fatalities was caused by fall from height, most of which were caused by sudden breaking of a surface walkway, and almost 20% by fall of objects, including burial. The analysis of the preventability of construction fatalities in Piedmont seems partly to rebut the assumption that more inspections are necessarily associated with a reduction in fatalities. The interpretation of the injury narrative descriptions, which are implemented by OHS inspectors as part of their usual activity, through a standardized model of analysis allows to identify the breaking of surface walkways as the most important mechanism of fatality among falls from height.

Fatality analysis reporting system and roadway inventory correlation.

DOT National Transportation Integrated Search

2013-01-01

In this project, we developed an integrated database to provide new analysis capabilities : for discovering correlations between roadway characteristics and the occurrence of : fatality collisions. Specifically, the aim of this data analysis project ...

Do coping strategies mediate the effects of emotional support on emotional well-being among Spanish-speaking Latina breast cancer survivors?

PubMed

Gonzales, Felisa A; Hurtado-de-Mendoza, Alejandra; Santoyo-Olsson, Jasmine; Nápoles, Anna María

2016-11-01

This study aimed to assess the relationship between emotional social support and emotional well-being among Latina immigrants with breast cancer and test whether two culturally relevant coping strategies, fatalism and acceptance, mediate this relationship. One hundred fifty Spanish-speaking Latinas within 1 year of breast cancer diagnosis participating in a randomized trial of a stress management intervention were assessed in person at baseline and via telephone 6 months later. Survey measures included baseline emotional support, fatalism, and acceptance and emotional well-being 6 months later. Generalized linear models estimated direct effects of emotional support on emotional well-being and indirect effects through fatalism and acceptance. Mean age was 50.1 (SD = 10.9) years; most women had low education and acculturation levels. Emotional support was negatively associated with fatalism (r = -0.24, p < 0.01) and positively associated with acceptance (r = 0.30, p < 0.001). Emotional support (r = 0.23, p = 0.005) and acceptance (r = 0.28, p = 0.001) were positively associated with emotional well-being, whereas fatalism (r = -0.36, p < 0.0001) was negatively associated with emotional well-being. In multivariable models, emotional support was associated with emotional well-being (b = 0.88, 95% CI: 0.24, 1.52). This direct effect remained significant when additionally controlling for fatalism (b = 0.66, 95% CI: 0.03, 1.30) and acceptance (b = 0.73, 95% CI: 0.09, 1.37) in separate models. There was a significant indirect effect of emotional support on emotional well-being through fatalism (b = 0.21, 95% CI: 0.04, 0.51) as well as a marginally significant effect through acceptance (b = 0.15, 95% CI: 0.001, 0.43). Emotional support may increase well-being among Spanish-speaking Latina cancer survivors by reducing cancer fatalism.Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Risk Factors for Anthroponotic Cutaneous Leishmaniasis at the Household Level in Kabul, Afghanistan

PubMed Central

Reithinger, Richard; Mohsen, Mohammad; Leslie, Toby

2010-01-01

Background Kabul, Afghanistan, is the largest focus of anthroponotic cutaneous leishmaniasis (ACL) in the world. ACL is a protozoan disease transmitted to humans by the bite of phlebotomine sand flies. Although not fatal, ACL can lead to considerable stigmatization of affected populations. Methods Using data from a standardized survey of 872 households in 4 wards of Kabul, Afghanistan, univariate and multivariate logistic regression analyses tested associations between presence of active ACL and ACL scars with 15 household-level variables. Findings Univariate analyses showed that active ACL was positively associated with household member's age, ACL prevalence, and brick wall type, but negatively associated with household number of rooms, bednet use, and proportion of windows with screens. Multivariate analysis showed a positive association between active ACL and household member's age, ACL prevalence, and brick wall type, and a negative association with household proportion of windows with screens. Conclusion Household-level charateristics were shown to be risk factors for ACL. Monitoring a selected number of household characteristics could assist in rapid assessments of household-level variation in risk of ACL. ACL prevention and control programs should consider improving house construction, including smoothing of walls and screening of windows. PMID:20351787

Urban street structure and traffic safety.

PubMed

Mohan, Dinesh; Bangdiwala, Shrikant I; Villaveces, Andres

2017-09-01

This paper reports the influence of road type and junction density on road traffic fatality rates in U.S. cities. The Fatality Analysis Reporting System (FARS) files were used to obtain fatality rates for all cities for the years 2005-2010. A stratified random sample of 16 U.S. cities was taken, and cities with high and low road traffic fatality rates were compared on their road layout details (TIGER maps were used). Statistical analysis was done to determine the effect of junction density and road type on road traffic fatality rates. The analysis of road network and road traffic crash fatality rates in these randomly selected U.S. cities shows that, (a) higher number of junctions per road length was significantly associated with a lower motor- vehicle crash and pedestrian mortality rates, and, (b) increased number of kilometers of roads of any kind was associated with higher fatality rates, but an additional kilometer of main arterial road was associated with a significantly higher increase in total fatalities. When compared to non-arterial roads, the higher the ratio of highways and main arterial roads, there was an association with higher fatality rates. These results have important implications for road safety professionals. They suggest that once the road and street structure is put in place, that will influence whether a city has low or high traffic fatality rates. A city with higher proportion of wider roads and large city blocks will tend to have higher traffic fatality rates, and therefore in turn require much more efforts in police enforcement and other road safety measures. Urban planners need to know that smaller block size with relatively less wide roads will result in lower traffic fatality rates and this needs to be incorporated at the planning stage. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Relationship between US Societal Fatality Risk per Vehicle Miles of Travel and Mass, for Individual Vehicle Models over Time (Model Year)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wenzel, Tom P.

This report presents a new approach to analyze the relationship between vehicle mass and risk: tracking fatality risk by vehicle model year and mass, for individual vehicle models. This approach is appealing as it greatly minimizes the influence of driver characteristics and behavior, and crash circumstances, on fatality risk. However, only the most popular vehicle models, with the largest number of fatalities, can be analyzed in this manner. While the analysis of all vehicle models of a given type suggests that there is a relationship between increased mass and fatality risk, analysis of the ten most popular four-door car modelsmore » separately suggests that this relationship is weak: in many cases when the mass of a specific vehicle model is increased societal fatality risk is unchanged or even increases. These results suggest that increasing the mass of an individual vehicle model does not necessarily lead to decreased societal fatality risk.« less

Economic development and road traffic fatalities in Russia: analysis of federal regions 2004-2011.

PubMed

He, Huan; Paichadze, Nino; Hyder, Adnan A; Bishai, David

2015-12-01

The relationship between economic development and road safety at sub-national level has not been well established. This study aims to assess the relationships between economic growth (measured by gross regional product (GRP)) and road traffic fatalities (RTFs) and crash fatality ratio (CFR) at sub-national level in Russia. We used published secondary data on annual RTFs and CFR obtained from the traffic police and socioeconomic development indicators from the statistics department for each Russian federal region (referred to in Russia as "subject") for 2004-2011. We used multivariate fixed effects models for longitudinal data to examine the GRP-RTF and the GRP-CFR relationships excluding regions with extreme values. Time (in years) and a set of relevant socioeconomic variables (territory, population, number of privately owned cars, number of public buses, length of public motor roads, number of physicians, and budget expenditure on health care and physical wellness) were also included as covariates in the models. The RTF rates decreased monotonically over time as GRP per capita increased in 66 studied regions during 2004-2011. This relationship was mainly explained by the number of privately owned cars and partially explained by year dummy variables, number of buses, and number of physicians. CFR also decreased monotonically as GRP per capita increased in 67 studied regions. This relationship between economic growth and CFR was fully explained by secular time trends. The year dummy effects on CFR were not mediated by other socioeconomic variables included in the study. For the period of 2004-2011 in Russia, the reduction in RTFs is mostly explained by increasing the number of private cars, while the reduction of CFR is mostly associated with year-effects suggesting a process of diffusion of knowledge, which is not solely dominated by economic growth.

Factors involved in fatal vehicle crashes

DOT National Transportation Integrated Search

2010-09-01

This report examines factors that contribute to fatal crashes involving a motor vehicle (e.g., car, truck, or bus). Accident level data was obtained from the National Highway Traffic Safety Administrations (NHTSAs) Fatality Analysis Reporting S...

Snakebites as cause of deaths in the Western Brazilian Amazon: Why and who dies? Deaths from snakebites in the Amazon.

PubMed

da Silva Souza, Anderson; de Almeida Gonçalves Sachett, Jacqueline; Alcântara, João Arthur; Freire, Monique; Alecrim, Maria das Graças Costa; Lacerda, Marcus; de Lima Ferreira, Luiz Carlos; Fan, Hui Wen; de Souza Sampaio, Vanderson; Monteiro, Wuelton Marcelo

2018-04-01

Snake envenoming represents a major burden for public health worldwide. In the Amazon, the official number of cases and deaths detected is probably underestimated because of the difficulty riverine and indigenous populations have reaching health centers in order to receive medical assistance. Thus, integrated analysis of health information systems must be used in order to improve adequate health policies. The aim of this work is to describe a series of deaths and identify risk factors for lethality from snakebites in the state of Amazonas, Brazil. All deaths from snakebites reported to the Brazilian Notifiable Diseases Surveillance System (SINAN) and to the Mortality Information System (SIM; ICD10-10th revision, X.29), from 2007 to 2015, were included. Variables were assessed by blocks with distal (ecological variables), intermediate (demographics) and proximal (clinical variables) components to identify predictors of case fatality. A total of 127 deaths from snakebites were recorded, with 58 pairs found through linkage of the SINAN and SIM databases (45.7%), 37 (29.1%) deaths found only in SINAN and 32 (25.2%) found only in the SIM. Deaths occurred mostly in males (95 cases; 74.8%) living in rural areas (78.6%). The most affected age group was the ≥61 years old (36 cases; 28.4%). Snakebites were presumably due to Bothrops snakes in 68.5% of the cases and Lachesis in 29.5% based on clinico-epidemiological diagnosis. A proportion of 26.2% of the cases received treatment over 24 h after the bite ocurred. On admission, cases were mostly classified as severe (65.6%). Overall, 28 patients (22.0%). Deceased without any medical assistance Antivenom was given to 53.5%. In the multivariate analysis, a distance from Manaus >300 km [OR = 3.40 (95%CI = 1.99-5.79); (p < 0.001)]; age ≥61 years [OR = 4.31 (95%CI = 1.22-15.21); (p = 0.023)] and Indigenous status [OR = 5.47 (95%CI = 2.37-12.66); (p < 0.001)] were independently associated with case fatality from snakebites. Severe snakebites [OR = 16.24 (95%CI = 4.37-60.39); (p < 0.001)] and a lack of antivenom administration [OR = 4.21 (95%CI = 1.30-13.19); (p = 0.014)] were also independently associated with case fatality. Respiratory failure/dyspnea, systemic bleeding, sepsis and shock were recorded only among fatal cases. In conclusion, i) death from snakebites was underreported in the mortality surveillance system; ii) older age groups living in remote municipalities and indigenous peoples were the population groups most prone to death; iii) lack or underdosage of antivenom resulted in higher case fatality and iv) systemic bleeding, circulatory shock, sepsis and acute respiratory failure were strongly associated to fatal outcome. Copyright © 2018 Elsevier Ltd. All rights reserved.

Factors Associated with Fatal Occupational Accidents among Mexican Workers: A National Analysis

PubMed Central

Gonzalez-Delgado, Mery; Gómez-Dantés, Héctor; Fernández-Niño, Julián Alfredo; Robles, Eduardo; Borja, Víctor H.; Aguilar, Miriam

2015-01-01

Objective To identify the factors associated with fatal occupational injuries in Mexico in 2012 among workers affiliated with the Mexican Social Security Institute. Methods Analysis of secondary data using information from the National Occupational Risk Information System, with the consequence of the occupational injury (fatal versus non-fatal) as the response variable. The analysis included 406,222 non-fatal and 1,140 fatal injuries from 2012. The factors associated with the lethality of the injury were identified using a logistic regression model with the Firth approach. Results Being male (OR=5.86; CI95%: 4.22-8.14), age (OR=1.04; CI95%: 1.03-1.06), employed in the position for 1 to 10 years (versus less than 1 year) (OR=1.37; CI95%: 1.15-1.63), working as a facilities or machine operator or assembler (OR: 3.28; CI95%: 2.12- 5.07) and being a worker without qualifications (OR=1.96; CI95%: 1.18-3.24) (versus an office worker) were associated with fatality in the event of an injury. Additionally, companies classified as maximum risk (OR=1.90; CI 95%: 1.38-2.62), workplace conditions (OR=7.15; CI95%: 3.63-14.10) and factors related to the work environment (OR=9.18; CI95%:4.36-19.33) were identified as risk factors for fatality in the event of an occupational injury. Conclusions Fatality in the event of an occupational injury is associated with factors related to sociodemographics (age, sex and occupation), the work environment and workplace conditions. Worker protection policies should be created for groups with a higher risk of fatal occupational injuries in Mexico. PMID:25790063

Traffic safety facts 1996 : overview

DOT National Transportation Integrated Search

1997-01-01

This overview fact sheet contains statistics on motor vehicle fatalities based on data from the Fatality Analysis Reporting System (FARS). FARS is a census of fatal crashes within the 50 states, the District of Columbia, and Puerto Rico (although Pue...

Traffic safety facts 1995 : overview

DOT National Transportation Integrated Search

1996-01-01

This overview fact sheet contains statistics on motor vehicle fatalities based on data from the Fatality Analysis Reporting System (FARS). FARS is a census of fatal crashes within the 50 states, the District of Columbia, and Puerto Rico (although Pue...

Rural/urban comparison

DOT National Transportation Integrated Search

2008-01-01

This fact sheet contains statistics on motor vehicle fatal crashes based on data from the Fatality Analysis Reporting System (FARS). FARS is a census of fatal crashes within the 50 States, District of Columbia, and Puerto Rico (although Puerto Rico i...

Socio-Economic Influences on Highway Fatalities : An Empirical Investigation

DOT National Transportation Integrated Search

1984-02-01

This study identifies socio-eonomic variables which are strongly associated with highway fatalities. Further analysis of the relationship between these variables and fatalities reveals that two of the variables, retail sales and personal income, infl...

Analysis of FARS data on state highways in Oklahoma.

DOT National Transportation Integrated Search

2012-11-01

Analysis of fatality automobile accident data can be challenging in rural areas where a relatively small number of : such accidents occurs on specific sections of highways. Combining crash data for 1998 to 2011 from the Fatality : Analysis Reporting ...

Socio-economic analysis of fatal crash trends : final report.

DOT National Transportation Integrated Search

2005-12-01

This report describes the analysis of fatal crash patterns and explores the impact of socioeconomic factors and safety regulations on statewide crash rates. This analysis separated statewide crash rates between 2002 and 2004 into two samples, 1) thos...

The effectiveness of drinking and driving policies for different alcohol-related fatalities: a quantile regression analysis.

PubMed

Ying, Yung-Hsiang; Wu, Chin-Chih; Chang, Koyin

2013-09-27

To understand the impact of drinking and driving laws on drinking and driving fatality rates, this study explored the different effects these laws have on areas with varying severity rates for drinking and driving. Unlike previous studies, this study employed quantile regression analysis. Empirical results showed that policies based on local conditions must be used to effectively reduce drinking and driving fatality rates; that is, different measures should be adopted to target the specific conditions in various regions. For areas with low fatality rates (low quantiles), people's habits and attitudes toward alcohol should be emphasized instead of transportation safety laws because "preemptive regulations" are more effective. For areas with high fatality rates (or high quantiles), "ex-post regulations" are more effective, and impact these areas approximately 0.01% to 0.05% more than they do areas with low fatality rates.

The Effectiveness of Drinking and Driving Policies for Different Alcohol-Related Fatalities: A Quantile Regression Analysis

PubMed Central

Ying, Yung-Hsiang; Wu, Chin-Chih; Chang, Koyin

2013-01-01

To understand the impact of drinking and driving laws on drinking and driving fatality rates, this study explored the different effects these laws have on areas with varying severity rates for drinking and driving. Unlike previous studies, this study employed quantile regression analysis. Empirical results showed that policies based on local conditions must be used to effectively reduce drinking and driving fatality rates; that is, different measures should be adopted to target the specific conditions in various regions. For areas with low fatality rates (low quantiles), people’s habits and attitudes toward alcohol should be emphasized instead of transportation safety laws because “preemptive regulations” are more effective. For areas with high fatality rates (or high quantiles), “ex-post regulations” are more effective, and impact these areas approximately 0.01% to 0.05% more than they do areas with low fatality rates. PMID:24084673

Work-related fatal motor vehicle traffic crashes: Matching of 2010 data from the Census of Fatal Occupational Injuries and the Fatality Analysis Reporting System.

PubMed

Byler, Christen; Kesy, Laura; Richardson, Scott; Pratt, Stephanie G; Rodríguez-Acosta, Rosa L

2016-07-01

Motor vehicle traffic crashes (MVTCs) remain the leading cause of work-related fatal injuries in the United States, with crashes on public roadways accounting for 25% of all work-related deaths in 2012. In the United States, the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) provides accurate counts of fatal work injuries based on confirmation of work relationship from multiple sources, while the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS) provides detailed data on fatal MVTCs based on police reports. Characterization of fatal work-related MVTCs is currently limited by data sources that lack either data on potential risk factors (CFOI) or work-relatedness confirmation and employment characteristics (FARS). BLS and the National Institute for Occupational Safety and Health (NIOSH) collaborated to analyze a merged data file created by BLS using CFOI and FARS data. A matching algorithm was created to link 2010 data from CFOI and FARS using date of incident and other case characteristics, allowing for flexibility in variables to address coding discrepancies. Using the matching algorithm, 953 of the 1044 CFOI "Highway" cases (91%) for 2010 were successfully linked to FARS. Further analysis revealed systematic differences between cases identified as work-related by both systems and by CFOI alone. Among cases identified as work-related by CFOI alone, the fatally-injured worker was considerably more likely to have been employed outside the transportation and warehousing industry or transportation-related occupations, and to have been the occupant of a vehicle other than a heavy truck. This study is the first step of a collaboration between BLS, NHTSA, and NIOSH to improve the completeness and quality of data on fatal work-related MVTCs. It has demonstrated the feasibility and value of matching data on fatal work-related traffic crashes from CFOI and FARS. The results will lead to improvements in CFOI and FARS case capture, while also providing researchers with a better description of fatal work-related MVTCs than would be available from the two data sources separately. Copyright © 2016. Published by Elsevier Ltd.

Clinical characteristics and predictors of mortality for Cryptococcus gattii infection in dogs and cats of southwestern British Columbia

PubMed Central

Duncan, Colleen; Stephen, Craig; Campbell, John

2006-01-01

Since 1999, Cryptococcus gattii has emerged as an important pathogen of humans and animals in southwestern British Columbia. Historically thought to be restricted to the tropics and subtropics, C. gattii has posed new diagnostic and treatment challenges to veterinary practitioners working within the recently identified endemic region. Clinical reports of canine and feline cryptococcosis caused by C. gattii diagnosed between January 1999 and December 2003 were included in this case series. The most common manifestations of disease were respiratory and central nervous system signs. Multivariate survival analysis revealed that the only significant predictor of mortality was the presence of central nervous system signs upon presentation or during therapy. Case fatality rates in both species were high. Further investigation into effective treatment regimes is warranted. PMID:17078248

Southeast regional fatal study : a causal chain analysis in North Carolina

DOT National Transportation Integrated Search

2002-01-01

This project completed the North Carolina portion of the pooled fund Southeast Fatal Analysis Project. In addition : to completing this portion of the causal chain analysis for NC Crashes, the project developed a ranked : comprehensive list of candid...

Investigating ethnic minorities' perceptions of safety climate in the construction industry.

PubMed

Chan, Albert P C; Wong, Francis K W; Hon, Carol K H; Lyu, Sainan; Javed, Arshad Ali

2017-12-01

An increasing number of ethnic minorities (EMs) have been employed in the construction industry to alleviate severe labor shortages in many countries. Unfortunately, statistics show that EMs have higher fatal and non-fatal occupational injury rates than their local counterparts. However, EMs are often underrepresented in safety climate (SC) research as they are difficult to reach and gauge their perception. A positive relationship has been widely found between SC and safety performance. Understanding the safety perceptions of EMs helps to reduce injuries and improve their safety performance. Based on a sample of 320 EMs from 20 companies in the construction industry, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the SC factors of EMs, and validate the extracted factors, respectively. Multivariate analysis of variance was undertaken to examine mean differences in perceptions of SC by personal characteristics. Three SC factors for EMs encapsulating 16 variables were identified through EFA. The hypothesized CFA model for a three-factor structure derived from EFA showed a satisfactory goodness-of-fit, composite reliability, and construct validity. Three SC factors were identified, namely: (a) safety management commitment, safety resources, and safety communication; (b) employee's involvement and workmate's influence; and (c) perception of safety rules, procedures and risks. The perceptions of SC differed significantly by nationality, marital status, the number of family members supported, and drinking habit. This study reveals the perception of EMs toward SC. The findings highlight the areas for safety improvement and provide leading indicators for safety performance of EMs. The findings are also enlightening for countries with a number of EMs, such as the United Sates, the United Kingdom, Australia, Singapore, and the Middle East. Copyright © 2017. Published by Elsevier Ltd.

Graphical fault tree analysis for fatal falls in the construction industry.

PubMed

Chi, Chia-Fen; Lin, Syuan-Zih; Dewi, Ratna Sari

2014-11-01

The current study applied a fault tree analysis to represent the causal relationships among events and causes that contributed to fatal falls in the construction industry. Four hundred and eleven work-related fatalities in the Taiwanese construction industry were analyzed in terms of age, gender, experience, falling site, falling height, company size, and the causes for each fatality. Given that most fatal accidents involve multiple events, the current study coded up to a maximum of three causes for each fall fatality. After the Boolean algebra and minimal cut set analyses, accident causes associated with each falling site can be presented as a fault tree to provide an overview of the basic causes, which could trigger fall fatalities in the construction industry. Graphical icons were designed for each falling site along with the associated accident causes to illustrate the fault tree in a graphical manner. A graphical fault tree can improve inter-disciplinary discussion of risk management and the communication of accident causation to first line supervisors. Copyright © 2014 Elsevier Ltd. All rights reserved.

Construction fatality due to electrical contact in Ontario, Canada, 1997-2007.

PubMed

Kim, Hwan; Lewko, John; Garritano, Enzo; Sharma, Bhanu; Moody, Joel; Colantonio, Angela

2016-06-27

Electrical contact is a leading cause of occupational fatality in the construction industry. However, research on the factors that contribute to electricity-related fatality in construction is limited. To characterize, using an adapted Haddon's Matrix, the factors that contribute to electricity-related occupational fatalities in the construction industry in Ontario, Canada. Coroner's data on occupational electricity-related fatalities between 1997-2007 in the construction industry were acquired from the Ontario Ministry of Labour. Using an adapted Haddon's Matrix, we characterized worker, agent, and environmental characteristics of electricity-related occupational fatalities in the province through a narrative text analysis. Electrical contact was responsible for 15% of all occupational fatalities among construction workers in Ontario. Factors associated with said occupational fatalities included direct contact with electrical sources, lower voltage sources, and working outdoors. This study provides a profile of electricity-related occupational fatalities among construction workers in Ontario, and can be used to inform safety regulations.

65 mph speed limit : analysis of fatal accident injury severity

DOT National Transportation Integrated Search

1989-11-01

Several studies of the fatality experience in the 38 states that implemented a65 mph speed : limit on Rural Interstate highways in 1987 concluded that the higher speed limit has : caused fatalities to increase. This relationship between the speed lim...

Description of veterinary events and risk factors for fatality in National Hunt flat racing Thoroughbreds in Great Britain (2000-2013).

PubMed

Allen, S E; Rosanowski, S M; Stirk, A J; Verheyen, K L P

2017-11-01

No large-scale studies have described veterinary events occurring in National Hunt (NH) flat racing or investigated risk factors for fatality in this race type. To describe injuries and conditions requiring veterinary attendance on race day and to determine risk factors for racehorse fatality in NH flat racing in Great Britain. Retrospective cohort study (2000-2013). Information from all NH flat races held over the study period, including horse, race and veterinary event report details, was combined. Veterinary events were described by type and anatomical structure(s) affected. Incidence per 1000 starts were calculated for all veterinary events and by event group, and stratified by certain horse- and race-level variables. Risk factors for fatality were determined using multivariable logistic regression modelling. Over the 14-year study period, 544 veterinary events were recorded, providing an overall incidence of 13.0 events per 1000 starts. The most common events were bone injuries (23.5%) and tendon or ligament injuries (16.4%). A fatal outcome was recorded for 117 horses (21.5% of all events), resulting in an incidence of 2.9 deaths per 1000 starts. Odds of fatality were 4.33 (95% confidence interval [CI] 1.59-11.82; P = 0.02) times higher in races restricted to conditional jockeys compared to those that were not. Horses starting in their first race experienced 1.44 (95% CI 1.00-2.08; P = 0.05) times the odds of death compared to those that had raced before. Classification of veterinary events frequently relied upon presumptive diagnosis. This study provides a benchmark for the ongoing surveillance of veterinary events in NH flat racing. These results support the phasing out of NH flat races restricted to conditional jockeys and highlight the need for further work to establish why NH flat racing Thoroughbreds competing in their first race are at increased risk for death. © 2017 EVJ Ltd.

Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants: PERU MIGRANT cohort study

PubMed Central

Lazo-Porras, María; Bernabe-Ortiz, Antonio; Málaga, Germán; Gilman, Robert H.; Acuña-Villaorduña, Ana; Cardenas-Montero, Deborah; Smeeth, Liam; Miranda, J. Jaime

2016-01-01

Introduction Whilst the relationship between lipids and cardiovascular mortality has been well studied and appears to be controversial, very little has been explored in the context of rural-to-urban migration in low-resource settings. Objective Determine the profile and related factors for HDL-c patterns (isolated and non-isolated low HDL-c) in three population-based groups according to their migration status, and determine the effect of HDL-c patterns on the rates of cardiovascular outcomes (i.e. non-fatal stroke and non-fatal myocardial infarction) and mortality. Methods Cross-sectional and 5-year longitudinal data from the PERU MIGRANT study, designed to assess the effect of migration on cardiovascular risk profiles and mortality in Peru. Two different analyses were performed: first, we estimated prevalence and associated factors with isolated and non-isolated low HDL-c at baseline. Second, using longitudinal information, relative risk ratios (RRR) of composite outcomes of mortality, non-fatal stroke and non-fatal myocardial infarction were calculated according to HDL-c levels at baseline. Results Data from 988 participants, rural (n = 201), rural-to-urban migrants (n = 589), and urban (n = 199) groups, was analysed. Low HDL-c was present in 56.5% (95%CI: 53.4%–59.6%) without differences by study groups. Isolated low HDL-c was found in 36.5% (95%CI: 33.5–39.5%), with differences between study groups. In multivariable analysis, urban group (vs. rural), female gender, overweight and obesity were independently associated with isolated low HDL-c. Only female gender, overweight and obesity were associated with non-isolated low HDL-c. Longitudinal analyses showed that non-isolated low HDL-c increased the risk of negative cardiovascular outcomes (RRR = 3.46; 95%CI: 1.23–9.74). Conclusions Isolated low HDL-c was the most common dyslipidaemia in the study population and was more frequent in rural subjects. Non-isolated low HDL-c increased three-to fourfold the 5-year risk of cardiovascular outcomes. PMID:26752691

Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants: PERU MIGRANT cohort study.

PubMed

Lazo-Porras, María; Bernabe-Ortiz, Antonio; Málaga, Germán; Gilman, Robert H; Acuña-Villaorduña, Ana; Cardenas-Montero, Deborah; Smeeth, Liam; Miranda, J Jaime

2016-03-01

Whilst the relationship between lipids and cardiovascular mortality has been well studied and appears to be controversial, very little has been explored in the context of rural-to-urban migration in low-resource settings. Determine the profile and related factors for HDL-c patterns (isolated and non-isolated low HDL-c) in three population-based groups according to their migration status, and determine the effect of HDL-c patterns on the rates of cardiovascular outcomes (i.e. non-fatal stroke and non-fatal myocardial infarction) and mortality. Cross-sectional and 5-year longitudinal data from the PERU MIGRANT study, designed to assess the effect of migration on cardiovascular risk profiles and mortality in Peru. Two different analyses were performed: first, we estimated prevalence and associated factors with isolated and non-isolated low HDL-c at baseline. Second, using longitudinal information, relative risk ratios (RRR) of composite outcomes of mortality, non-fatal stroke and non-fatal myocardial infarction were calculated according to HDL-c levels at baseline. Data from 988 participants, rural (n = 201), rural-to-urban migrants (n = 589), and urban (n = 199) groups, was analysed. Low HDL-c was present in 56.5% (95%CI: 53.4%-59.6%) without differences by study groups. Isolated low HDL-c was found in 36.5% (95%CI: 33.5-39.5%), with differences between study groups. In multivariable analysis, urban group (vs. rural), female gender, overweight and obesity were independently associated with isolated low HDL-c. Only female gender, overweight and obesity were associated with non-isolated low HDL-c. Longitudinal analyses showed that non-isolated low HDL-c increased the risk of negative cardiovascular outcomes (RRR = 3.46; 95%CI: 1.23-9.74). Isolated low HDL-c was the most common dyslipidaemia in the study population and was more frequent in rural subjects. Non-isolated low HDL-c increased three-to fourfold the 5-year risk of cardiovascular outcomes. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Soluble form of receptor for advanced glycation end products and incidence of new cardiovascular events among patients with cardiovascular disease.

PubMed

Reichert, Stefan; Triebert, Ulrike; Santos, Alexander Navarrete; Hofmann, Britt; Schaller, Hans-Günter; Schlitt, Axel; Schulz, Susanne

2017-11-01

Soluble RAGE (sRAGE) serum level could be a biomarker for atherosclerosis and subsequent diseases such as cardiovascular disease (CVD). Therefore, we wanted to investigate whether peripheral sRAGE level is associated with new cardiovascular events among patients with CVD using the Cox's regression analysis. In this three-year longitudinal cohort study, 1002 in-patients with angiographically proven CVD were included. In 933 patients, sRAGE levels were determined by a commercial available ELISA kit at the time of baseline examination. The combined endpoint was defined as myocardial infarction, stroke/TIA (non-fatal, fatal), and cardiovascular death. For risk analysis, sRAGE values were distributed in quartiles. For generation of adjusted hazard ratios (HR), other risk factors for CVD, such as age, gender, current smoking, body mass index, diabetes, hypertension, dyslipoproteinemia, family history of CVD, severe periodontitis, serum levels for C-reactive protein and interleukin-6, were recorded. 886 patients completed the 3-year follow-up. The overall incidence of the combined endpoint was 16%. Patients with sRAGE levels >838.19 pg/ml (fourth quartile) had the highest incidence of recurrent CVD events (24.9% versus 13.1%, p < 0.0001). In multivariate Cox regression with respect to further confounders for CVD, the association between sRAGE and new CVD events was confirmed (HR = 1.616, 95% CI 1.027-2.544, p = 0.038). Elevated sRAGE serum level is associated with further adverse events in patients with CVD. Copyright © 2017 Elsevier B.V. All rights reserved.

High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study.

PubMed

Bazazi, Alexander R; Zelenev, Alexei; Fu, Jeannia J; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L

2015-07-01

Overdose is the leading cause of death among opioid users, but no data are available on overdose among people who inject drugs in Malaysia. We present the first estimates of the prevalence and correlates of recent non-fatal overdose among people who inject drugs in Malaysia. In 2010, 460 people who inject drugs were recruited using respondent-driven sampling (RDS) in Klang Valley to assess health outcomes associated with injection drug use. Self-reported history of non-fatal overdose in the previous 6 months was the primary outcome. Sociodemographic, behavioral and structural correlates of non-fatal overdose were assessed using multivariable logistic regression. All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Most injected daily (91.3%) and were male (96.3%) and ethnically Malay (90.4%). Overall, 20% of participants had overdosed in the prior 6 months, and 43.3% had ever overdosed. The RDS-adjusted estimate of the 6-month period prevalence of overdose was 12.3% (95% confidence interval [CI] 7.9-16.6%). Having injected for more years was associated with lower odds of overdose (adjusted odds ratio [AOR] 0.6 per 5 years of injection, CI: 0.5-0.7). Rushing an injection from fear of the police nearly doubled the odds of overdose (AOR 1.9, CI: 1.9-3.6). Alcohol use was associated with recent non-fatal overdose (AOR 2.1, CI: 1.1-4.2), as was methamphetamine use (AOR 2.3, CI: 1.3-4.6). When adjusting for past-month drug use, intermittent but not daily methadone use was associated with overdose (AOR 2.8, CI: 1.5-5.9). This study reveals a large, previously undocumented burden of non-fatal overdose among people who inject drugs in Malaysia and highlights the need for interventions that might reduce the risk of overdose, such as continuous opioid substitution therapy, provision of naloxone to prevent fatal overdose, treatment of polysubstance use, and working with police to improve the risk environment. Copyright © 2014 Elsevier B.V. All rights reserved.

High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study

PubMed Central

Bazazi, Alexander R.; Zelenev, Alexei; Fu, Jeannia J.; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L.

2014-01-01

Background Overdose is the leading cause of death among opioid users, but no data are available on overdose among people who inject drugs in Malaysia. We present the first estimates of the prevalence and correlates of recent non-fatal overdose among people who inject drugs in Malaysia. Methods In 2010, 460 people who inject drugs were recruited using respondent-driven sampling (RDS) in Klang Valley to assess health outcomes associated with injection drug use. Self-reported history of non-fatal overdose in the previous 6 months was the primary outcome. Sociodemographic, behavioral and structural correlates of non-fatal overdose were assessed using multivariable logistic regression. Results All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Most injected daily (91.3%) and were male (96.3%) and ethnically Malay (90.4%). Overall, 20% of participants had overdosed in the prior 6 months, and 43.3% had ever overdosed. The RDS-adjusted estimate of the 6-month period prevalence of overdose was 12.3% (95% confidence interval [CI] 7.9–16.6%). Having injected for more years was associated with lower odds of overdose (adjusted odds ratio [AOR] 0.6 per 5 years of injection, CI 0.5–0.7). Rushing an injection from fear of the police nearly doubled the odds of overdose (AOR 1.9, CI 1.9–3.6). Alcohol use was associated with recent non-fatal overdose (AOR 2.1, CI 1.1–4.2), as was methamphetamine use (AOR 2.3, CI 1.3–4.6). When adjusting for past-month drug use, intermittent but not daily methadone use was associated with overdose (AOR 2.8, CI 1.5–5.9). Conclusion This study reveals a large, previously undocumented burden of non-fatal overdose among people who inject drugs in Malaysia and highlights the need for interventions that might reduce the risk of overdose, such as continuous opioid substitution therapy, provision of naloxone to prevent fatal overdose, treatment of polysubstance use, and working with police to improve the risk environment. PMID:25532449

Fatal crashes involving large trucks, 2015 : analysis brief.

DOT National Transportation Integrated Search

2017-04-01

In 2015, 32,166 fatal crashes took place on our Nations roadways, with 11.2 percent (3,598) involving at least one large truck (see Figure 1). This report examines the various ways of looking at fatal crashes and presents a variety of crash rates ...

Fatality Reduction by Air Bags: Analyses of Accident Data through Early 1996

DOT National Transportation Integrated Search

1996-08-01

The fatality risk of front-seat occupants of passenger cars and light trucks equipped with air bags is compared to the corresponding risk in similar vehicles without air bags, based on statistical analysis of Fatal Accident Reporting System (FARS)dat...

Glider accidents: an analysis of 143 cases, 2001-2005.

PubMed

van Doorn, Robert R A; de Voogt, Alexander J

2007-01-01

The majority of aviation crashes and casualties take place in general and sport aviation. Although gliding has gained popularity in recent decades, we could find no systematic analysis of glider accidents. This study determined factors associated with both non-fatal and fatal glider accidents to document their position within sport and general aviation accidents, and to suggest preventive measures and improvements. We performed a retrospective review of glider accidents for the period 2001-2005 in the database maintained by the U.S. National Transportation Safety Board (NTSB). A total of 117 non-fatal and 26 fatal glider accidents were reported for the 5-yr period. Adverse weather was the cause in 20% of all non-fatal accidents, 60% of which occurred in the cruise phase. Logistic regression revealed that fatal accidents were predicted by pilot error, flight phase, and home-built aircraft. Factors contributing to glider crashes are specific to this type of sport aviation. Owners of home-built gliders should pay particular attention to the aircraft's specifications and design limits.

A human factors analysis of fatal and serious injury accidents in Alaska, 2004-2009.

DOT National Transportation Integrated Search

2011-12-01

"This report summarizes the analysis of 97 general aviation accidents in Alaska that resulted in a fatality or serious : injury to one or more aircraft occupants for the years 2004-2009. The accidents were analyzed using the Human : Factors Analysis ...

Evaluation of poly-drug use in methadone-related fatalities using segmental hair analysis.

PubMed

Nielsen, Marie Katrine Klose; Johansen, Sys Stybe; Linnet, Kristian

2015-03-01

In Denmark, fatal poisoning among drug addicts is often related to methadone. The primary mechanism contributing to fatal methadone overdose is respiratory depression. Concurrent use of other central nervous system (CNS) depressants is suggested to heighten the potential for fatal methadone toxicity. Reduced tolerance due to a short-time abstinence period is also proposed to determine a risk for fatal overdose. The primary aims of this study were to investigate if concurrent use of CNS depressants or reduced tolerance were significant risk factors in methadone-related fatalities using segmental hair analysis. The study included 99 methadone-related fatalities collected in Denmark from 2008 to 2011, where both blood and hair were available. The cases were divided into three subgroups based on the cause of death; methadone poisoning (N=64), poly-drug poisoning (N=28) or methadone poisoning combined with fatal diseases (N=7). No significant differences between methadone concentrations in the subgroups were obtained in both blood and hair. The methadone blood concentrations were highly variable (0.015-5.3, median: 0.52mg/kg) and mainly within the concentration range detected in living methadone users. In hair, methadone was detected in 97 fatalities with concentrations ranging from 0.061 to 211ng/mg (median: 11ng/mg). In the remaining two cases, methadone was detected in blood but absent in hair specimens, suggesting that these two subjects were methadone-naive users. Extensive poly-drug use was observed in all three subgroups, both recently and within the last months prior to death. Especially, concurrent use of multiple benzodiazepines was prevalent among the deceased followed by the abuse of morphine, codeine, amphetamine, cannabis, cocaine and ethanol. By including quantitative segmental hair analysis, additional information on poly-drug use was obtained. Especially, 6-acetylmorphine was detected more frequently in hair specimens, indicating that regular abuse of heroin was common among the deceased. In conclusion, continuous exposure of methadone provide by segmental hair analysis suggested that reduced tolerance of methadone was not a critical factor among methadone-related fatalities. In contrast, a high abundance of co-ingested CNS depressants suggested that adverse effects from drug-drug interactions were more important risk factors for fatal outcome in these deaths. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Assessment of NHTSA’s Report “Relationships Between Fatality Risk, Mass, and Footprint in Model Year 2004-2011 Passenger Cars and LTVs” (LBNL Phase 1)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wenzel, Tom P.

In its 2012 report NHTSA simulated the effect four fleetwide mass reduction scenarios would have on the change in annual fatalities. NHTSA estimated that the most aggressive of these scenarios (reducing mass 5.2% in heavier light trucks and 2.6% in all other vehicles types except lighter cars) would result in a small reduction in societal fatalities. LBNL replicated the methodology NHTSA used to simulate six mass reduction scenarios, including the mass reductions recommended in the 2015 NRC committee report, and estimated in 2021 and 2025 by EPA in the TAR, using the updated data through 2012. The analysis indicates thatmore » the estimated x change in fatalities under each scenario based on the updated analysis is comparable to that in the 2012 analysis, but less beneficial or more detrimental than that in the 2016 analysis. For example, an across the board 100-lb reduction in mass would result in an estimated 157 additional annual fatalities based on the 2012 analysis, but would result in only an estimated 91 additional annual fatalities based on the 2016 analysis, and an additional 87 fatalities based on the current analysis. The mass reductions recommended by the 2015 NRC committee report6 would result in a 224 increase in annual fatalities in the 2012 analysis, a 344 decrease in annual fatalities in the 2016 analysis, and a 141 increase in fatalities in the current analysis. The mass reductions EPA estimated for 2025 in the TAR7 would result in a 203 decrease in fatalities based on the 2016 analysis, but an increase of 39 fatalities based on the current analysis. These results support NHTSA’s conclusion from its 2012 study that, when footprint is held fixed, “no judicious combination of mass reductions in the various classes of vehicles results in a statistically significant fatality increase and many potential combinations are safety-neutral as point estimates.”Like the previous NHTSA studies, this updated report concludes that the estimated effect of mass reduction while maintaining footprint on societal U.S. fatality risk is small, and not statistically significant at the 95% or 90% confidence level for all vehicle types based on the jack-knife method NHTSA used. This report also finds that the estimated effects of other control variables, such as vehicle type, specific safety technologies, and crash conditions such as whether the crash occurred at night, in a rural county, or on a high-speed road, on risk are much larger, in some cases two orders of magnitude larger, than the estimated effect of mass or footprint reduction on risk. Finally, this report shows that after accounting for the many vehicle, driver, and crash variables NHTSA used in its regression analyses, there remains a wide variation in risk by vehicle make and model, and this variation is unrelated to vehicle mass. Although the purpose of the NHTSA and LBNL reports is to estimate the effect of vehicle mass reduction on societal risk, this is not exactly what the regression models are estimating. Rather, they are estimating the recent historical relationship between mass and risk, after accounting for most measurable differences between vehicles, drivers, and crash times and locations. In essence, the regression models are comparing the risk of a 2600-lb Dodge Neon with that of a 2500-lb Honda Civic, after attempting to account for all other differences between the two vehicles. The models are not estimating the effect of literally removing 100 pounds from the Neon, leaving everything else unchanged. In addition, the analyses are based on the relationship of vehicle mass and footprint on risk for recent vehicle designs (model year 2004 to 2011). These relationships may or may not continue into the future as manufacturers utilize new vehicle designs and incorporate new technologies, such as more extensive use of strong lightweight materials and specific safety technologies. Therefore, throughout this report we use the phrase “the estimated effect of mass (or footprint) reduction on risk” as shorthand for “the estimated change in risk as a function of its relationship to mass (or footprint) for vehicle models of recent design.”« less

Physical performance and clinical outcomes in dialysis patients: a secondary analysis of the EXCITE trial.

PubMed

Torino, Claudia; Manfredini, Fabio; Bolignano, Davide; Aucella, Filippo; Baggetta, Rossella; Barillà, Antonio; Battaglia, Yuri; Bertoli, Silvio; Bonanno, Graziella; Castellino, Pietro; Ciurlino, Daniele; Cupisti, Adamasco; D'Arrigo, Graziella; De Paola, Luciano; Fabrizi, Fabrizio; Fatuzzo, Pasquale; Fuiano, Giorgio; Lombardi, Luigi; Lucisano, Gaetano; Messa, Piergiorgio; Rapanà, Renato; Rapisarda, Francesco; Rastelli, Stefania; Rocca-Rey, Lisa; Summaria, Chiara; Zuccalà, Alessandro; Tripepi, Giovanni; Catizone, Luigi; Zoccali, Carmine; Mallamaci, Francesca

2014-01-01

Scarce physical activity predicts shorter survival in dialysis patients. However, the relationship between physical (motor) fitness and clinical outcomes has never been tested in these patients. We tested the predictive power of an established metric of motor fitness, the Six-Minute Walking Test (6MWT), for death, cardiovascular events and hospitalization in 296 dialysis patients who took part in the trial EXCITE (ClinicalTrials.gov Identifier: NCT01255969). During follow up 69 patients died, 90 had fatal and non-fatal cardiovascular events, 159 were hospitalized and 182 patients had the composite outcome. In multivariate Cox models - including the study allocation arm and classical and non-classical risk factors - an increase of 20 walked metres during the 6MWT was associated to a 6% reduction of the risk for the composite end-point (P=0.001) and a similar relationship existed between the 6MWT, mortality (P<0.001) and hospitalizations (P=0.03). A similar trend was observed for cardiovascular events but this relationship did not reach statistical significance (P=0.09). Poor physical performance predicts a high risk of mortality, cardiovascular events and hospitalizations in dialysis patients. Future studies, including phase-2 EXCITE, will assess whether improving motor fitness may translate into better clinical outcomes in this high risk population. © 2014 S. Karger AG, Basel.

Investigation of elevated case-fatality rate in poliomyelitis outbreak in Pointe Noire, Republic of Congo, 2010.

PubMed

Gregory, Christopher J; Ndiaye, Serigne; Patel, Minal; Hakizamana, Elisaphan; Wannemuehler, Kathleen; Ndinga, Edouard; Chu, Susan; Talani, Pascal; Kretsinger, Katrina

2012-11-15

Multiple cases of paralysis, often resulting in death, occurred among young adults during a wild poliovirus (WPV) type 1 outbreak in Pointe Noire, Republic of Congo, in 2010. We conducted an investigation to identify factors associated with fatal outcomes among persons with poliomyelitis in Pointe Noire. Polio cases were defined as acute flaccid paralysis (AFP) cases reported from 7 October to 7 December 2010 with either a stool specimen positive for WPV or clinically classified as polio-compatible. Data were obtained from medical records, hospital databases, AFP case investigation forms and, when possible, via interviews with persons with polio or surrogates using a standard questionnaire. A total of 369 polio cases occurred in Pointe Noire between 7 October and 7 December 2010. Median age was 22 years for nonsurvivors and 18 years for survivors (P = .01). Small home size, as defined by ≤2 rooms, use of a well for drinking water during a water shortage, and age ≥15 years were risk factors for death in multivariate analysis. Consideration should be given during polio risk assessment planning and outbreak response to water/sanitation status and potential susceptibility to polio in older children and adults. Serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation might be useful to guide preparedness and response planning.

External cause-specific summaries of occupational fatal injuries. Part II: an analysis of years of potential life lost.

PubMed

Bailer, A John; Bena, James F; Stayner, Leslie T; Halperin, William E; Park, Robert M

2003-03-01

Fatal injury surveillance data provide an opportunity to assess the impact of occupational injuries and may indicate which industries or occupations are appreciably more hazardous than others, and thus should be given priority in public health intervention. Fatalities from the National Traumatic Occupational Fatality surveillance system served as the basis for examining external cause (E-code) specific impact summaries. Years of potential life lost (YPLL) were calculated for fatal injuries in the years 1983-1994. Industries and occupations were compared with respect to frequency of fatal injuries. In addition, injuries in categories of external causes are examined across all industries and occupations. Machinery, electric current, homicide, falls, and transportation-related are the external cause groups highlighted by high frequency/rate of occurrence. Electric current event groups are also characterized by high average YPLL. Poisoning, conflagration, and lightning were also identified in several occupations as having high associated average YPLL. The external-cause-specific analysis of average YPLL identified industries and occupations where, on average, younger workers were dying in fatal injuries. Noteworthy in this assessment were homicides and falls. The YPLL measure coupled with more commonly employed indices (e.g., rates) may provide a fuller description of the impact of occupational fatal injuries.

Geo-demographic analysis of fatal motorcycle crashes

DOT National Transportation Integrated Search

2001-01-01

The objective of this study is to analyze the combined motor vehicle crash data from the Fatality Analysis Reporting System (FARS) with the Claritas geo-demographic database from the lifestyle perspective to determine the appropriate media to use in ...

Ignition Interlock Laws: Effects on Fatal Motor Vehicle Crashes, 1982-2013.

PubMed

McGinty, Emma E; Tung, Gregory; Shulman-Laniel, Juliana; Hardy, Rose; Rutkow, Lainie; Frattaroli, Shannon; Vernick, Jon S

2017-04-01

Alcohol-involved motor vehicle crashes are a major cause of preventable mortality in the U.S., leading to more than 10,000 fatalities in 2013. Ignition interlocks, or alcohol-sensing devices connected to a vehicle's ignition to prevent it from starting if a driver has a predetermined blood alcohol content (BAC) level, are a promising avenue for preventing alcohol-involved driving. This study sought to assess the effects of laws requiring ignition interlocks for some or all drunk driving offenders on alcohol-involved fatal crashes. A multilevel modeling approach assessed the effects of state interlock laws on alcohol-involved fatal crashes in the U.S. from 1982 to 2013. Monthly data on alcohol-involved crashes in each of the 50 states was collected in 2014 from the National Highway Traffic Safety Administration Fatality Analysis Reporting System. Random-intercept models accounted for between-state variation in alcohol-involved fatal crash rates and autocorrelation of within-state crash rates over time. Analysis was conducted in 2015. State laws requiring interlocks for all drunk driving offenders were associated with a 7% decrease in the rate of BAC >0.08 fatal crashes and an 8% decrease in the rate of BAC ≥0.15 fatal crashes, translating into an estimated 1,250 prevented BAC >0.08 fatal crashes. Laws requiring interlocks for segments of high-risk drunk driving offenders, such as repeat offenders, may reduce alcohol-involved fatal crashes after 2 years of implementation. Ignition interlock laws reduce alcohol-involved fatal crashes. Increasing the spread of interlock laws that are mandatory for all offenders would have significant public health benefit. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

The predictor of mortality outcome in adult patients with Ebola virus disease during the 2014-2015 outbreak in Guinea.

PubMed

Cherif, M S; Koonrungsesomboon, N; Diallo, M P; Le Gall, E; Kassé, D; Cherif, F; Koné, A; Diakité, M; Camara, F; Magassouba, N

2017-04-01

The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014-2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68.1%. Univariate analyses identified factors possibly associated with mortality outcome, including patient age (p < 0.001), history of visiting or close contact with a suspected or confirmed EVD patient (p = 0.035), and seven clinical symptoms on admission, i.e., fever (p = 0.003), hiccups (p < 0.001), vomiting (p = 0.003), diarrhea (p < 0.001), cough (p = 0.001), sore throat (p = 0.016), and unexplained bleeding (p = 0.021). The multivariate analysis showed that patient age was independently associated with mortality outcome of EVD (OR = 1.06; 95%CI = 1.03-1.09; p < 0.001), while none the of clinical symptoms on admission were significantly associated with the mortality outcome. Our analysis indicates that older age was the only independent factor associated with death among EVD adult patients in Guinea. This suggests that older EVD patients should receive intensive medical care and be carefully monitored.

Impact of texting laws on motor vehicular fatalities in the United States.

PubMed

Ferdinand, Alva O; Menachemi, Nir; Sen, Bisakha; Blackburn, Justin L; Morrisey, Michael; Nelson, Leonard

2014-08-01

Using a panel study design, we examined the effects of different types of texting bans on motor vehicular fatalities. We used the Fatality Analysis Reporting System and a difference-in-differences approach to examine the incidence of fatal crashes in 2000 through 2010 in 48 US states with and without texting bans. Age cohorts were constructed to examine the impact of these bans on age-specific traffic fatalities. Primarily enforced laws banning all drivers from texting were significantly associated with a 3% reduction in traffic fatalities in all age groups, and those banning only young drivers from texting had the greatest impact on reducing deaths among those aged 15 to 21 years. Secondarily enforced restrictions were not associated with traffic fatality reductions in any of our analyses.

Impact of Texting Laws on Motor Vehicular Fatalities in the United States

PubMed Central

Ferdinand, Alva O.; Blackburn, Justin L.; Morrisey, Michael; Nelson, Leonard

2014-01-01

Using a panel study design, we examined the effects of different types of texting bans on motor vehicular fatalities. We used the Fatality Analysis Reporting System and a difference-in-differences approach to examine the incidence of fatal crashes in 2000 through 2010 in 48 US states with and without texting bans. Age cohorts were constructed to examine the impact of these bans on age-specific traffic fatalities. Primarily enforced laws banning all drivers from texting were significantly associated with a 3% reduction in traffic fatalities in all age groups, and those banning only young drivers from texting had the greatest impact on reducing deaths among those aged 15 to 21 years. Secondarily enforced restrictions were not associated with traffic fatality reductions in any of our analyses. PMID:24922151

Rates and predictors of stroke-associated case fatality in black Central African patients.

PubMed

Longo-Mbenza, B; Lelo Tshinkwela, M; Mbuilu Pukuta, J

2008-01-01

To identify case fatality rates and predictors of stroke in a private clinic in Kinshasa, Democratic Republic of Congo. Two hundred and twelve black Africans were consecutively admitted to a clinic and prospectively assessed during the first 30 days by CT scan-proven stroke types and outcome. Univariate and multivariate analyses were used to estimate the in-hospital mortality risk for the following baseline characteristics: age, gender, education, arterial hypertension, diabetes, stroke types, leukocyte count, and haematocrit, blood glucose, uric acid, fibrinogen and total cholesterol levels. Haemorrhagic and ischaemic strokes were present in 52 and 48% of the study population, respectively; and 44% of all stroke type patients, 29% of haemorrhagic stroke and 31% of ischaemic stroke patients died. Compared to the survivors, deceased patients were significantly (p < 0.001) older with higher leukocyte counts and haematocrit, haemoglobin and fibrinogen levels, but lower glycaemic levels. The variable significantly associated with all stroke type mortalities in the multivariate model was ischaemic stroke (HR = 4.28, p < 0.001). The univariate risk factors of mortality in patients with ischaemic stroke were higher fibrinogenaemia (RR = 6.4; 95% CI = 4.8-8.2 for tertile 3 and RR = 12.9; 95% CI = 7.8-18.4 for tertile 4; p < 0.001) and higher glycaemia (RR = 3.3; 95% CI = 1.4-5.7 for tertile 3 and RR = 6.7; 95% CI = 5.2-9.2 for tertile 4; p < 0.001). We have shown that all acute stroke types remain a deadly nosological entity, and ischaemic stroke, baseline haematocrit and fibrinogen levels, and dependency on others' care were significantly associated with all stroke mortalities. Moreover, hyperfibrinogaemia and hyperglycaemia were the significant predictors of case fatality in ischaemic stroke patients. In Africa, the top priority for resource allocation for stroke services should go to the primary prevention of stroke.

Acute kidney injury and edaravone in acute ischemic stroke: the Fukuoka Stroke Registry.

PubMed

Kamouchi, Masahiro; Sakai, Hironori; Kiyohara, Yutaka; Minematsu, Kazuo; Hayashi, Kunihiko; Kitazono, Takanari

2013-11-01

A free radical scavenger, edaravone, which has been used for the treatment of ischemic stroke, was reported to cause acute kidney injury (AKI) as a fatal adverse event. The aim of the present study was to clarify whether edaravone is associated with AKI in patients with acute ischemic stroke. From the Fukuoka Stroke Registry database, 5689 consecutive patients with acute ischemic stroke who were hospitalized within 24 hours of the onset of symptoms were included in this study. A logistic regression analysis for the Fukuoka Stroke Registry cohort was done to identify the predictors for AKI. A propensity score-matched nested case-control study was also performed to elucidate any association between AKI and edaravone. Acute kidney injury occurred in 128 of 5689 patients (2.2%) with acute ischemic stroke. A multivariate analysis revealed that the stroke subtype, the basal serum creatinine level, and the presence of infectious complications on admission were each predictors of developing AKI. In contrast, a free radical scavenger, edaravone, reduced the risk of developing AKI (multivariate-adjusted odds ratio [OR] .45, 95% confidence interval [CI] .30-.67). Propensity score-matched case-control study confirmed that edaravone use was negatively associated with AKI (propensity score-adjusted OR .46, 95% CI .29-.74). Although AKI has a significant impact on the clinical outcome of hospital inpatients, edaravone has a protective effect against the development of AKI in patients with acute ischemic stroke. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Traffic fatality indicators in Brazil: State diagnosis based on data envelopment analysis research.

PubMed

Bastos, Jorge Tiago; Shen, Yongjun; Hermans, Elke; Brijs, Tom; Wets, Geert; Ferraz, Antonio Clóvis Pinto

2015-08-01

The intense economic growth experienced by Brazil in recent decades and its consequent explosive motorization process have evidenced an undesirable impact: the increasing and unbroken trend in traffic fatality numbers. In order to contribute to road safety diagnosis on a national level, this study presents a research into two main indicators available in Brazil: mortality rate (represented by fatalities per capita) and fatality rate (represented by two sub-indicators, i.e., fatalities per vehicle and fatalities per vehicle kilometer traveled). These indicators were aggregated into a composite indicator or index through a multiple layer data envelopment analysis (DEA) composite indicator model, which looks for the optimum combination of indicators' weights for each decision-making unit, in this case 27 Brazilian states. The index score represents the road safety performance, based on which a ranking of states can be made. Since such a model has never been applied for road safety evaluation in Brazil, its parameters were calibrated based on the experience of more consolidated European Union research in ranking its member countries using DEA techniques. Secondly, cluster analysis was conducted aiming to provide more realistic performance comparisons and, finally, the sensitivity of the results was measured through a bootstrapping method application. It can be concluded that by combining fatality indicators, defining clusters and applying bootstrapping procedures a trustworthy ranking can be created, which is valuable for nationwide road safety planning. Copyright © 2015 Elsevier Ltd. All rights reserved.

An Independent Evaluation of the Switching Operations Facility Analysis 2010 Working Group's Processes

DOT National Transportation Integrated Search

2009-12-01

The Switching Operations Fatality Analysis (SOFA) Working Group was formed to analyze the factors contributing to fatalities in switching operations. The 2010 Working Group invited an independent team of evaluators to assess the thoroughness of the S...

Complete Streets and Adult Bicyclist Fatalities: Applying G-Computation to Evaluate an Intervention That Affects the Size of a Population at Risk.

PubMed

Mooney, Stephen J; Magee, Caroline; Dang, Kolena; Leonard, Julie C; Yang, Jingzhen; Rivara, Frederick P; Ebel, Beth E; Rowhani-Rahbar, Ali; Quistberg, D Alex

2018-05-14

"Complete Streets" policies require transportation engineers to make provisions for pedestrians, cyclists and transit users. These policies may make bicycling safer for individual cyclists while increasing overall bicycle fatalities if more individuals cycle due to improved infrastructure. We merged county-level records of Complete Streets policies with Fatality Analysis Reporting System counts of cyclist fatalities occurring between January 2000 and December 2015. Because comprehensive county cycling estimates were not available, we used bicycle commute estimates from the American Community Survey and US Census as a proxy for the cycling population, and limited analysis to 183 counties (accounting for over half the US population) for which cycle commute estimates were consistently non-zero. We used G-computation to estimate the effect of policies on overall cyclist fatalities while also accounting for potential policy effects on the size of the cycling population. Over 16 years, 5,254 cyclists died in these counties, representing 34 fatalities per 100,000 cyclist-years. We estimated that Complete Streets policies made cycling safer, averting 0.6 fatalities per 100,000 cyclist-years (95% CI: 0.3, 1.0) by encouraging a 2.4% increase in cycling and a 0.7% increase in cyclist fatalities. G-computation is a useful tool for understanding policy impact on risk and exposure.

Mortality and Case Fatality Due to Visceral Leishmaniasis in Brazil: A Nationwide Analysis of Epidemiology, Trends and Spatial Patterns

PubMed Central

Martins-Melo, Francisco Rogerlândio; Lima, Mauricélia da Silveira; Ramos, Alberto Novaes; Alencar, Carlos Henrique; Heukelbach, Jorg

2014-01-01

Background Visceral leishmaniasis (VL) is a significant public health problem in Brazil and several regions of the world. This study investigated the magnitude, temporal trends and spatial distribution of mortality related to VL in Brazil. Methods We performed a study based on secondary data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil from 2000 to 2011, in which VL was recorded as cause of death. We present epidemiological characteristics, trend analysis of mortality and case fatality rates by joinpoint regression models, and spatial analysis using municipalities as geographical units of analysis. Results In the study period, 12,491,280 deaths were recorded in Brazil. VL was mentioned in 3,322 (0.03%) deaths. Average annual age-adjusted mortality rate was 0.15 deaths per 100,000 inhabitants and case fatality rate 8.1%. Highest mortality rates were observed in males (0.19 deaths/100,000 inhabitants), <1 year-olds (1.03 deaths/100,000 inhabitants) and residents in Northeast region (0.30 deaths/100,000 inhabitants). Highest case fatality rates were observed in males (8.8%), ≥70 year-olds (43.8%) and residents in South region (17.7%). Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change – APC: 9.4%; 95% confidence interval – CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4). Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil. Conclusions Despite ongoing control strategies, mortality related to VL in Brazil is increasing. Mortality and case fatality vary considerably between regions, and surveillance and control measures should be prioritized in high-risk clusters. Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil. PMID:24699517

Comparison of teen driver fatality rates by vehicle type in the United States.

PubMed

Trowbridge, Matthew J; McKay, Mary Pat; Maio, Ronald F

2007-10-01

To compare national fatality rates for teen drivers by vehicle type. Fatality rates were calculated for 16- to 19-year-old drivers by vehicle type using data from the Fatal Analysis Reporting System (1999-2003) and estimates of miles driven from the National Household Transportation Survey (2001). Relative fatality risks for teen drivers of sports utility vehicles (SUVs) and pickups were calculated using passenger cars as a reference. Per vehicle mile driven, the fatality risk for both male and female teens driving SUVs was decreased relative to passenger car drivers (male teens: relative risk [RR], 0.33 [95% confidence interval [CI] = 0.29 to 0.37]; female teens: RR, 0.45 [95% CI = 0.34 to 0.59]). Fatality rates for male teens driving pickups were also lower per mile driven compared with male passenger car drivers (RR, 0.55 [95% CI = 0.51 to 0.60]). Fatality rates for female teens driving pickups and passenger cars were not statistically different but appear potentially higher for pickups (RR, 1.19 [95% CI = 0.98 to 1.44]). Both SUVs and pickups demonstrated significantly higher rates of fatal rollovers than passenger cars. Female adolescent drivers of SUVs and pickups were at particularly high risk for fatal rollovers per vehicle mile driven compared with passenger cars (SUV: RR, 1.88 [95% CI = 1.19 to 2.96]; pickup: RR, 3.42 [95% CI = 2.29 to 5.10]). Fatality rates for teen drivers vary significantly by vehicle type. From 1999 to 2003 in the United States, fatal rollovers were significantly more likely per mile driven for teen drivers of both SUVs and pickups compared with passenger cars. However, overall fatality rates (i.e., all crash types) for teen drivers of SUVs and male drivers of pickups were lower per mile driven than for teen drivers of passenger cars. The results of this ecological analysis cannot predict the individual-level fatality risk for teens driving different vehicle types. However, the significant variability in fatality rates among SUVs, pickups, and passenger cars seen at a population level suggests that vehicle choice should be further explored as a potentially modifiable risk factor in interventions to address teen driver safety.

Single-Fraction Proton Beam Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hattangadi-Gluth, Jona A.; Chapman, Paul H.; Kim, Daniel

2014-06-01

Purpose/Objective(s): To evaluate the obliteration rate and potential adverse effects of single-fraction proton beam stereotactic radiosurgery (PSRS) in patients with cerebral arteriovenous malformations (AVMs). Methods and Materials: From 1991 to 2010, 248 consecutive patients with 254 cerebral AVMs received single-fraction PSRS at our institution. The median AVM nidus volume was 3.5 cc (range, 0.1-28.1 cc), 23% of AVMs were in critical/deep locations (basal ganglia, thalamus, or brainstem), and the most common prescription dose was 15 Gy(relative biological effectiveness [RBE]). Univariable and multivariable analyses were performed to assess factors associated with obliteration and hemorrhage. Results: At a median follow-up time of 35 months (range, 6-198 months),more » 64.6% of AVMs were obliterated. The median time to total obliteration was 31 months (range, 6-127 months), and the 5-year and 10-year cumulative incidence of total obliteration was 70% and 91%, respectively. On univariable analysis, smaller target volume (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.86-0.93, P<.0001), smaller treatment volume (HR 0.93, 95% CI 0.90-0.96, P<.0001), higher prescription dose (HR 1.16, 95% CI 1.07-1.26, P=.001), and higher maximum dose (HR 1.14, 95% CI 1.05-1.23, P=.002) were associated with total obliteration. Deep/critical location was also associated with decreased likelihood of obliteration (HR 0.68, 95% CI 0.47-0.98, P=.04). On multivariable analysis, critical location (adjusted HR [AHR] 0.42, 95% CI 0.27-0.65, P<.001) and smaller target volume (AHR 0.81, 95% CI 0.68-0.97, P=.02) remained associated with total obliteration. Posttreatment hemorrhage occurred in 13 cases (5-year cumulative incidence of 7%), all among patients with less than total obliteration, and 3 of these events were fatal. The most common complication was seizure, controlled with medications, both acutely (8%) and in the long term (9.1%). Conclusions: The current series is the largest modern series of PSRS for cerebral AVMs. PSRS can achieve a high obliteration rate with minimal morbidity. Post-treatment hemorrhage remains a potentially fatal risk among patients who have not yet responded to treatment.« less

Global dengue death before and after the new World Health Organization 2009 case classification: A systematic review and meta-regression analysis.

PubMed

Low, Gary Kim-Kuan; Ogston, Simon A; Yong, Mun-Hin; Gan, Seng-Chiew; Chee, Hui-Yee

2018-06-01

Since the introduction of 2009 WHO dengue case classification, no literature was found regarding its effect on dengue death. This study was to evaluate the effect of 2009 WHO dengue case classification towards dengue case fatality rate. Various databases were used to search relevant articles since 1995. Studies included were cohort and cross-sectional studies, all patients with dengue infection and must report the number of death or case fatality rate. The Joanna Briggs Institute appraisal checklist was used to evaluate the risk of bias of the full-texts. The studies were grouped according to the classification adopted: WHO 1997 and WHO 2009. Meta-regression was employed using a logistic transformation (log-odds) of the case fatality rate. The result of the meta-regression was the adjusted case fatality rate and odds ratio on the explanatory variables. A total of 77 studies were included in the meta-regression analysis. The case fatality rate for all studies combined was 1.14% with 95% confidence interval (CI) of 0.82-1.58%. The combined (unadjusted) case fatality rate for 69 studies which adopted WHO 1997 dengue case classification was 1.09% with 95% CI of 0.77-1.55%; and for eight studies with WHO 2009 was 1.62% with 95% CI of 0.64-4.02%. The unadjusted and adjusted odds ratio of case fatality using WHO 2009 dengue case classification was 1.49 (95% CI: 0.52, 4.24) and 0.83 (95% CI: 0.26, 2.63) respectively, compared to WHO 1997 dengue case classification. There was an apparent increase in trend of case fatality rate from the year 1992-2016. Neither was statistically significant. The WHO 2009 dengue case classification might have no effect towards the case fatality rate although the adjusted results indicated a lower case fatality rate. Future studies are required for an update in the meta-regression analysis to confirm the findings. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of urban sprawl and vehicle miles traveled on traffic fatalities.

PubMed

Yeo, Jiho; Park, Sungjin; Jang, Kitae

2015-01-01

Previous research suggests that urban sprawl increases auto-dependency and that excessive auto use increases the risk of traffic fatalities. This indirect effect of urban sprawl on traffic fatalities is compared to non-vehicle miles traveled (VMT)-related direct effect of sprawl on fatalities. We conducted a path analysis to examine the causal linkages among urban sprawl, VMT, traffic fatalities, income, and fuel cost. The path diagram includes 2 major linkages: the direct relationship between urban sprawl and traffic fatalities and the indirect effect on fatalities through increased VMT in sprawling urban areas. To measure the relative strength of these causal linkages, path coefficients are estimated using data collected nationally from 147 urbanized areas in the United States. Through both direct and indirect paths, urban sprawl is associated with greater numbers of traffic fatalities, but the direct effect of sprawl on fatalities is more influential than the indirect effect. Enhancing traffic safety can be achieved by impeding urban sprawl and encouraging compact development. On the other hand, policy tools reducing VMT may be less effective than anticipated for traffic safety.

Fatal crashes of passenger vehicles before and after adding antilock braking systems.

PubMed

Farmer, C M; Lund, A K; Trempel, R E; Braver, E R

1997-11-01

Fatal crash rates of passenger cars and vans were compared for the last model year before four-wheel antilock brakes were introduced and the first model year for which antilock brakes were standard equipment. Vehicles selected for analysis had no other significant design changes between the model years being compared, and the model years with and without antilocks were no more than two years apart. The overall fatal crash rates were similar for the two model years. However, the vehicles with antilocks were significantly more likely to be involved in crashes fatal to their own occupants, particularly single-vehicle crashes. Conversely, antilock vehicles were less likely to be involved in crashes fatal to occupants of other vehicles or nonoccupants (pedestrians, bicyclists). Overall, antilock brakes appear to have had little effect on fatal crash involvement. Further study is needed to better understand why fatality risk has increased for occupants of antilock vehicles.

Surveillance of traffic incident management-related occupational fatalities in Kentucky, 2005-2016.

PubMed

Bunn, T L; Slavova, S; Chandler, M; Hanner, N; Singleton, M

2018-05-19

Traffic incidents occurring on roadways require the coordinated effort of multiple responder and recovery entities, including communications, law enforcement, fire and rescue, emergency medical services, hazardous materials, transportation agencies, and towing and recovery. The objectives of this study were to (1) identify and characterize transportation incident management (TIM)-related occupational fatalities; (2) assess concordance of surveillance data sources in identifying TIM occupations, driver vs. pedestrian status, and occupational fatality incident location; and (3) determine and compare U.S. occupational fatality rates for TIM industries. The Kentucky Fatality Assessment and Control Evaluation (FACE) program analyzed 2005-2016 TIM occupational fatality data using multiple data sources: death certificate data, Collision Report Analysis for Safer Highways (CRASH) data, and media reports, among others. Literal text analysis was performed on FACE data, and a multiple linear regression model and SAS proc sgpanel were used to estimate and visualize the U.S. TIM occupational mortality trend lines and confidence bounds. There were 29 TIM fatalities from 2005 to 2015 in Kentucky; 41% of decedents were in the police protection occupation, and 21% each were in the fire protection and motor vehicle towing industries. Over one half of the TIM decedents were performing work activities as pedestrians when they died. Media reports identified the majority of the occupational fatalities as TIM related (28 of 29 TIM-related deaths); the use of death certificates as the sole surveillance data source only identified 17 of the 29 deaths as TIM related, and the use of CRASH data only identified 4 of the 29 deaths as TIM related. Injury scenario text analysis showed that law enforcement vehicle pursuit, towing and recovery vehicle loading, and disabled vehicle response were particular high-risk activities that led to TIM deaths. Using U.S. data, the motor vehicle towing industry had a significantly higher risk for occupational mortality compared to the fire protection and police protection industries. Multiple data sources are needed to comprehensively identify TIM fatalities and to examine the circumstances surrounding TIM fatalities, because no one data source in itself was adequate and undercounted the total number of TIM fatalities. The motor vehicle towing industry, in particular, is at elevated risk for occupational mortality, and targeted mandatory TIM training for the motor vehicle towing industry should be considered. In addition, enhanced law enforcement roadside safety training during vehicle pursuit and apprehension of suspects is recommended.

Spatial and temporal analysis of fatal off-piste and backcountry avalanche accidents in Austria with a comparison of results in Switzerland, France, Italy and the US

NASA Astrophysics Data System (ADS)

Pfeifer, Christian; Höller, Peter; Zeileis, Achim

2018-02-01

In this article we analyzed spatial and temporal patterns of fatal Austrian avalanche accidents caused by backcountry and off-piste skiers and snowboarders within the winter periods 1967/1968-2015/2016. The data were based on reports of the Austrian Board for Alpine Safety and reports of the information services of the federal states. Using the date and the location of the recorded avalanche accidents, we were able to carry out spatial and temporal analyses applying generalized additive models and Markov random-field models. As a result of the trend analysis we noticed an increasing trend of backcountry and off-piste avalanche fatalities within the winter periods 1967/1968-2015/2016 (although slightly decreasing in recent years), which is in contradiction to the widespread opinion in Austria that the number of fatalities is constant over time. Additionally, we compared Austrian results with results of Switzerland, France, Italy and the US based on data from the International Commission of Alpine Rescue (ICAR). As a result of the spatial analysis, we noticed two hot spots of avalanche fatalities (Arlberg-Silvretta and Sölden). Because of the increasing trend and the rather narrow regional distribution of the fatalities, initiatives aimed at preventing avalanche accidents were highly recommended.

The case-fatality rate of meningococcal disease in Catalonia, 1990-1997.

PubMed

Domínguez, Angela; Cardeñosa, Neus; Pañella, Helena; Orcau, Angels; Companys, Maria; Alseda, Miquel; Oviedo, Manuel; Carmona, Glòria; Minguell, Sofia; Salleras, Lluis

2004-01-01

The objective was to analyse the case-fatality rate (CFR) of meningococcal disease (MD) in Catalonia, Spain. A retrospective study was carried out. Clinical histories of cases of MD reported for the period 1990-1997 in Catalonia were reviewed. For all cases, the variables gender, age, clinical type, y of presentation, province, phenotype and death by meningococcal disease were collected. The association between death and the other variables was studied by bivariate and unconditional logistic regression analysis. In the 2343 cases studied there were 146 deaths (6.2%) due to meningococcal disease. The CFR was higher in females (OR: 1.5, 95%CI: 1.1-2.1), in the 20 to 49 y (OR: 2.4, 95%CI: 1.2-4.9) and > or = 50 y (OR: 5.3, 95%CI: 2.8-10.1) age groups, in cases with septicaemia (OR: 2.4, 95%CI: 1.6-3.5), in the cases produced by serogroup A (OR: 4.7, 95%CI: 1.0-23.4) and in cases occurring during 1993 (OR: 2.1, 95%CI: 1.1-4.1) or in the province of Lleida (OR: 2.9, 95%CI: 1.2-7.2). In the multivariate analysis, death was associated with the 20-49 y age group (OR: 3.9, 95%CI: 1.8-8.4), the > or = 50 y age group (OR: 7.3, 95%CI: 3.6-14.7), septicaemia (OR: 3.1; 95%CI: 2.0-4.7) and residing in the province of Lleida (OR: 3.2; 95%CI: 1.2-8.5). The CFR of meningococcal disease in Catalonia was not associated with the emergent phenotype C:2b:P1.2,5 strain, which caused an outbreak in other regions of Spain.

ω-3 Polyunsaturated Fatty Acid Biomarkers and Coronary Heart Disease

PubMed Central

Del Gobbo, Liana C.; Imamura, Fumiaki; Aslibekyan, Stella; Marklund, Matti; Virtanen, Jyrki K.; Wennberg, Maria; Yakoob, Mohammad Y.; Chiuve, Stephanie E.; dela Cruz, Luicito; Frazier-Wood, Alexis C.; Fretts, Amanda M.; Guallar, Eliseo; Matsumoto, Chisa; Prem, Kiesha; Tanaka, Tosh; Wu, Jason H. Y.; Zhou, Xia; Helmer, Catherine; Ingelsson, Erik; Yuan, Jian-Min; Barberger-Gateau, Pascale; Campos, Hannia; Chaves, Paulo H. M.; Djoussé, Luc; Giles, Graham G.; Gómez-Aracena, Jose; Hodge, Allison M.; Hu, Frank B.; Jansson, Jan-Håkan; Johansson, Ingegerd; Khaw, Kay-Tee; Koh, Woon-Puay; Lemaitre, Rozenn N.; Lind, Lars; Luben, Robert N.; Rimm, Eric B.; Risérus, Ulf; Samieri, Cecilia; Franks, Paul W.; Siscovick, David S.; Stampfer, Meir; Steffen, Lyn M.; Steffen, Brian T.; Tsai, Michael Y.; van Dam, Rob M.; Voutilainen, Sari; Willett, Walter C.; Woodward, Mark; Mozaffarian, Dariush

2016-01-01

IMPORTANCE The role of ω-3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. OBJECTIVE To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20:5ω-3), docosapentaenoic acid (DPA; 22:5ω-3), and docosahexaenoic acid (DHA; 22:6ω-3) and plant-derived α-linolenic acid (ALA; 18:3ω-3) for incident CHD. DATA SOURCES A global consortium of 19 studies identified by November 2014. STUDY SELECTION Available prospective (cohort, nested case-control) or retrospective studies with circulating or tissue ω-3 biomarkers and ascertained CHD. DATA EXTRACTION AND SYNTHESIS Each study conducted standardized, individual-level analysis using harmonized models, exposures, outcomes, and covariates. Findings were centrally pooled using random-effects meta-analysis. Heterogeneity was examined by age, sex, race, diabetes, statins, aspirin, ω-6 levels, and FADS desaturase genes. MAIN OUTCOMES AND MEASURES le;&-1qIncident total CHD, fatal CHD, and nonfatal myocardial infarction (MI). RESULTS The 19 studies comprised 16 countries, 45 637 unique individuals, and 7973 total CHD, 2781 fatal CHD, and 7157 nonfatal MI events, with ω-3 measures in total plasma, phospholipids, cholesterol esters, and adipose tissue. Median age at baseline was 59 years (range, 18–97 years), and 28 660 (62.8%) were male. In continuous (per 1-SD increase) multivariable-adjusted analyses, the ω-3 biomarkers ALA, DPA, and DHA were associated with a lower risk of fatal CHD, with relative risks (RRs) of 0.91 (95% CI, 0.84–0.98) for ALA, 0.90 (95% CI, 0.85–0.96) for DPA, and 0.90 (95% CI, 0.84–0.96) for DHA. Although DPA was associated with a lower risk of total CHD (RR, 0.94; 95% CI, 0.90–0.99), ALA (RR, 1.00; 95% CI, 0.95–1.05), EPA (RR, 0.94; 95% CI, 0.87–1.02), and DHA (RR, 0.95; 95% CI, 0.91–1.00)were not. Significant associations with nonfatal MI were not evident per 1 SD. Across quintiles, lower risk of nonfatal MI was evident with EPA (RR, 0.71; 95% CI, 0.56–0.90) and ALA (RR, 0.87; 95% CI, 0.78–0.97), and lower risk of fatal CHD was evident with DPA (RR, 0.76; 95% CI, 0.65–0.90) and DHA (RR, 0.77; 95% CI, 0.64–0.89). Associations appeared generally stronger in phospholipids and total plasma. Restricted cubic splines did not identify evidence of nonlinearity in dose responses. CONCLUSIONS AND RELEVANCE On the basis of available studies of free-living populations globally, biomarker concentrations of seafood and plant-derived ω-3 fatty acids are associated with a lower incidence of fatal CHD. PMID:27357102

76 FR 51120 - Denial of Motor Vehicle Defect Petition

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... crashes an air bag should have deployed, which were not always well-founded, or based on any technical analysis. There were 5 reports of non-deployment in a population of 176,471 \\4\\ Chevrolet Cobalt vehicles... NHTSA's Fatality Analysis Reporting System (FARS) tracks all fatal crashes involving motor vehicles in...

Traffic safety facts 1997 : a compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system

DOT National Transportation Integrated Search

1998-11-01

In this annual report, Traffic Safety Facts 1997: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System, the National Highway Traffic Safety Administration (NHTSA) presents descriptive ...

Reducing fatalities and severe injuries on Florida's high-speed multi-lane arterial corridors : part II, analysis of the crash level data, final report, April 2009

DOT National Transportation Integrated Search

2009-04-28

This report presents the analysis conducted to identify the factors that contribute to severe and fatal crash occurrence on multilane corridors. The authors preliminary investigation using simultaneous ordered probit model provided enough evidence...

Traffic safety facts 2007 : a compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system

DOT National Transportation Integrated Search

2007-01-01

In this annual report, Traffic Safety Facts 2007: A Compilation of Motor Vehicle Crash Data from the Fatality : Analysis Reporting System and the General Estimates System, the National Highway Traffic Safety Administration : (NHTSA) presents descript...

Traffic safety facts 2008 : a compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system

DOT National Transportation Integrated Search

2008-01-01

In this annual report, Traffic Safety Facts 2008: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System, the National Highway Traffic Safety Administration (NHTSA) presents descriptive ...

Traffic safety facts 2009 : a compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system

DOT National Transportation Integrated Search

2009-01-01

In this annual report, Traffic Safety Facts 2009: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System, the National Highway Traffic Safety Administration (NHTSA) presents descriptive ...

Electrical deaths in the US construction: an analysis of fatality investigations.

PubMed

Zhao, Dong; Thabet, Walid; McCoy, Andrew; Kleiner, Brian

2014-01-01

Electrocution is among the 'fatal four' in US construction according to the Occupational Safety and Health Administration. Learning from failures is believed to be an effective path to success, with deaths being the most serious system failures. This paper examined the failures in electrical safety by analysing all electrical fatality investigations (N = 132) occurring between 1989 and 2010 from the Fatality Assessment and Control Evaluation programme that is completed by the National Institute of Occupational Safety and Health. Results reveal the features of the electrical fatalities in construction and disclose the most common electrical safety challenges on construction sites. This research also suggests the sociotechnical system breakdowns and the less effectiveness of current safety training programmes may significantly contribute to worker's unsafe behaviours and electrical fatality occurrences.

Adverse weather conditions and fatal motor vehicle crashes in the United States, 1994-2012.

PubMed

Saha, Shubhayu; Schramm, Paul; Nolan, Amanda; Hess, Jeremy

2016-11-08

Motor vehicle crashes are a leading cause of injury mortality. Adverse weather and road conditions have the potential to affect the likelihood of motor vehicle fatalities through several pathways. However, there remains a dearth of assessments associating adverse weather conditions to fatal crashes in the United States. We assessed trends in motor vehicle fatalities associated with adverse weather and present spatial variation in fatality rates by state. We analyzed the Fatality Analysis Reporting System (FARS) datasets from 1994 to 2012 produced by the National Highway Traffic Safety Administration (NHTSA) that contains reported weather information for each fatal crash. For each year, we estimated the fatal crashes that were associated with adverse weather conditions. We stratified these fatalities by months to examine seasonal patterns. We calculated state-specific rates using annual vehicle miles traveled data for all fatalities and for those related to adverse weather to examine spatial variations in fatality rates. To investigate the role of adverse weather as an independent risk factor for fatal crashes, we calculated odds ratios for known risk factors (e.g., alcohol and drug use, no restraint use, poor driving records, poor light conditions, highway driving) to be reported along with adverse weather. Total and adverse weather-related fatalities decreased over 1994-2012. Adverse weather-related fatalities constituted about 16 % of total fatalities on average over the study period. On average, 65 % of adverse weather-related fatalities happened between November and April, with rain/wet conditions more frequently reported than snow/icy conditions. The spatial distribution of fatalities associated with adverse weather by state was different than the distribution of total fatalities. Involvement of alcohol or drugs, no restraint use, and speeding were less likely to co-occur with fatalities during adverse weather conditions. While adverse weather is reported for a large number of motor vehicle fatalities for the US, the type of adverse weather and the rate of associated fatality vary geographically. These fatalities may be addressed and potentially prevented by modifying speed limits during inclement weather, improving road surfacing, ice and snow removal, and providing transit alternatives, but the impact of potential interventions requires further research.

Non-fatal injuries among Pacific infants in Auckland: data from the Pacific Islands families first two years of life study.

PubMed

Schluter, Philip J; Paterson, Janis; Percival, Teuila

2006-03-01

Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0-24 months. A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data. The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0-6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks-12 months and 174 (95% CI: 151, 199) injuries for infants aged 13-24 months. In the multivariable GEE model, older infants (P < 0.001), infants who were male (P = 0.01), born to Pacific Island fathers and non-Pacific Island mothers (P < 0.001), and in higher or unknown income groups (P = 0.01) were significantly more likely to suffer injury events. No significant two-factor interaction with infant age was identified. Among Pacific infants, non-fatal injury is common and injury incidence rates are considerably higher than national levels. Male infants and those born into ethnically mixed families, where the father was of Pacific Island ethnicity and the mother was non-Pacific, were at increased relative risk of injury and might benefit from specific injury prevention targeting. However, given the high injury incidence levels found, we advocate that investigation and targeting of culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand.

Development and validation of a prognostic model to predict death in patients with traumatic bleeding, and evaluation of the effect of tranexamic acid on mortality according to baseline risk: a secondary analysis of a randomised controlled trial.

PubMed

Perel, P; Prieto-Merino, D; Shakur, H; Roberts, I

2013-06-01

Severe bleeding accounts for about one-third of in-hospital trauma deaths. Patients with a high baseline risk of death have the most to gain from the use of life-saving treatments. An accurate and user-friendly prognostic model to predict mortality in bleeding trauma patients could assist doctors and paramedics in pre-hospital triage and could shorten the time to diagnostic and life-saving procedures such as surgery and tranexamic acid (TXA). The aim of the study was to develop and validate a prognostic model for early mortality in patients with traumatic bleeding and to examine whether or not the effect of TXA on the risk of death and thrombotic events in bleeding adult trauma patients varies according to baseline risk. Multivariable logistic regression and risk-stratified analysis of a large international cohort of trauma patients. Two hundred and seventy-four hospitals in 40 high-, medium- and low-income countries. We derived prognostic models in a large placebo-controlled trial of the effects of early administration of a short course of TXA [Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial]. The trial included 20,127 trauma patients with, or at risk of, significant bleeding, within 8 hours of injury. We externally validated the model on 14,220 selected trauma patients from the Trauma Audit and Research Network (TARN), which included mainly patients from the UK. We examined the effect of TXA on all-cause mortality, death due to bleeding and thrombotic events (fatal and non-fatal myocardial infarction, stroke, deep-vein thrombosis and pulmonary embolism) within risk strata in the CRASH-2 trial data set and we estimated the proportion of premature deaths averted by applying the odds ratio (OR) from the CRASH-2 trial to each of the risk strata in TARN. For the stratified analysis according baseline risk we considered the intervention TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo. For the prognostic models we included predictors for death in hospital within 4 weeks of injury. For the stratified analysis we reported ORs for all causes of death, death due to bleeding, and fatal and non-fatal thrombotic events associated with the use of TXA according to baseline risk. A total of 3076 (15%) patients died in the CRASH-2 trial and 1705 (12%) in the TARN data set. Glasgow Coma Scale score, age and systolic blood pressure were the strongest predictors of mortality. Discrimination and calibration were satisfactory, with C-statistics > 0.80 in both CRASH-2 trial and TARN data sets. A simple chart was constructed to readily provide the probability of death at the point of care, while a web-based calculator is available for a more detailed risk assessment. TXA reduced all-cause mortality and death due to bleeding in each stratum of baseline risk. There was no evidence of heterogeneity in the effect of TXA on all-cause mortality (p-value for interaction = 0.96) or death due to bleeding (p= 0.98). There was a significant reduction in the odds of fatal and non-fatal thrombotic events with TXA (OR = 0.69, 95% confidence interval 0.53 to 0.89; p= 0.005). There was no evidence of heterogeneity in the effect of TXA on the risk of thrombotic events (p= 0.74). This prognostic model can be used to obtain valid predictions of mortality in patients with traumatic bleeding. TXA can be administered safely to a wide spectrum of bleeding trauma patients and should not be restricted to the most severely injured. Future research should evaluate whether or not the use of this prognostic model in clinical practice has an impact on the management and outcomes of trauma patients.

Listeria monocytogenes meningitis in the Netherlands, 1985-2014: A nationwide surveillance study.

PubMed

Koopmans, Merel M; Bijlsma, Merijn W; Brouwer, Matthijs C; van de Beek, Diederik; van der Ende, Arie

2017-07-01

Listeria monocytogenes can cause sepsis and meningitis. We report national surveillance data on L. monocytogenes meningitis in the Netherlands, describing incidence changes, genetic epidemiology and fatality rate. We analyzed data from the Netherlands Reference Laboratory of Bacterial Meningitis for cases of L. monocytogenes meningitis. Strains were assessed by serotyping and bacterial population structure by multi-locus sequence typing. A total of 375 cases of Listeria meningitis were identified between 1985 and 2014. Peak incidence rates were observed in neonates (0.61 per 100,000 live births) and older adults (peak at 87 year; 0.53 cases per 100,000 population of the same age). Neonatal listerial meningitis decreased 17-fold from 1.95 per 100,000 live births between 1985 and 1989, to 0.11 per 100,000 live births between 2010 and 2014. Overall case fatality rate was 31%, in a multivariate analysis older age and concomitant bacteremia were associated with mortality (both p < 0.01). Clonal complexes (CC) CC1, CC2 and CC3 decreased over time from respectively 32% to 12%, 33% to 9% and 10% to 2% (all p < 0.001), while CC6 increased from 2% to 26% (p < 0.001). The incidence of neonatal listerial meningitis has declined over the past 25 years. The genotype CC6 has become the predominant genotype in listerial meningitis in the Netherlands. Mortality of listeria meningitis has remained high. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Influence of individual characteristics and working conditions in the level of injury accident at work by registered in Andalusia, Spain, in 2003].

PubMed

Muñoz, Julia Bolívar; Codina, Antonio Daponte; Cruz, Laura López; Rodríguez, Inmaculada Mateo

2009-01-01

The study of the severity of occupational injuries is very important for the establishment of prevention plans. The aim of this paper is to analyze the distribution of occupational injuries by a) individual factors b) work place characteristics and c) working conditions and to analyze the severity of occupational injuries by this characteristics in men and women in Andalusia. Injury data came from the accident registry of the Ministry of Labor and social issues in 2003. Dependent variable: the severity of the injury: slight, serious, very serious and fatal; the independent variables: the characteristics of the worker, company data, and the accident itself. Bivariate and multivariate analysis were done to estimate the probability of serious, very serious and fatal injury, related to other variables, through odds ratio (OR), and using a 95% confidence interval (CI 95%). The 82.4% of the records were men and 17.6% were women, of whom the 78,1% are unskilled manual workers, compared to 44.9% of men. The men belonging to class I have a higher probability of more severe lesions (OR = 1.67, 95% CI = 1.17-2.38). The severity of the injury is associated with sex, age and type of injury. In men it is also related with the professional situation, the place where the accident happened, an unusual job, the size and the characteristics of the company and the social class, and in women with the sector.

Clozapine-associated neutropenia and agranulocytosis in Argentina (2007-2012).

PubMed

Balda, María V; Garay, Osvaldo U; Papale, Rosa M; Bignone, Inés; Bologna, Viviana G; Brandolini, Andrés; Prokopez, Cintia R; Balasini, Juan I; Baldessarini, Ross J; Daray, Federico M

2015-03-01

The risks of severe leukopenia and agranulocytosis have varied over time and among geographical regions and cultures, with little information available on South American populations. Accordingly, we reviewed and analyzed data from a 6-year experience monitored by an Argentine national registry to which reporting of adverse events reports is required. We analyzed data for 2007-2012 from the pharmacovigilance program of the Argentine drug-regulatory agency (ANMAT) using standard bivariate and multivariate statistical methods and survival analysis. We identified 378 cases of adverse hematological events over 6 years among an average of 12 305 individuals/year treated with clozapine (308±133 mg/day) to estimate the mean annualized rates of leukopenia [0.19 (95% confidence interval [CI] 0.11-0.27)], neutropenia [0.38 (95% CI 0.34-0.43)], and agranulocytosis [0.05 (95% CI 0.02-0.08)] % per year [median latency 2 (95% CI 1.3-2.1) months]; fatalities related to agranulocytosis averaged 4.2 (95% CI 0.0-9.2) per 100 000 treated individuals/year. Factors associated significantly and independently with agranulocytosis were female sex, older age, and use of other drugs in addition to clozapine. With monitoring by international standards, recent risks of clozapine-associated agranulocytosis in Argentina were lower, but fatality rates were higher than that in other regions of the world. Risk factors include the use of multiple psychotropic drugs, female sex, and older age.

Does national expenditure on research and development influence stroke outcomes?

PubMed

Kim, Young Dae; Jung, Yo Han; Norrving, Bo; Ovbiagele, Bruce; Saposnik, Gustavo

2017-10-01

Background Expenditure on research and development is a macroeconomic indicator representative of national investment. International organizations use this indicator to compare international research and development activities. Aim We investigated whether differences in expenditures on research and development at the country level may influence the incidence of stroke and stroke mortality. Methods We compared stroke metrics with absolute amount of gross domestic expenditure on R&D (GERD) per-capita adjusted for purchasing power parity (aGERD) and relative amount of GERD as percent of gross domestic product (rGERD). Sources included official data from the UNESCO, the World Health Organization, the World Bank, and population-based studies. We used correlation analysis and multivariable linear regression modeling. Results Overall, data on stroke mortality rate and GERD were available from 66 countries for two periods (2002 and 2008). Age-standardized stroke mortality rate was associated with aGERD (r = -0.708 in 2002 and r = -0.730 in 2008) or rGERD (r = -0.545 in 2002 and r = -0.657 in 2008) (all p < 0.001). Multivariable analysis showed a lower aGERD and rGERD were independently and inversely associated with higher stroke mortality (all p < 0.05). The estimated prevalence of hypertension, diabetes, or obesity was higher in countries with lower aGERD. The analysis of 27 population-based studies showed consistent inverse associations between aGERD or rGERD and incident risk of stroke and 30-day case fatality. Conclusions There is higher stroke mortality among countries with lower expenditures in research and development. While this study does not prove causality, it suggests a potential area to focus efforts to improve global stroke outcomes.

Reverse left ventricular remodeling after acute myocardial infarction: the prognostic impact of left ventricular global torsion.

PubMed

Spinelli, Letizia; Morisco, Carmine; Assante di Panzillo, Emiliano; Izzo, Raffaele; Trimarco, Bruno

2013-04-01

Reverse left ventricular (LV) remodeling (>10 % reduction in LV end-systolic volume) may occur in patients recovering for acute ST-elevation myocardial infarction (STEMI), undergoing percutaneous revascularization of infarct-related coronary artery (PCI). To detect whether LV global torsion obtained by two-dimensional speckle-tracking echocardiography was predictive of reverse LV remodeling, 75 patients with first anterior wall STEMI were studied before (T1) and after PCI (T2) and at 6-month follow-up. Two-year clinical follow-up was also accomplished. LV volumes and both LV sphericity index and conic index were obtained by three-dimensional echocardiography. Reverse remodeling was observed in 25 patients (33 %). By multivariate analysis, independent predictors of reverse LV remodeling were: LV conic index, T2 LV torsion and Δ torsion (difference between T2 and T1 LV torsion expressed as percentage of this latter). According to receiver operating characteristic analysis, 1.34°/cm for T2 LV torsion (sensitivity 88 % and specificity 80 %) and 54 % for Δ torsion (sensitivity 92 % and specificity 82 %) were the optimal cutoff values in predicting reverse LV remodeling. In up to 24 month follow-up, 4 non-fatal re-infarction, 7 hospitalization for heart failure and 4 cardiac deaths occurred. By multivariate Cox analysis, the best variable significantly associated with event-free survival rate was reverse LV remodeling with a hazard ratio = 9.9 (95 % confidence interval, 7.9-31.4, p < 0.01). In conclusion, reverse LV remodeling occurring after anterior wall STEMI is associated with favorable long-term outcome. The improvement of global LV torsion following coronary artery revascularization is the major predictor of reverse LV remodeling.

Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time-series analysis (2001-10) conducted in Brazil.

PubMed

Andreuccetti, Gabriel; Carvalho, Heraclito B; Cherpitel, Cheryl J; Ye, Yu; Ponce, Julio C; Kahn, Tulio; Leyton, Vilma

2011-12-01

In Brazil, a new law introduced in 2008 has lowered the blood alcohol concentration limit for drivers from 0.06 to 0.02, but the effectiveness in reducing traffic accidents remains uncertain. This study evaluated the effects of this enactment on road traffic injuries and fatalities. Time-series analysis using autoregressive integrated moving average (ARIMA) modelling. State and capital of São Paulo, Brazil.   A total of 1,471,087 non-fatal and 51,561 fatal road traffic accident cases in both regions. Monthly rates of traffic injuries and fatalities per 100,000 inhabitants from January 2001 to June 2010. The new traffic law was responsible for significant reductions in traffic injury and fatality rates in both localities (P<0.05). A stronger effect was observed for traffic fatality (-7.2 and -16.0% in the average monthly rate in the State and capital, respectively) compared to traffic injury rates (-1.8 and -2.3% in the State and capital, respectively). Lowering the blood alcohol concentration limit in Brazil had a greater impact on traffic fatalities than injuries, with a higher effect in the capital, where presumably the police enforcement was enhanced. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Gender, age and circumstances analysis of flood and landslide fatalities in Italy.

PubMed

Salvati, Paola; Petrucci, Olga; Rossi, Mauro; Bianchi, Cinzia; Pasqua, Aurora A; Guzzetti, Fausto

2018-01-01

Floods and landslides are frequent and destructive geo-hydrological hazards that cause harm to people every year. We analysed data on 1292 landslide and 771 flood fatalities that occurred in Italy in the 50-year period 1965-2014, to determine the dependence of the fatalities on gender and age and the circumstances of death by type of hazard. The multinomial probability mass function of the expected fatalities by gender and age, as reported by national census data, were estimated and compared with the observed landslide and flood fatalities. We identified the age categories over or under represented when the observed fatalities were respectively higher or lower than the modelled expected deaths. We found that in Italy males are more vulnerable to floods and landslides for most of the age categories. Apart from children, males are over-represented up to the age of 89 for floods and up to 79 for landslides, whereas females are under-represented up to the age of 59 for floods and landslides, and over-represented above 70 for floods and between 60 and 79 for landslides. To consider the demographic and socio-cultural changes over time, we performed a temporal analysis splitting the record into two non-overlapping subsets of 25year each. The analysis demonstrated that the over-representation of males compared to the females, both for landslide and flood is statistically significant and does not vary in time, indicating a different propensity towards the risk taking and a different degree of exposure between males and females. Analysis of the data allowed to identify the common circumstances of death. Landslides fatalities occurred frequently indoor, whereas the majority of the flood fatalities occurred outdoor, outlining the different dynamics of the hazards. Floods killed numerous people along roads and drivers or passengers travelling in vehicles. We expect that the results of this work will be helpful to design recommendations for self-protecting actions, and proactive policies that can contribute to reduce the human toll of floods and landslides in Italy, and elsewhere. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado.

PubMed

Aydelotte, Jayson D; Brown, Lawrence H; Luftman, Kevin M; Mardock, Alexandra L; Teixeira, Pedro G R; Coopwood, Ben; Brown, Carlos V R

2017-08-01

To evaluate motor vehicle crash fatality rates in the first 2 states with recreational marijuana legalization and compare them with motor vehicle crash fatality rates in similar states without recreational marijuana legalization. We used the US Fatality Analysis Reporting System to determine the annual numbers of motor vehicle crash fatalities between 2009 and 2015 in Washington, Colorado, and 8 control states. We compared year-over-year changes in motor vehicle crash fatality rates (per billion vehicle miles traveled) before and after recreational marijuana legalization with a difference-in-differences approach that controlled for underlying time trends and state-specific population, economic, and traffic characteristics. Pre-recreational marijuana legalization annual changes in motor vehicle crash fatality rates for Washington and Colorado were similar to those for the control states. Post-recreational marijuana legalization changes in motor vehicle crash fatality rates for Washington and Colorado also did not significantly differ from those for the control states (adjusted difference-in-differences coefficient = +0.2 fatalities/billion vehicle miles traveled; 95% confidence interval = -0.4, +0.9). Three years after recreational marijuana legalization, changes in motor vehicle crash fatality rates for Washington and Colorado were not statistically different from those in similar states without recreational marijuana legalization. Future studies over a longer time remain warranted.

The effect of the 1997 Texas motorcycle helmet law on motorcycle crash fatalities.

PubMed

Bavon, Al; Standerfer, Christina

2010-01-01

This study seeks to determine the effect of the Texas motorcycle helmet law on fatalities since the repeal of the universal helmet law in 1997. Texas monthly motorcycle accident data between 1994 and 2004 were obtained from the National Highway Transportation Safety Administration's Fatality Analysis Reporting System (FARS) and supplemented with motorcycle registration data from the Texas Department of Transportation. An ARIMA model was used to estimate the impact of the law. A sharp increase in fatality rates occurred immediately following the implementation of the law in September 1997. Deaths increased by 30%, fatality rates per motorcycle registrations increased by 15.2%, and fatality rates per vehicle miles traveled increased by 25% after repeal. Helmet use decreased from 77% in 1996 to 63% in 1997 and 36% in 1998 and thereafter. The parameter estimates of the ARIMA model (0,0,0) (0,1,1) show that the change in the law led to statistically significant increases of 2.3 fatalities and 1.18 fatality rate per 100 billion vehicle miles traveled. The repeal of the universal helmet law in Texas in 1997 has had a significant adverse effect on motorcyclist fatalities in Texas.

Decrease of morbidity in road traffic accidents in a high income country - an analysis of 24,405 accidents in a 21 year period.

PubMed

Ernstberger, Antonio; Joeris, Alexander; Daigl, Monica; Kiss, Miklos; Angerpointner, Katharina; Nerlich, Michael; Schmucker, Uli

2015-10-01

The WHO initiated the "Decade of Action for Road Safety" because the fatality on road traffic accidents could become the fifth leading cause of death in 2030. On the contrary, fatalities continue to decrease in high income countries. The aim of the study was to find evidence for changes in injury severity of passenger car occupants after road traffic accidents in Germany over time, and to find contributing factors. Data from the German In Depth Accident Study (GIDAS), representative for Germany, was used. A total of 24.405 accidents, reported from 1991 until 2011. 44.503 adult passenger car occupants were examined. A multivariable logistic regression model was developed to find reasons for observed trends over time. The relative decrease in mortality was 68.8% from 1991 until 2011. Between 2006 and 2011, the percentage of severely injured traffic victims was less than half, both in terms of the whole body and individual body regions. For injuries with an Abbreviated Injury Scale (AIS) ≥ 2, the percentage of persons with lower leg injuries declined by 72.5%, followed by the percentage of persons with pelvic injuries (61.5%), upper extremity injuries (57.7%), head injuries (54.3%), thorax injuries (50.0%), and abdomen injuries (40.0%). The multivariable regression model found 13 independent variables associated with injury prevention (e.g. seat belt use: OR 0.41, CI 95% 0.32-0.49; airbag: OR 0.86, CI 95% 0.75-0.99). The implementation of protective factors increased over time while accident constellations with a high probability for severe injury decreased over time. The decrease of severe injuries after road traffic accidents can be only attributed to a comprehensive approach including the enforcement of road safety policies and innovations in car engineering and emergency medicine. Traffic related measures and alcohol level control, and seat belt usage enforcement next to other technical advances are considered especially important. Copyright © 2015 Elsevier Ltd. All rights reserved.

The state of the residential fire fatality problem in Sweden: Epidemiology, risk factors, and event typologies.

PubMed

Jonsson, Anders; Bonander, Carl; Nilson, Finn; Huss, Fredrik

2017-09-01

Residential fires represent the largest category of fatal fires in Sweden. The purpose of this study was to describe the epidemiology of fatal residential fires in Sweden and to identify clusters of events. Data was collected from a database that combines information on fatal fires with data from forensic examinations and the Swedish Cause of Death-register. Mortality rates were calculated for different strata using population statistics and rescue service turnout reports. Cluster analysis was performed using multiple correspondence analysis with agglomerative hierarchical clustering. Male sex, old age, smoking, and alcohol were identified as risk factors, and the most common primary injury diagnosis was exposure to toxic gases. Compared to non-fatal fires, fatal residential fires more often originated in the bedroom, were more often caused by smoking, and were more likely to occur at night. Six clusters were identified. The first two clusters were both smoking-related, but were separated into (1) fatalities that often involved elderly people, usually female, whose clothes were ignited (17% of the sample), (2) middle-aged (45-64years old), (often) intoxicated men, where the fire usually originated in furniture (30%). Other clusters that were identified in the analysis were related to (3) fires caused by technical fault, started in electrical installations in single houses (13%), (4) cooking appliances left on (8%), (5) events with unknown cause, room and object of origin (25%), and (6) deliberately set fires (7%). Fatal residential fires were unevenly distributed in the Swedish population. To further reduce the incidence of fire mortality, specialized prevention efforts that focus on the different needs of each cluster are required. Cooperation between various societal functions, e.g. rescue services, elderly care, psychiatric clinics and other social services, with an application of both human and technological interventions, should reduce residential fire mortality in Sweden. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Progress towards zero, an international comparison: Improvements in traffic fatality from 1990 to 2010 for different age groups in the USA and 15 of its peers.

PubMed

Ahangari, Hamed; Atkinson-Palombo, Carol; Garrick, Norman W

2016-06-01

In January 2015, the United States Department of Transportation (USDOT) announced that the official target of the federal government transportation safety policy was zero deaths. Having a better understanding of traffic fatality trends of various age cohorts-and to what extent the US is lagging other countries-is a crucial first step to identifying policies that may help the USDOT achieve its goal. In this paper we analyze fatality rates for different age cohorts in developed countries to better understand how road traffic fatality patterns vary across countries by age cohort. Using benchmarking analysis and comparative index analysis based on panel data modelling and data for selected years between 1990 and 2010, we compare changes in the rate of road traffic fatality over time, as well as the absolute level of road traffic fatality for six age groups in the US, with 15 other developed countries. Our findings illustrate tremendous variations in road fatality rates (both in terms of the absolute values and the rates of improvement over time) among different age cohorts in all of the 16 countries. Looking specifically at the US, our analysis shows that safety improvements for Youngsters (15-17 years old) was much better than for other age groups, and closely tracked peer countries. In sharp contrast, Children (0-14 years old) and Seniors (+65 years old) in the US, fare very poorly when compared to peer countries. For example, in 2010, Children in the US were a stunning five times more likely to experience a road traffic fatality than Children in the UK. This startling statistic suggests an immediate need to explore further the causes and potential solutions to these disparities. This is especially important if countries, including the US, are to achieve the ambitious goals set out in Zero Vision initiatives. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

Risk factors affecting fatal bus accident severity: Their impact on different types of bus drivers.

PubMed

Feng, Shumin; Li, Zhenning; Ci, Yusheng; Zhang, Guohui

2016-01-01

While the bus is generally considered to be a relatively safe means of transportation, the property losses and casualties caused by bus accidents, especially fatal ones, are far from negligible. The reasons for a driver to incur fatalities are different in each case, and it is essential to discover the underlying risk factors of bus fatality severity for different types of drivers in order to improve bus safety. The current study investigates the underlying risk factors of fatal bus accident severity to different types of drivers in the U.S. by estimating an ordered logistic model. Data for the analysis are retrieved from the Buses Involved in Fatal Accidents (BIFA) database from the USA for the years 2006-2010. Accidents are divided into three levels by counting their equivalent fatalities, and the drivers are classified into three clusters by the K-means cluster analysis. The analysis shows that some risk factors have the same impact on different types of drivers, they are: (a) season; (b) day of week; (c) time period; (d) number of vehicles involved; (e) land use; (f) manner of collision; (g) speed limit; (h) snow or ice surface condition; (i) school bus; (j) bus type and seating capacity; (k) driver's age; (l) driver's gender; (m) risky behaviors; and (n) restraint system. Results also show that some risk factors only have impact on the "young and elder drivers with history of traffic violations", they are: (a) section type; (b) number of lanes per direction; (c) roadway profile; (d) wet road surface; and (e) cyclist-bus accident. Notably, history of traffic violations has different impact on different types of bus drivers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Epidemiology of occupational injuries by nationality in Qatar: Evidence for focused occupational safety programmes.

PubMed

Al-Thani, Hassan; El-Menyar, Ayman; Consunji, Rafael; Mekkodathil, Ahammed; Peralta, Ruben; Allen, Katharine A; Hyder, Adnan A

2015-09-01

Occupational injuries are the second leading cause of trauma admission in Qatar. Given the wide diversity of the country's migrant worker populations at risk, this study aimed to analyse and describe the epidemiology of these injuries based on the workers nationality residing in Qatar. A retrospective analysis of trauma registry data on occupational-related injuries was conducted. The analysis included all patients [aged ≥18 years] admitted to the Level I Hamad Trauma Center, from January 1, 2010 to December 31, 2013. Out of 6555 trauma admissions, 2015 (30.7%) patients had occupational injury. The admitted Case Fatality Rate (CFR) was 4.3 per 100 occupational injury related trauma admissions. Overall non-fatal occupational injury rate was 37.34 per 100,000 workers, whereas fatal injury rate was 1.58 per 100,000 workers. Most of the workers experiencing occupational injuries were from Nepal (28%), India (20%) and Bangladesh (9%). Fatal occupational injuries were predominately among Indians (20%), Nepalese (19%), and Filipinos/Bangladeshis (both 8%). Filipinos had the highest admitted CFR at 8.2 deaths per 100 trauma admissions with the next highest being Indians and Indonesians (4.2 per 100 trauma admissions). During the study period, the incidence of severe occupational injuries decreased despite a simultaneous increase in the worker population within Qatar. Almost one in four occupational injuries was a major trauma (ISS≥16). Nepalese and Indian workers represented 29% and 18% of all major trauma cases. Non-fatal occupational injuries appear to follow a pattern distinct from fatal ones. High-risk worker populations as defined by those with high admitted CFRs, experiencing the most severe or fatal injuries, must be the focus of targeted risk factor analysis and occupational safety interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Update in Cardiovascular Safety of Glucagon Like Peptide-1 Receptor Agonists In Patients With Type 2 Diabetes. A Mixed Treatment Comparison Meta-Analysis of Randomised Controlled Trials.

PubMed

Al Yami, Majed S; Alfayez, Osamah M; Alsheikh, Razan

2018-03-29

The aim of this mixed treatment comparison (MTC) meta-analysis was to determine glucagon like peptide-1 (GLP-1) receptor agonists' effects on cardiovascular (CV) outcomes in patients with type 2 diabetes (T2DM). A comprehensive, systematic review was conducted using EMBASE and Medline databases. All included trials were large CV outcome trials of GLP-1 agonists versus placebo in T2DM. The primary outcomes of this MTC meta-analysis were death from CV causes, non-fatal MI, and non-fatal stroke. Hospitalisation for heart failure (HF) was evaluated as a secondary endpoint. A total of four trials, including 33,457 patients, met eligibility criteria and were retained for the meta-analysis. Our pairwise meta-analysis results showed a 13% reduction in death from cardiovascular causes in patients who received GLP-1 agonists versus placebo (RR 0.87, 95% CI: 0.78-0.96). However, no statistically significant reduction was observed with GLP-1 agonists in terms of reducing non-fatal MI (RR 0.95, 95% CI: 0.86-1.04), non-fatal stroke events (RR 0.89, 95% CI: 0.76-1.03), and rates of HF hospitalisation (RR 0.94, 95% CI: 0.84-1.04). The network meta-analysis (NMA) showed no significant differences among all the interventions. Glucagon like peptide-1 therapy was associated with a significant reduction in cardiovascular (CV) death. However, GLP-1 agonists seem to have a safety profile comparable to placebo in terms of reducing non-fatal myocardial infarction (MI), non-fatal stroke events, and rates of HF hospitalisation. Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Physician flight accidents.

DOT National Transportation Integrated Search

1966-09-01

An analysis of physician flight accidents during the period 1964-1965 is presented. More than thirty physicians sustained fatal injuries while piloting light aircraft: a fatality record four times the ratio of physician pilots in the general aviation...

Nonoccupant Fatalities Associated with Backing Crashes

DOT National Transportation Integrated Search

1997-02-01

National Highway Traffic Safety Administration's National Center for Statistics : and Analysis (NCSA) recently completed a study of data from the National Center : Health Statistics (NCHS) to obtain an estimate of the number of nonoccupant : fataliti...

Gender and geographical inequalities in fatal drug overdose in Iran: A province-level study in 2006 and 2011.

PubMed

Rostami, Mehran; Karamouzian, Mohammad; Khosravi, Ardeshir; Rezaeian, Shahab

2018-06-01

We aimed to compare the fatal drug overdose rates in Iran in 2006 and 2011. This analysis was performed based on data on fatal drug overdose cases from the Iranian death registration system. The crude and adjusted rates per 100,000 populations for geographical regions stratified by gender and age groups were calculated using the 2006 and 2011 census of Iranian population. Annual percentage change was calculated to examine annual changes of fatal drug overdose rates across different regions. The overall age-adjusted rate of fatal drug overdose decreased from 3.62 in 2006 to 2.77 in 2011. A substantial difference in the distribution of fatal drug overdoses was found across geographical regions by gender and age groups. Rates of fatal drug overdose were higher among Iranian men and in both younger and older age groups which call for scaling up harm reduction and increasing access to gender- and age-specific substance use treatment services. Copyright © 2018 Elsevier Ltd. All rights reserved.

Macroeconomic fluctuations and motorcycle fatalities in the U.S.

PubMed

French, Michael T; Gumus, Gulcin

2014-03-01

The effects of business cycles on health outcomes in general, and on traffic fatalities in particular, have received much attention recently. In this paper, we focus on motorcycle safety and examine the impact of changing levels of economic activity on fatal crashes by motorcyclists in the United States. We analyze state-level longitudinal data with 1,104 state/year observations from the 1988-2010 Fatality Analysis Reporting System (FARS). Using the extensive motorcycle crash characteristics available in FARS, we examine not only total fatality rates but also rates decomposed by crash type, day, time, and the level of the motorcycle operator's blood alcohol content. Our results are consistent with much of the existing literature showing that traffic fatality rates are pro-cyclical. The estimates suggest that a 10% increase in real income per capita is associated with a 10.4% rise in the total motorcycle fatality rate. Along with potential mechanisms, policymakers and public health officials should consider the effects of business cycles on motorcycle safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

A statistical analysis of the global historical volcanic fatalities record

USGS Publications Warehouse

Auker, Melanie Rose; Sparks, Robert Stephen John; Siebert, Lee; Crosweller, H. S.; Ewert, John W.

2013-01-01

A new database of volcanic fatalities is presented and analysed, covering the period 1600 to 2010 AD. Data are from four sources: the Smithsonian Institution, Witham (2005), CRED EM-DAT and Munich RE. The data were combined and formatted, with a weighted average fatality figure used where more than one source reports an event; the former two databases were weighted twice as strongly as the latter two. More fatal incidents are contained within our database than similar previous works; approximately 46% of the fatal incidents are listed in only one of the four sources, and fewer than 10% are in all four. 278,880 fatalities are recorded in the database, resultant from 533 fatal incidents. The fatality count is dominated by a handful of disasters, though the majority of fatal incidents have caused fewer than ten fatalities. Number and empirical probability of fatalities are broadly correlated with VEI, but are more strongly influenced by population density around volcanoes and the occurrence and extent of lahars (mudflows) and pyroclastic density currents, which have caused 50% of fatalities. Indonesia, the Philippines, and the West Indies dominate the spatial distribution of fatalities, and there is some negative correlation between regional development and number of fatalities. With the largest disasters removed, over 90% of fatalities occurred between 5 km and 30 km from volcanoes, though the most devastating eruptions impacted far beyond these distances. A new measure, the Volcano Fatality Index, is defined to explore temporal changes in societal vulnerability to volcanic hazards. The measure incorporates population growth and recording improvements with the fatality data, and shows prima facie evidence that vulnerability to volcanic hazards has fallen during the last two centuries. Results and interpretations are limited in scope by the underlying fatalities data, which are affected by under-recording, uncertainty, and bias. Attempts have been made to estimate the extent of these issues, and to remove their effects where possible.The data analysed here are provided as supplementary material. An updated version of the Smithsonian fatality database fully integrated with this database will be publicly available in the near future and subsequently incorporate new data.

Factors Associated with Delayed Ejection in Mishaps Between 1993 and 2013.

PubMed

Miles, John E

2015-09-01

The purpose of this investigation was to identify factors associated with Air Force aviators delaying ejection during in-flight emergencies. The investigator reviewed all reports within the Air Force Safety Automated System describing mishaps that resulted in the destruction of Air Force ejection-seat equipped aircraft between 1993 and 2013. Crewmembers were classified as either timely or delayed ejectors based on altitude at onset of emergency, altitude at ejection, and a determination regarding whether or not the aircraft was controlled during the mishap sequence. Univariate analysis and multivariate logistic regression were used to explore the association between delayed ejection and multiple potential risk factors. In total, 366 crewmembers were involved in in-flight emergencies in ejection-seat-equipped aircraft that resulted in the loss of the aircraft; 201 (54.9%) of these crewmembers delayed ejection until their aircraft had descended below recommended minimum ejection altitudes. Multivariate analysis indicated that independent risk factors for delayed ejection included increased crewmember flight hours and a mechanical or human-factors related cause of the emergency versus bird strike or midair collision. This investigation provided quantitative assessments of factors associated with aviators delaying ejection during in-flight emergencies. Increased odds of delay among crewmembers with greater than 1500 total flight hours suggests that complacency and overconfidence may adversely influence the ejection decision to at least as great a degree as inexperience. Increased odds of delay during mechanical and human factors mishaps confirms previously reported hypotheses and reaffirms the importance of targeting these areas to reduce aviator injuries and fatalities.

Elevated plasma levels of PAI-1 predict cardiovascular events and cardiovascular mortality in prevalent peritoneal dialysis patients.

PubMed

Arikan, Hakki; Koc, Mehmet; Tuglular, Serhan; Ozener, Cetin; Akoglu, Emel

2009-01-01

Elevated plasminogen activator inhibitor-1 (PAI-1) levels are associated with increased cardiovascular (CV) risk in the general population. It has been shown that peritoneal dialysis (PD) patients have increased plasma levels of PAI-1. The aim of this study was to investigate whether PAI-1 independently predicted CV outcome in PD patients. Seventy-two PD patients (53% females, mean age 49.9 +/- 16.1 years) were studied. Twelve patients who underwent kidney transplantation and 14 patients who transferred to hemodialysis during follow-up were excluded from the analysis. The remaining 46 patients (54% female, mean age 54 +/- 16 years, dialytic age 42 +/- 30 months) were followed a mean time of 45.4 +/- 19.4 months (range 8-71 months). Baseline PAI-1, clinical, and laboratory parameters were assessed in all patients. Survival analyses were made with Kaplan-Meier and Cox regression analysis, with all-cause mortality and CV mortality and CV events (CVEs) as clinical end points. During the follow-up, 29 patients died (17 from CV causes), and 28 fatal and non-fatal CVEs were recorded. The patients were divided according to plasma PAI-1 levels (i.e., 41 ng/mL). The significant independent predictors of all-cause of mortality were age (60 years; p = 0.018), CRP (5 mg/L; p = 0.015), and serum albumin (<3.5 g/L; p = 0.011). Multivariable Cox regression analysis showed that plasma PAI-1 41 ng/mL was independently predictive of higher CV mortality (p = 0.021) and CVEs (p = 0.001). The only other independent predictor of CV mortality was only CRP (5 mg/L; p = 0.008). Plasma levels of PAI-1 41 ng/mL is a significant predictor of CV mortality and CVEs in PD patients.

Community acquired bacterial meningitis in Cuba: a follow up of a decade

PubMed Central

2010-01-01

Background Community acquired Bacterial Meningitis (BM) remains a serious threat to global health. Cuban surveillance system for BM allowed to characterize the main epidemiological features of this group of diseases, as well as to assess the association of some variables with mortality. Results of the BM surveillance in Cuba are presented in this paper. Methods A follow up of BM cases reported to the Institute "Pedro Kourí" by the National Bacterial Meningitis Surveillance System from 1998 to 2007 was completed. Incidence and case-fatality rate (CFR) were calculated. Univariate analysis and logistic regression were used to elucidate associated factors to mortality comparing death versus survival. Relative Risk (RR) or odds ratio and its 95% confidence interval (CI 95%) were estimated, using either a Chi-squared Test or Fisher's Exact Test as appropriate. A Holt-Winters model was used to assess seasonality. Results 4 798 cases of BM (4.3 per 100 000 population) were reported, with a decreasing trend of the incidence. Highest incidence was observed in infants and elderly. Overall CFR reached 24.1% affecting mostly older adults. S. pneumoniae (23.6%), N. meningitidis(8.2%) and H. influenzaetype b (6.0%) were the main causative agents. Males predominate in the incidence. Highest incidence and CFR were mainly clustered in the centre of the island. The univariate analysis did not show association between delayed medical consultation (RR = 1.20; CI = 1.07-1.35) or delayed hospitalization (RR = 0.98; CI = 0.87-1.11) and the fatal outcome. Logistic regression model showed association of categories housewife, pensioned, imprisoned, unemployed, S. peumoniae and other bacteria with mortality. Seasonality during September, January and March was observed. Conclusions The results of the National Program for Control and Prevention of the Neurological Infectious Syndrome evidenced a reduction of the BM incidence, but not the CFR. Multivariate analysis identified an association of mortality with some societal groups as well as with S. peumoniae. PMID:20500858

Lateral automobile impacts and the risk of traumatic brain injury.

PubMed

Bazarian, Jeffrey J; Fisher, Susan Gross; Flesher, William; Lillis, Robert; Knox, Kerry L; Pearson, Thomas A

2004-08-01

We determine the relative risk and severity of traumatic brain injury among occupants of lateral impacts compared with occupants of nonlateral impacts. This was a secondary analysis of the National Highway Traffic Safety Administration's National Automotive Sampling System, Crashworthiness Data Systems for 2000. Analysis was restricted to occupants of vehicles in which at least 1 person experienced an injury with Abbreviated Injury Scale score greater than 2. Traumatic brain injury was defined as an injury to the head or skull with an Abbreviated Injury Scale score greater than 2. Outcomes were analyzed using the chi2 test and multivariate logistic regression, with adjustment of variance to account for weighted probability sampling. Of the 1,115 occupants available for analysis, impact direction was lateral for 230 (18.42%) occupants and nonlateral for 885 (81.58%) occupants. One hundred eighty-seven (16.07%) occupants experienced a traumatic brain injury, 14.63% after lateral and 16.39% after nonlateral impact. The unadjusted relative risk of traumatic brain injury after lateral impact was 0.89 (95% confidence interval [CI] 0.51 to 1.56). After adjusting for several important crash-related variables, the relative risk of traumatic brain injury was 2.60 (95% CI 1.1 to 6.0). Traumatic brain injuries were more severe after lateral impact according to Abbreviated Injury Scale and Glasgow Coma Scale scores. The proportion of fatal or critical crash-related traumatic brain injuries attributable to lateral impact was 23.5%. Lateral impact is an important independent risk factor for the development of traumatic brain injury after a serious motor vehicle crash. Traumatic brain injuries incurred after lateral impact are more severe than those resulting from nonlateral impact. Vehicle modifications that increase head protection could reduce crash-related severe traumatic brain injuries by up to 61% and prevent up to 2,230 fatal or critical traumatic brain injuries each year in the United States.

Community acquired bacterial meningitis in Cuba: a follow up of a decade.

PubMed

Pérez, Antonio E; Dickinson, Félix O; Rodríguez, Misladys

2010-05-25

Community acquired Bacterial Meningitis (BM) remains a serious threat to global health. Cuban surveillance system for BM allowed to characterize the main epidemiological features of this group of diseases, as well as to assess the association of some variables with mortality. Results of the BM surveillance in Cuba are presented in this paper. A follow up of BM cases reported to the Institute "Pedro Kourí" by the National Bacterial Meningitis Surveillance System from 1998 to 2007 was completed. Incidence and case-fatality rate (CFR) were calculated. Univariate analysis and logistic regression were used to elucidate associated factors to mortality comparing death versus survival. Relative Risk (RR) or odds ratio and its 95% confidence interval (CI 95%) were estimated, using either a Chi-squared Test or Fisher's Exact Test as appropriate. A Holt-Winters model was used to assess seasonality. 4798 cases of BM (4.3 per 100,000 population) were reported, with a decreasing trend of the incidence. Highest incidence was observed in infants and elderly. Overall CFR reached 24.1% affecting mostly older adults. S. pneumoniae (23.6%), N. meningitidis (8.2%) and H. influenzae type b (6.0%) were the main causative agents. Males predominate in the incidence. Highest incidence and CFR were mainly clustered in the centre of the island. The univariate analysis did not show association between delayed medical consultation (RR = 1.20; CI = 1.07-1.35) or delayed hospitalization (RR = 0.98; CI = 0.87-1.11) and the fatal outcome. Logistic regression model showed association of categories housewife, pensioned, imprisoned, unemployed, S. pneumoniae and other bacteria with mortality. Seasonality during September, January and March was observed. The results of the National Program for Control and Prevention of the Neurological Infectious Syndrome evidenced a reduction of the BM incidence, but not the CFR. Multivariate analysis identified an association of mortality with some societal groups as well as with S. pneumoniae.

Injury patterns of soldiers in the second Lebanon war.

PubMed

Schwartz, Dagan; Glassberg, Elon; Nadler, Roy; Hirschhorn, Gil; Marom, Ophir Cohen; Aharonson-Daniel, Limor

2014-01-01

In the second Lebanon war in 2006, the Israeli Defense Forces fought against well-prepared and well-equipped paramilitary forces. The conflict took place near the Israeli border and major Israeli medical centers. Good data records were maintained throughout the campaign, allowing accurate analysis of injury characteristics. This study is an in-depth analysis of injury mechanisms, severity, and anatomic locations. Data regarding all injured soldiers were collected from all care points up to the definitive care hospitals and were cross-referenced. In addition, trauma branch physicians and nurses interviewed medical teams to validate data accuracy. Injuries were analyzed using Injury Severity Score (ISS) (when precise anatomic data were available) and multiple injury patterns scoring for all. A total of 833 soldiers sustained combat-related injury during the study period, including 119 fatalities (14.3%). Although most soldiers (361) sustained injury only to one Abbreviated Injury Scale (AIS) region, the average number of regions per soldier was 2.0 but was 1.5 for survivors versus 4.2 for fatalities. Current war injury classifications have limitations that hinder valid comparisons between campaigns and settings. In addition, limitation on full autopsy in war fatalities further hinders data use. To partly compensate for those limitations, we have looked at the correlation between fatality rates and number of involved anatomic regions and found it to be strong. We have also found high fatality rates in some "combined" injuries such as head and chest injuries (71%) or in the abdomen and an extremity (75%). The use of multiinjury patterns analysis may help understand fatality rates and improve the utility of war injury analysis. Epidemiologic study, level III.

Protecting the AG pilot.

DOT National Transportation Integrated Search

1966-09-01

Summarized data resulting from a detailed review of fatal and non-fatal aerial applicator accidents are presented with an analysis of the factors underlying the accidents. The role of toxic substance is evaluated. Preventive and newer therapeutic app...

Brief communication: Loss of life due to Hurricane Harvey

NASA Astrophysics Data System (ADS)

Jonkman, Sebastiaan N.; Godfroy, Maartje; Sebastian, Antonia; Kolen, Bas

2018-04-01

An analysis was made of the loss of life caused by Hurricane Harvey. Information was collected for 70 fatalities that occurred due to the event and were recovered within the first 2 weeks after landfall. Most fatalities occurred due to drowning (81 %), particularly in and around vehicles. Males (70 %) and people over 50 years old (56 %) were overrepresented in the dataset. More than half of the fatalities occurred in the greater Houston area (n = 37), where heavy rainfall and dam releases caused unprecedented urban flooding. The majority of fatalities were recovered outside the designated 100- and 500-year flood hazard areas.

The association between high-risk behavior and central nervous system injuries: analysis of traffic-related fatalities in a large coroner's series.

PubMed

Pakula, Andrea; Shaker, Adel; Martin, Maureen; Skinner, Ruby

2013-10-01

High-risk behaviors leading to traffic fatalities are often a result of severe traumatic brain and spine injuries. The objective of the study was to analyze patterns of behavior in drivers and motorcyclists that are associated with central nervous system (CNS)-related prehospital deaths that may serve as a basis for future prevention initiatives. Our study group comprised 514 fatalities with severe CNS injuries documented at autopsy. The majority (n = 491) was the result of motor vehicle collisions (MVCs). In this group, male drivers predominated and the majority, 80 per cent, wore seatbelts. Toxicology analysis revealed 53 per cent of drivers with a mean concentration of ethanol above the legal limit. Texting while driving comprised 45 per cent of the study group. Less than 5 per cent of the fatalities were the result of road or weather conditions. In the motorcycle group (n = 23), 100 per cent of the victims were unhelmeted. We report a large autopsy series of CNS-related deaths with analysis of behavioral factors associated with the fatalities. Substance abuse and distracted driving are dominant patterns of high-risk behavior in MVCs and not wearing a motorcycle helmet is deadly for victims of motorcycle crashes.

Fatal Passenger Vehicle Crashes with At Least 1 Driver Younger than 15 Years: A Fatality Analysis Reporting System Study

ERIC Educational Resources Information Center

Frisch, Larry; Plessinger, Alexander

2007-01-01

Context: A small number of fatalities continue to occur due to motor vehicle crashes on highways in which at least 1 passenger vehicle (automobile, van, or small truck) is driven by a child younger than 15 years. Purpose: The purpose of this study was to extend previous work suggesting that such crashes occur frequently in the Southern states and…

Are airbags a dangerous safety measure? A meta-analysis of the effects of frontal airbags on driver fatalities.

PubMed

Høye, Alena

2010-11-01

A meta-analysis has been conducted of the effectiveness of frontal airbags in reducing driver fatalities, and some potential moderator variables for airbag effectiveness have been investigated. The results confirm the assumption that airbags reduce accident fatalities among belted drivers, but the results are too heterogeneous for drawing conclusions about the size of the overall effect. No support has been found for the hypothesis that airbags increase overall fatality risk, as has been found in the study by Meyer and Finney (Meyer, M., Finney, T., 2005. Who wants Airbags? Chance, 18 (19) 3-16). The results do not seem to be affected by publication bias, and no indications of confounding effects of vehicle characteristics or impact velocity have been found. In frontal collisions belted driver fatalities were found to be reduced by about 22% when all types of airbags are regarded together. The revision of the test criteria for airbags in the USA in 1997 has improved airbag effectiveness. For unbelted drivers airbags are neither effective nor counterproductive, but may increase fatality risk in single vehicle accidents. The results show that there is a lack of knowledge about the effects of airbags in accidents that are not frontal collisions. 2010 Elsevier Ltd. All rights reserved.

Age and pedestrian injury severity in motor-vehicle crashes: a heteroskedastic logit analysis.

PubMed

Kim, Joon-Ki; Ulfarsson, Gudmundur F; Shankar, Venkataraman N; Kim, Sungyop

2008-09-01

This research explores the injury severity of pedestrians in motor-vehicle crashes. It is hypothesized that the variance of unobserved pedestrian characteristics increases with age. In response, a heteroskedastic generalized extreme value model is used. The analysis links explanatory factors with four injury outcomes: fatal, incapacitating, non-incapacitating, and possible or no injury. Police-reported crash data between 1997 and 2000 from North Carolina, USA, are used. The results show that pedestrian age induces heteroskedasticity which affects the probability of fatal injury. The effect grows more pronounced with increasing age past 65. The heteroskedastic model provides a better fit than the multinomial logit model. Notable factors increasing the probability of fatal pedestrian injury: increasing pedestrian age, male driver, intoxicated driver (2.7 times greater probability of fatality), traffic sign, commercial area, darkness with or without streetlights (2-4 times greater probability of fatality), sport-utility vehicle, truck, freeway, two-way divided roadway, speeding-involved, off roadway, motorist turning or backing, both driver and pedestrian at fault, and pedestrian only at fault. Conversely, the probability of a fatal injury decreased: with increasing driver age, during the PM traffic peak, with traffic signal control, in inclement weather, on a curved roadway, at a crosswalk, and when walking along roadway.

Fatality rate of pedestrians and fatal crash involvement rate of drivers in pedestrian crashes: a case study of Iran.

PubMed

Kashani, Ali Tavakoli; Besharati, Mohammad Mehdi

2017-06-01

The aim of this study was to uncover patterns of pedestrian crashes. In the first stage, 34,178 pedestrian-involved crashes occurred in Iran during a four-year period were grouped into homogeneous clusters using a clustering analysis. Next, some in-cluster and inter-cluster crash patterns were analysed. The clustering analysis yielded six pedestrian crash groups. Car/van/pickup crashes on rural roads as well as heavy vehicle crashes were found to be less frequent but more likely to be fatal compared to other crash clusters. In addition, after controlling for crash frequency in each cluster, it was found that the fatality rate of each pedestrian age group as well as the fatal crash involvement rate of each driver age group varies across the six clusters. Results of present study has some policy implications including, promoting pedestrian safety training sessions for heavy vehicle drivers, imposing limitations over elderly heavy vehicle drivers, reinforcing penalties toward under 19 drivers and motorcyclists. In addition, road safety campaigns in rural areas may be promoted to inform people about the higher fatality rate of pedestrians on rural roads. The crash patterns uncovered in this study might also be useful for prioritizing future pedestrian safety research areas.

Rheumatoid Arthritis, Anti-CCP Positivity, and Cardiovascular Disease Risk in the Women’s Health Initiative

PubMed Central

Mackey, Rachel H.; Kuller, Lewis H.; Deane, Kevin D.; Walitt, Brian T.; Chang, Yuefang F.; Holers, V. Michael; Robinson, William H.; Tracy, Russell P.; Hlatky, Mark A.; Eaton, Charles; Liu, Simin; Freiberg, Matthew S.; Talabi, Mehret Birru; Schelbert, Erik B.; Moreland, Larry W.

2015-01-01

Objective This report evaluates incidence of cardiovascular disease (CVD) morbidity and mortality over 10 years among the >160,000 postmenopausal women in the Women’s Health Initiative (WHI) in relation to self-reported RA, disease modifying anti-rheumatic drugs (DMARD) use, anti-CCP+, RF+, CVD risk factors, joint pain, and inflammation (white blood cell (WBC) count and IL-6.) Methods Anti-CCP and RF were measured on a sample (n=9,988) of WHI participants with self-reported RA. RA was classified as self-reported RA plus anti-CCP+ positivity and/or use of DMARDs. Self-reported RA that was both anti-CCP− and DMARD− was classified as “unverified RA.” Results Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD and total mortality were higher for women with RA vs. no RA, with multivariable-adjusted HR(95%CI) of 1.46(1.17, 1.83) for CHD, and 2.55(1.86, 3.51) for fatal CVD. Within RA, anti-CCP+ and RF+ were not significantly associated with higher risk of any outcomes, despite slightly higher risk of fatal CVD and death for anti-CCP+ vs. anti-CCP− RA. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even for women with no RA. CVD incidence was increased for RA vs. no RA at almost all risk factor levels, except low levels of joint pain or inflammation. Within RA, inflammation was more strongly associated with fatal CVD and total mortality than CHD or CVD. Conclusion Among postmenopausal women, RA was associated with 1.5-2.5 higher CVD risk, strongly associated with CV risk factors, joint pain severity, and inflammation, but similar for anti-CCP+ and RF+. Clinical Trial Registration clinicaltrials.gov identifier: NCT00000611 PMID:25988241

Fatal crashes involving large numbers of vehicles and weather.

PubMed

Wang, Ying; Liang, Liming; Evans, Leonard

2017-12-01

Adverse weather has been recognized as a significant threat to traffic safety. However, relationships between fatal crashes involving large numbers of vehicles and weather are rarely studied according to the low occurrence of crashes involving large numbers of vehicles. By using all 1,513,792 fatal crashes in the Fatality Analysis Reporting System (FARS) data, 1975-2014, we successfully described these relationships. We found: (a) fatal crashes involving more than 35 vehicles are most likely to occur in snow or fog; (b) fatal crashes in rain are three times as likely to involve 10 or more vehicles as fatal crashes in good weather; (c) fatal crashes in snow [or fog] are 24 times [35 times] as likely to involve 10 or more vehicles as fatal crashes in good weather. If the example had used 20 vehicles, the risk ratios would be 6 for rain, 158 for snow, and 171 for fog. To reduce the risk of involvement in fatal crashes with large numbers of vehicles, drivers should slow down more than they currently do under adverse weather conditions. Driver deaths per fatal crash increase slowly with increasing numbers of involved vehicles when it is snowing or raining, but more steeply when clear or foggy. We conclude that in order to reduce risk of involvement in crashes involving large numbers of vehicles, drivers must reduce speed in fog, and in snow or rain, reduce speed by even more than they already do. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Association of Graduated Driver Licensing With Driver, Non-Driver, and Total Fatalities Among Adolescents.

PubMed

Zhu, Motao; Zhao, Songzhu; Long, D Leann; Curry, Allison E

2016-07-01

Graduated driver licensing systems typically require an extended learner permit phase, and create night-time driving or passenger restrictions for adolescent drivers. Restricted driving might increase the use of alternative transportation to replace driving and consequently increase crashes and injuries for passengers, bus riders, pedestrians, and bicyclists. This study examined whether graduated driver licensing increases non-driver fatalities among adolescents, and whether it reduces total traffic fatalities combining drivers and non-drivers. Longitudinal analyses were conducted using data from the 1995-2012 U.S. Fatality Analysis Reporting System. Adjusted rate ratios were estimated for being fatally injured in a crash according to: (1) presence/absence of a graduated driver licensing system; and (2) four levels of graduated driver licensing systems (absent, weak, medium, strong). Analyses were conducted in 2015. Among adolescents aged 16 years, graduated driver licensing was not associated with increased passenger fatalities (adjusted rate ratio, 0.96; 95% CI=0.90, 1.03) or pedestrian and bicyclist fatalities (adjusted rate ratio, 1.09; 95% CI=0.85, 1.39), but was associated with an 11% reduction in total traffic fatalities. Among those aged 17 years, graduated driver licensing was not associated with increased fatalities as passengers, pedestrians, or bicyclists, and was not associated with reduced total traffic fatalities. In general, graduated driver licensing systems were not associated with increased fatalities as passengers, pedestrians, bicyclists, and bus riders. Graduated driver licensing systems were associated with reduced total fatalities of adolescents aged 16 years. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The turning point in the number of traffic fatalities: two hypotheses about changes in underlying trends.

PubMed

Brüde, Ulf; Elvik, Rune

2015-01-01

The number of traffic fatalities reached a peak in many highly motorised countries around 1970. Some previous studies have suggested that the turning point in the number of traffic fatalities was inevitable and did not reflect a change in the underlying trends influencing the number of traffic fatalities. Other studies suggest that trends in traffic growth and fatality rate changed from before to after the turning point. This paper proposes two hypotheses about the turning point in the number of traffic fatalities. One hypothesis is that the long-term trends in traffic growth and fatality rate were the same before and after the turning point. The other hypothesis is that the long-term trends in traffic growth and fatality rate were different before and after the turning point was reached, in particular that the annual percentage decline in fatality rate became greater after the turning point than before. Such a change would suggest that road safety policy became more effective. Analysis of data for six countries (Denmark, Great Britain, Netherlands, Norway, Sweden, United States) lends stronger support to the latter hypothesis than to the former. The lesson for policy makers, in particular in countries where the number of traffic fatalities is still growing, is that they should not expect a turning point to be reached without policy interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

The relationship of alcohol safety laws to drinking drivers in fatal crashes.

PubMed

Voas, R B; Tippetts, A S; Fell, J

2000-07-01

This paper presents an analysis of the relationships between the passage of key alcohol safety laws and the number of drinking drivers in fatal crashes. The study evaluated three major alcohol safety laws--administrative license revocation laws, 0.10 illegal per se, and 0.08 illegal per se laws--on the proportion of drinking drivers in fatal crashes. Drivers aged 21 and older in fatal crashes at two BAC levels--0.01-0.09 and 0.10 or greater--were considered separately. Drivers under age 21 were not included because they are affected by the Minimum Legal Drinking Age (MLDA) law. This study used data on drinking drivers in fatal crashes from the Fatality Analysis Reporting System (FARS) covering 16 years (1982-1997) for all 50 states and the District of Columbia. Also included in the study were such variables as per capita alcohol consumption and annual vehicle miles traveled (VMT), which could affect the number of alcohol-related crashes. The results indicate that each of the three laws had a significant relationship to the downward trend in alcohol-related fatal crashes in the United States over that period. This paper points out that this long-term trend is not the product of a single law. Instead, it is the result of the growing impact of several laws over time plus the affect of some factors not included in the model tested (such as the increasing use of sobriety checkpoints and the media's attention to the drinking-and-driving problem).

Road traffic fatalities in selected governorates of Iraq from 2010 to 2013: prospective surveillance.

PubMed

Leidman, Eva; Maliniak, Maret; Sultan, Abdul-Salam Saleh; Hassan, Ahmed; Hussain, Syed Jaffar; Bilukha, Oleg O

2016-01-01

The insurgency tactics that characterize modern warfare, such as suicide car bombs and roadside bombs, have the potential to significantly impact road traffic injuries in conflict affected-countries. As road traffic incidents are one of the top ten causes of death in Iraq, changes in incidence have important implications for the health system. We aimed to describe patterns of road traffic fatalities for all demographic groups and types of road users in Iraq during a period characterized by a resurgence in insurgency activity. Iraqi Ministry of Health routine prospective injury surveillance collects information on all fatal injuries in eight governorates of Iraq: Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. From all injury fatalities documented at the coroner office, we analyzed only those attributed to road traffic that occurred between 1 January 2010 and 31 December 2013. Coroners ascertain information from physical examinations, police reports and family members. Analysis included 7,976 road traffic fatalities. Overall, 6,238 (78.2 %) fatalities were male and 2,272 (28.5 %) were children under 18 years of age. The highest numbers of road traffic fatalities were among males 15 to 34 years of age and children of both sexes under 5 years of age. 49.2 % of fatalities occurred among pedestrians. Among children and females, the majority of road traffic fatalities were pedestrians, 69.0 % and 56.6 %, respectively. Fatalities among motorcyclists (3.7 %) and bicyclists (0.4 %) were least common. Rates of road traffic fatalities ranged from 8.6 to 10.7 per 100,000 population. The injury surveillance system provides the first data from a conflict-affected country on road traffic fatalities disaggregated by type of road user. The highest numbers of fatalities were among children and young men. Nearly half of fatalities were pedestrians, a proportion nearly double that of any neighboring country. As insurgency activity increased in 2013, the number of road traffic fatalities declined.

CABLE MEDIAN BARRIER FAILURE ANALYSIS AND REMEDIATION, PHASE II

DOT National Transportation Integrated Search

2013-06-20

On divided roadways, cross-median fatalities are disproportionately overrepresented in fatal and serious injury crashes. Many state DOTs sought to mitigate cross-median crash risk by installing cable median barriers. Despite increased crash rates, st...

Key Impact Factors on Dam Break Fatalities

NASA Astrophysics Data System (ADS)

Huang, D.; Yu, Z.; Song, Y.; Han, D.; Li, Y.

2016-12-01

Dam failures can lead to catastrophes on human society. However, there is a lack of research about dam break fatalities, especially on the key factors that affect fatalities. Based on the analysis of historical dam break cases, most studies have used the regression analysis to explore the correlation between those factors and fatalities, but without implementing optimization to find the dominating factors. In order to understand and reduce the risk of fatalities, this study has proposed a new method to select the impact factors on the fatality. It employs an improved ANN (Artificial Neural Network) combined with LOOCV (Leave-one-out cross-validation) and SFS (Stepwise Forward Selection) approach to explore the nonlinear relationship between impact factors and life losses. It not only considers the factors that have been widely used in the literature but also introduces new factors closely involved with fatalities. Dam break cases occurred in China from 1954 to 2013 are summarized, within which twenty-five cases are selected with a comprehensive coverage of geographic position and temporal variation. Twelve impact factors are taken into account as the inputs, i.e., severity of dam break flood (SF), population at risk (PR), public understanding of dam break (UB), warning time (TW), evacuation condition (EC), weather condition during dam break (WB), dam break mode (MB), water storage (SW), building vulnerability (VB), dam break time (TB), average distance from the affected area to the dam (DD) and preventive measures by government (PG).From those, three key factors of SF, MB and TB are chosen. The proposed method is able to extract the key factors, and the derived fatality model performs well in various types of dam break conditions.

Towards a harmonised approach to reducing quad-related fatal injuries in Australia and New Zealand: a cross-sectional comparative analysis.

PubMed

Lilley, Rebbecca; Lower, Tony; Davie, Gabrielle

2017-10-01

This study compares the patterns of quad-related fatal injuries between Australia and New Zealand (NZ). Fatal injuries from July 2007 to June 2012 involving a quad (quad bike or all-terrain vehicle) were identified from coronial files. Data described the socio-demographic, injury, vehicle and environment factors associated with incidents. Injury patterns were compared between countries. A total of 101 quad-related fatalities were identified: 69 in Australia and 32 in NZ (7.3 and 8.0 annual fatalities per 100,000 vehicles). Of these, 95 closed cases were examined in detail and factors in common included fatalities occurring mainly in males, on farms, involving a rollover and resulting in crush injuries to the head and thorax. Helmet use and alcohol/drug involvement were infrequent. Differences were observed with regard to age, season of fatal incident and the presence of a slope. Fatality patterns are broadly similar. The few differences could be attributed to differing agricultural commodity mix, demographics and topography. This study's findings support harmonised cross-country injury prevention efforts primarily focused on safe design and engineering principles to reduce this injury burden. © 2017 The Authors.

The effect of recent trends in vehicle design on U.S. societal fatality risk per vehicle mile traveled, and their projected future relationship with vehicle mass.

PubMed

Wenzel, Tom

2013-07-01

The National Highway Traffic Safety Administration (NHTSA) recently updated its 2003 and 2010 logistic regression analyses of the effect of a reduction in light-duty vehicle mass on US fatality risk per vehicle mile traveled (VMT). The current NHTSA analysis is the most thorough investigation of this issue to date. LBNL's assessment of the analysis indicates that the estimated effect of mass reduction on risk is smaller than in the previous studies, and statistically non-significant for all but the lightest cars. The effects three recent trends in vehicle designs and technologies have on societal fatality risk per VMT are estimated, and whether these changes might affect the relationship between vehicle mass and fatality risk in the future. Side airbags are found to reduce fatality risk in cars, but not necessarily light trucks or CUVs/minivans, struck in the side by another light-duty vehicle; reducing the number of fatalities in cars struck in the side is predicted to reduce the estimated detrimental effect of footprint reduction, but increase the detrimental effect of mass reduction, in cars on societal fatality risk. Better alignment of light truck bumpers with those of other vehicles appears to result in a statistically significant reduction in risk imposed on car occupants; however, reducing this type of fatality will likely have little impact on the estimated effect of mass or footprint reduction on risk. Finally, shifting light truck drivers into safer, car-based vehicles, such as sedans, CUVs, and minivans, would result in larger reductions in societal fatalities than expected from even substantial reductions in the masses of light trucks. A strategy of shifting drivers from truck-based to car-based vehicles would reduce fuel use and greenhouse gas emissions, while improving societal safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Drug involvement of fatally injured drivers

DOT National Transportation Integrated Search

2010-11-01

While data focusing on the danger of driving under the influence : of alcohol is readily available and often cited, less is : known or discussed about drivers under the influence of : other drugs. The Fatality Analysis Reporting System (FARS), : a ce...

Fatal injuries in offshore oil and gas operations - United States, 2003-2010.

PubMed

2013-04-26

During 2003-2010, the U.S. oil and gas extraction industry (onshore and offshore, combined) had a collective fatality rate seven times higher than for all U.S. workers (27.1 versus 3.8 deaths per 100,000 workers). The 11 lives lost in the 2010 Deepwater Horizon explosion provide a reminder of the hazards involved in offshore drilling. To identify risk factors to offshore oil and gas extraction workers, CDC analyzed data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), a comprehensive database of fatal work injuries, for the period 2003-2010. This report describes the results of that analysis, which found that 128 fatalities in activities related to offshore oil and gas operations occurred during this period. Transportation events were the leading cause (65 [51%]); the majority of these involved aircraft (49 [75%]). Nearly one fourth (31 [24%]) of the fatalities occurred among workers whose occupations were classified as "transportation and material moving." To reduce fatalities in offshore oil and gas operations, employers should ensure that the most stringent applicable transportation safety guidelines are followed.

Deaths due to Intentional Explosions in Selected Governorates of Iraq from 2010 to 2013: Prospective Surveillance.

PubMed

Bilukha, Oleg O; Leidman, Eva Z; Sultan, Abdul-Salam Saleh; Jaffar Hussain, Syed

2015-12-01

The aim of this study was to describe the most recent trends and epidemiologic patterns of fatal injuries resulting from explosions in Iraq, one of the countries most affected by violence from explosive devices. Iraqi Ministry of Health (MoH) routine prospective injury surveillance collects information on all fatal injuries recorded by coroners from physical examinations, police reports, and family members in eight governorates of Iraq: Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. This study analyzed explosive-related fatal injuries that occurred from January 1, 2010 through December 31, 2013. Analysis included 2,803 fatal injuries. The number of fatal injuries declined from 2010 through 2012, followed by an increase in 2013. One-thousand one-hundred and one explosion-related fatalities were documented in 2013, more than twice as many as in 2012 or in 2011. Most fatalities were among men aged 20-39 years. Of all causalities, 194 (6.9%) were among females and 302 (10.8%) were among children aged less than 18 years. The majority of fatalities were caused by improvised explosive devices (IEDs): car bombs (15.3%), suicide bombs (4.0%), and other IEDs (29.6%). The highest number of fatalities occurred in streets and roads. Of all deaths, 95.6% occurred in three governorates: Baghdad, Ninevah, and Al-Anbar. Explosives continue to result in a high number of fatal injuries in Iraq. Following a period of declining violence from explosives, in 2013, fatalities increased. Most explosion-related injuries resulted from IEDs; males aged 20-39 years were at greatest risk.

Cost effectiveness analysis of a smoke alarm giveaway program in Oklahoma City, Oklahoma.

PubMed

Haddix, A C; Mallonee, S; Waxweiler, R; Douglas, M R

2001-12-01

To estimate the cost effectiveness of the Lifesavers Residential Fire and Injury Prevention Program (LRFIPP), a smoke alarm giveaway program. In 1990, the LRFIPP distributed over 10,000 smoke alarms in an area of Oklahoma City at high risk for residential fire injuries. The program also included fire prevention education and battery replacement components. A cost effectiveness analysis was conducted from the societal and health care systems perspectives. The study compared program costs with the total costs of medical treatment and productivity losses averted over a five year period. Fatal and non-fatal residential fire related injuries prevented were estimated from surveillance data. Medical costs were obtained from chart reviews of patients with fire related injuries that occurred during the pre-intervention period. During the five years post-intervention, it is estimated that the LRFIPP prevented 20 fatal and 24 non-fatal injuries. From the societal perspective, the total discounted cost of the program was $531,000. Total discounted net savings exceeded $15 million. From the health care system perspective, the total discounted net savings were almost $1 million and would have a net saving even if program effectiveness was reduced by 64%. The program was effective in reducing fatal and non-fatal residential fire related injuries and was cost saving. Similar programs in other high risk areas would be good investments even if program effectiveness was lower than that achieved by the LRFIPP.

Early prognostic markers for fatal fulminant hepatic failure cases with viral hepatitis: proton nuclear magnetic resonance spectroscopic studies of serum.

PubMed

Bala, Lakshmi; Mehrotra, Mayank; Mohindra, Samir; Saxena, Rajan; Khetrapal, Chunni Lal

2013-02-01

Fulminant hepatic failure is associated with liver metabolic derangements which could have fatal consequences. The aim of the present study is to identify serum markers for early prediction of the outcome. Proton nuclear magnetic resonance spectroscopic studies of serum of fulminant hepatic failure patients due to viral hepatitis with grade II/III of encephalopathy (twenty-four: ten prospective and fourteen retrospective) and twenty-five controls were undertaken. Of the twenty-four patients, fifteen survived with medical management alone while nine had fatal outcome. The results demonstrated significantly elevated indices of amino acids (alanine, lysine, glutamine, histidine, tyrosine, phenylalanine and 1,2-propanediol) in fatal cases compared to survivors and controls. Principal component analysis showed clear separation of fatal and surviving cases. Liver function parameters were significantly deranged in patients but they failed to provide early significant differences between surviving and fatal cases. Compared to model for end-stage liver disease scores, principal component analysis appear to be better as an early prognostic indicator. Biochemical mapping of pathways suggested interruptions in amino acid metabolism and urea cycle. Proton nuclear magnetic resonance studies of serum have the potential of rapidly identifying patients with irreversible fulminant hepatic failure requiring liver transplantation as life saving option. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Rising gasoline prices increase new motorcycle sales and fatalities.

PubMed

Zhu, He; Wilson, Fernando A; Stimpson, Jim P; Hilsenrath, Peter E

2015-12-01

We examined whether sales of new motorcycles was a mechanism to explain the relationship between motorcycle fatalities and gasoline prices. The data came from the Motorcycle Industry Council, Energy Information Administration and Fatality Analysis Reporting System for 1984-2009. Autoregressive integrated moving average (ARIMA) regressions estimated the effect of inflation-adjusted gasoline price on motorcycle sales and logistic regressions estimated odds ratios (ORs) between new and old motorcycle fatalities when gasoline prices increase. New motorcycle sales were positively correlated with gasoline prices (r = 0.78) and new motorcycle fatalities (r = 0.92). ARIMA analysis estimated that a US$1 increase in gasoline prices would result in 295,000 new motorcycle sales and, consequently, 233 new motorcycle fatalities. Compared to crashes on older motorcycle models, those on new motorcycles were more likely to be young riders, occur in the afternoon, in clear weather, with a large engine displacement, and without alcohol involvement. Riders on new motorcycles were more likely to be in fatal crashes relative to older motorcycles (OR 1.14, 95 % confidence interval (CI) 1.02-1.28) when gasoline prices increase. Our findings suggest that, in response to increasing gasoline prices, people tend to purchase new motorcycles, and this is accompanied with significantly increased crash risk. There are several policy mechanisms that can be used to lower the risk of motorcycle crash injuries through the mechanism of gas prices and motorcycle sales such as raising awareness of motorcycling risks, enhancing licensing and testing requirements, limiting motorcycle power-to-weight ratios for inexperienced riders, and developing mandatory training programs for new riders.

Estimating the over-involvement of suspended, revoked, and unlicensed drivers as at-fault drivers in California fatal crashes.

PubMed

Brar, Sukhvir S

2014-09-01

Quasi-induced exposure analysis was used to estimate annual fatal crash involvement rates for validly licensed, suspended or revoked (S/R), and unlicensed drivers in California from 1987 through 2009 using fatal crash data obtained from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and crash culpability determinations from the California Highway Patrol's Statewide Integrated Traffic Records System. Although there was some year-to-year fluctuation in the annual estimates, S/R and unlicensed drivers were over-involved as at-fault drivers in fatal crashes during every year of the 23-year time period relative to validly licensed drivers. The fatal crash involvement ratios combined across all years were 0.86 for validly licensed drivers, 2.23 for S/R drivers, and 2.34 for unlicensed drivers. Hence, compared to validly licensed drivers, the odds of being at-fault for a fatal crash were 160% higher for S/R drivers (involvement ratio=2.60) and 173% higher for unlicensed drivers (involvement ratio=2.73). The excess risks of S/R and unlicensed drivers are somewhat lower than estimates found in a prior study using the same technique, but the results nonetheless provide evidence that S/R and unlicensed drivers are much more hazardous on the road than are validly licensed drivers and emphasize the importance of using strong countermeasures-including vehicle impoundment-to reduce their high crash risk. These findings support interventions to help reduce driving among S/R and unlicensed drivers. Published by Elsevier Ltd.

[Related factors for severe liver fibrosis in chronic hepatitis C patients with remunerated blood donation history in Jurong of Jiangsu province].

PubMed

Yao, Y N; Huang, P; Chen, H B; Zhang, L; Chen, M Z; Yu, R B

2017-01-10

Objective: The incidence of liver fibrosis in patients with chronic hepatitis C is high. Without effective treatment, it would lead to liver cirrhosis. This study is to identify the related factors for the incidence of liver fibrosis in patients with chronic hepatitis C in order to make early intervention treatment and reduce the case fatality rate. Methods: This cross-sectional survey was conducted in adults aged ≥50 years with local residence for more than 5 years in Jurong of Jiangsu province from March to May in 2015, the patients infected with hepatitis C virus through remunerated blood donation were screened and included in the analysis. Descriptive statistical analysis was done to compare the differences in the incidence of liver fibrosis among the patients with different age, sex and education level or co-infected with hepatitis B virus or not. The risk factors for severe liver fibrosis were identified with univariate and multivariate logistic regression analysis. Liver fibrosis was diagnosed by using FIB-4 index method. Results: A total of 719 patients with chronic hepatitis C were surveyed. Severe liver fibrosis developed in 285 of the 719 patients, in whom 21.84 % was males. Multivariate logistic regression analysis showed that the patients with higher education level ( OR =0.65, 95 %CI : 0.47-0.90) and with access of antiviral therapy ( OR =0.33, 95 %CI : 0.22-0.49) had lower risk for severe liver fibrosis, the patients with high fasting blood glucose level ( OR =1.80, 95 % CI : 1.19-2.77) and abnormal white blood cell count ( OR =2.77, 95 % CI : 1.95-3.90) had higher risk for severe liver fibrosis. Conclusions: The incidence of severe liver fibrosis in patients with hepatitis C was affected by many factors. Higher education level and antiviral therapy were the protective factors, but high fasting blood glucose level and abnormal white blood cell count were the risk factors.

Relating traffic fatalities to GDP in Europe on the long term.

PubMed

Antoniou, Constantinos; Yannis, George; Papadimitriou, Eleonora; Lassarre, Sylvain

2016-07-01

Modeling road safety development can provide important insight into policies for the reduction of traffic fatalities. In order to achieve this goal, both the quantifiable impact of specific parameters, as well as the underlying trends that cannot always be measured or observed, need to be considered. One of the key relationships in road safety links fatalities with risk and exposure, where exposure reflects the amount of travel, which in turn translates to how much travelers are exposed to risk. In general two economic variables: GDP and unemployment rate are selected to analyse the statistical relationships with some indicators of road accident fatality risk. The objective of this research is to provide an overview of relevant literature on the topic and outline some recent developments in macro-panel data analysis that have resulted in ongoing research that has the potential to improve our ability to forecast traffic fatality trends, especially under turbulent financial situations. For this analysis, time series of the number of fatalities and GDP in 30 European countries for a period of 38 years (1975-2012) are used. This process relies on estimating long-term models (as captured by long term time-series models, which model each country separately). Based on these developments, utilizing state-of-the-art modelling and analysis techniques such as the Common Correlated Effects Mean Group estimator (Pesaran), the long-term elasticity mean value equals 0.63, and is significantly different from zero for 10 countries only. When we take away the countries, where the number of fatalities is stationary, the average elasticity takes a higher value of nearly 1. This shows the strong sensitivity of the estimate of the average elasticity over a panel of European countries and underlines the necessity to be aware of the underlying nature of the time series, to get a suitable regression model. Copyright © 2016 Elsevier Ltd. All rights reserved.

Lightning related fatalities in livestock: veterinary expertise and the added value of lightning location data.

PubMed

Vanneste, E; Weyens, P; Poelman, D R; Chiers, K; Deprez, P; Pardon, B

2015-01-01

Although lightning strike is an important cause of sudden death in livestock on pasture and among the main reasons why insurance companies consult an expert veterinarian, scientific information on this subject is limited. The aim of the present study was to provide objective information on the circumstantial evidence and pathological findings in lightning related fatalities (LRF), based on a retrospective analysis of 410 declarations, examined by a single expert veterinarian in Flanders, Belgium, from 1998 to 2012. Predictive logistic models for compatibility with LRF were constructed based on anamnestic, environmental and pathological factors. In addition, the added value of lightning location data (LLD) was evaluated. Pathognomonic singe lesions were present in 84/194 (43%) confirmed reports. Factors which remained significantly associated with LRF in the multivariable model were age, presence of a tree or open water in the near surroundings, tympany and presence of feed in the oral cavity at the time of investigation. This basic model had a sensitivity (Se) of 53.8% and a specificity (Sp) of 88.2%. Relying only on LLD to confirm LRF in livestock resulted in a high Se (91.3%), but a low Sp (41.2%), leading to a high probability that a negative case would be wrongly accepted as an LRF. The best results were obtained when combining the model based on the veterinary expert investigation (circumstantial evidence and pathological findings), together with the detection of cloud-to-ground (CG) lightning at the time and location of death (Se 89.1%; Sp 66.7%). Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of Lipoprotein (a) on Long-Term Outcomes in Patients with Coronary Artery Disease Treated with Statin After a First Percutaneous Coronary Intervention

PubMed Central

Suwa, Satoru; Miyauchi, Katsumi; Sonoda, Taketo; Konishi, Hirokazu; Tsuboi, Shuta; Wada, Hideki; Naito, Ryo; Dohi, Tomotaka; Kasai, Takatoshi; Okazaki, Shinya; Isoda, Kikuo; Daida, Hiroyuki

2017-01-01

Aims: Cardiovascular risk persists despite intensive lipid lowering therapy using statins. Serum levels of lipoprotein (a) [Lp(a)] can be a residual cardiovascular risk for adverse events. Aim of the present study was to evaluate the impact of Lp(a) on long-term clinical outcomes in patients treated with statin after percutaneous coronary intervention. Methods: We prospectively enrolled 3507 consecutive CAD patients who underwent a first percutaneous coronary intervention (PCI) between 1997 and 2011 at our institution. We identified 1768 patients (50.4%) who had treated with statin during PCI. Eligible 1336 patients were stratified to two groups according to Lp(a) levels (median Lp (a) 21.5 mg/dL). The primary outcome was major adverse cardiac events (MACE) including cardiac death and non-fatal acute coronary syndrome. Results: MACE occurred 144 (10.8%) including 34 (2.5%) cardiac death and 110 (8.7%) non-fatal ACS during median follow-up period of 1920 days. The cumulative rate of MACE was significantly higher in group with high Lp(a) group (log-rank p = 0.0460). Multivariate Cox regression analysis showed a significant correlation between Lp (a) levels treated as a natural logarithm-transformed continuous variable and increased MACE (adjusted HR for MACE 1.28, 95%CI 1.04–1.58, p = 0.0184) Conclusion: Elevated levels of Lp(a) is significantly associated with long-term adverse clinical outcomes among CAD patients who received statin therapy after PCI. PMID:28321012

Influence of primary and secondary prevention indications on anxiety about the implantable cardioverter-defibrillator.

PubMed

Rahmawati, Anita; Chishaki, Akiko; Ohkusa, Tomoko; Sawatari, Hiroyuki; Tsuchihashi-Makaya, Miyuki; Ohtsuka, Yuko; Nakai, Mori; Miyazono, Mami; Hashiguchi, Nobuko; Sakurada, Harumizu; Takemoto, Masao; Mukai, Yasushi; Inoue, Shujirou; Sunagawa, Kenji; Chishaki, Hiroaki

2016-04-01

Implantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias. A multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD). Patients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8. In our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality.

Influence of primary and secondary prevention indications on anxiety about the implantable cardioverter-defibrillator

PubMed Central

Rahmawati, Anita; Chishaki, Akiko; Ohkusa, Tomoko; Sawatari, Hiroyuki; Tsuchihashi-Makaya, Miyuki; Ohtsuka, Yuko; Nakai, Mori; Miyazono, Mami; Hashiguchi, Nobuko; Sakurada, Harumizu; Takemoto, Masao; Mukai, Yasushi; Inoue, Shujirou; Sunagawa, Kenji; Chishaki, Hiroaki

2015-01-01

Background Implantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias. Methods A multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD). Results Patients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8. Conclusions In our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality. PMID:27092190

Fatal Occupational Injuries among Non-governmental Employees in Malaysia

PubMed Central

Abas, Adinegara bin Lutfi; Mohd Said, Datuk Abd. Razzak B.; Aziz Mohammed, Mohammed Azman B.; Sathiakumar, Nalini

2012-01-01

Background In Malaysia, surveillance of fatal occupational injuries is fragmented. We therefore analyzed an alternative data source from Malaysia’s Social Security organization, the PERKESO. Methods We conducted a secondary data analysis of the PERKESO database comprised of 7 million employees from 2002 to 2006. Results Overall, the average annual incidence was 9.2 fatal occupational injuries per 100,000 workers. During the five-year period, there was a decrease in the absolute number of fatal injuries by 16% and the incidence by 34%. The transportation sector reported the highest incidence of fatal injuries (35.1/100,000), followed by agriculture (30.5/100,000) and construction (19.3/100,000) sectors. Persons of Indian ethnicity were more likely to sustain fatal injuries compared to other ethnic groups. Conclusions Government and industry should develop rigorous strategies to detect hazards in the workplace, especially in sectors that continuously record high injury rates. Targeted interventions emphasizing worker empowerment coupled with systematic monitoring and evaluation is critical to ensure success in prevention and control measures. PMID:22544443

Booster seat laws and child fatalities: a case-control study.

PubMed

Farmer, P; Howard, A; Rothman, L; Macpherson, A

2009-10-01

A case-control study examined, primarily, the association between booster seat laws and fatalities among children in frontal collisions and, secondarily, the association between booster seat laws and reported restraint use, and restraint use and child fatalities. Children who died in a crash in the US were cases, and children who survived a fatal crash were controls. Subjects were child passengers (4-8 years old) in the Fatality Analysis Reporting System Database, 1995-2005. In states with a booster seat law, children were less likely to die than in states without a law (OR 0.80; 95% CI 0.66 to 0.98). They were also more likely to be restrained (adjusted OR 1.59; 95% CI 1.21 to 2.09) and were more likely to be correctly restrained (adjusted OR 4.44; 95% CI 3.18 to 6.20). It is concluded that booster seat laws are associated with a decrease in child deaths and an increase in correct restraint use among children involved in a fatal crash in the USA.

A statistical analysis of the effects of a uniform minimum drinking age

DOT National Transportation Integrated Search

1987-04-01

This report examines the relationship between minimum drinking age (MDA) and : highway fatalities during the 1975-1985 period, when 35 states changed their : MDAs. An econometric model of fatalities involving the 18-20 year-old driver : normalized by...

The relationship of alcohol safety laws to drinking drivers in fatal crashes

DOT National Transportation Integrated Search

1999-08-01

This paper presents an analysis of the relationships between the passage of key alcohol safety laws and the number of drinking drivers in fatal crashes. The study evaluated the impact of three major alcohol safety laws (administrative license revocat...

Estimation of fatality and injury risk by means of in-depth fatal accident investigation data.

PubMed

Yannis, George; Papadimitriou, Eleonora; Dupont, Emmanuelle; Martensen, Heike

2010-10-01

In this article the factors affecting fatality and injury risk of road users involved in fatal accidents are analyzed by means of in-depth accident investigation data, with emphasis on parameters not extensively explored in previous research. A fatal accident investigation (FAI) database is used, which includes intermediate-level in-depth data for a harmonized representative sample of 1300 fatal accidents in 7 European countries. The FAI database offers improved potential for analysis, because it includes information on a number of variables that are seldom available, complete, or accurately recorded in road accident databases. However, the fact that only fatal accidents are examined requires for methodological adjustments, namely, the correction for two types of effects on a road user's baseline risk: "accident size" effects, and "relative vulnerability" effects. Fatality and injury risk can be then modeled through multilevel logistic regression models, which account for the hierarchical dependences of the road accident process. The results show that the baseline fatality risk of road users involved in fatal accidents decreases with accident size and increases with the vulnerability of the road user. On the contrary, accident size increases nonfatal injury risk of road users involved in fatal accidents. Other significant effects on fatality and injury risk in fatal accidents include road user age, vehicle type, speed limit, the chain of accident events, vehicle maneuver, and safety equipment. In particular, the presence and use of safety equipment such as seat belt, antilock braking system (ABS), and electronic stability program (ESP) are protection factors for car occupants, especially for those seated at the front seats. Although ABS and ESP systems are typically associated with positive effects on accident occurrence, the results of this research revealed significant related effects on accident severity as well. Moreover, accident consequences are more severe when the most harmful event of the accident occurs later within the accident chain.

Fatally injured pedestrians and bicyclists in the United States with high blood alcohol concentrations.

PubMed

Eichelberger, Angela H; McCartt, Anne T; Cicchino, Jessica B

2018-06-01

Little research has focused on the problem of alcohol impairment among pedestrians and bicyclists in the United States. The aim of the current study was to investigate the prevalence, trends, and characteristics of alcohol-impaired fatally injured pedestrians and bicyclists. Data from the Fatality Analysis Reporting System (FARS) were analyzed for fatally injured passenger vehicle drivers, pedestrians, and bicyclists 16 and older during 1982-2014. Logistic regression models examined whether personal, roadway, and crash characteristics were associated with high blood alcohol concentrations (BACs) among fatally injured pedestrians and bicyclists. From 1982 to 2014, the percentage of fatally injured pedestrians with high BACs (≥0.08g/dL) declined from 45% to 35%, and the percentage of fatally injured bicyclists with high BACs declined from 28% to 21%. By comparison, the percentage of fatally injured passenger vehicle drivers with high BACs declined from 51% in 1982 to 32% in 2014. The largest reductions in alcohol impairment among fatally injured pedestrians and bicyclists were found among ages 16-20. During 2010-2014, fatally injured pedestrians and bicyclists ages 40-49 had the highest odds of having a high BAC, compared with other age groups. A substantial proportion of fatally injured pedestrians and bicyclists have high BACs, and this proportion has declined less dramatically than for fatally injured passenger vehicle drivers during the past three decades. Most countermeasures used to address alcohol-impaired driving may have only limited effectiveness in reducing fatalities among alcohol-impaired pedestrians and bicyclists. Efforts should increase public awareness of the risk of walking or bicycling when impaired. Results suggest the primary target audience for educational campaigns directed at pedestrians and bicyclists is middle-age males. Further research should evaluate the effectiveness of potential countermeasures, such as lowering speeds or improving lighting in urban areas. Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.

The Short-term Prognostic Value of the Triglyceride-to-high-density Lipoprotein Cholesterol Ratio in Acute Ischemic Stroke

PubMed Central

Wang, Huan; Lei, Leix; Zhang, Han-Qing; Gu, Zheng-Tian; Xing, Fang-Lan; Yan, Fu-Ling

2018-01-01

The triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) is a simple approach to predicting unfavorable outcomes in cardiovascular disease. The influence of TG/HDL-C on acute ischemic stroke remains elusive. The purpose of this study was to investigate the precise effect of TG/HDL-C on 3-month mortality after acute ischemic stroke (AIS). Patients with AIS were enrolled in the present study from 2011 to 2017. A total of 1459 participants from a single city in China were divided into retrospective training and prospective test cohorts. Medical records were collected periodically to determine the incidence of fatal events. All participants were followed for 3 months. Optimal cutoff values were determined using X-tile software to separate the training cohort patients into higher and lower survival groups based on their lipid levels. A survival analysis was conducted using Kaplan-Meier curves and a Cox proportional hazards regression model. A total of 1459 patients with AIS (median age 68.5 years, 58.5% male) were analyzed. Univariate Cox regression analysis confirmed that TG/HDL-C was a significant prognostic factor for 3-month survival. X-tile identified 0.9 as an optimal cutoff for TG/HDL-C. In the univariate analysis, the prognosis of the TG/HDL-C >0.9 group was markedly superior to that of TG/HDL-C ≤0.9 group (P<0.001). A multivariate Cox regression analysis showed that TG/HDL-C was independently correlated with a reduced risk of mortality (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.24-0.62; P<0.001). These results were confirmed in the 453 patients in the test cohort. A nomogram was constructed to predict 3-month case-fatality, and the c-indexes of predictive accuracy were 0.684 and 0.670 in the training and test cohorts, respectively (P<0.01). The serum TG/HDL-C ratio may be useful for predicting short-term mortality after AIS. PMID:29896437

The Short-term Prognostic Value of the Triglyceride-to-high-density Lipoprotein Cholesterol Ratio in Acute Ischemic Stroke.

PubMed

Deng, Qi-Wen; Li, Shuo; Wang, Huan; Lei, Leix; Zhang, Han-Qing; Gu, Zheng-Tian; Xing, Fang-Lan; Yan, Fu-Ling

2018-06-01

The triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) is a simple approach to predicting unfavorable outcomes in cardiovascular disease. The influence of TG/HDL-C on acute ischemic stroke remains elusive. The purpose of this study was to investigate the precise effect of TG/HDL-C on 3-month mortality after acute ischemic stroke (AIS). Patients with AIS were enrolled in the present study from 2011 to 2017. A total of 1459 participants from a single city in China were divided into retrospective training and prospective test cohorts. Medical records were collected periodically to determine the incidence of fatal events. All participants were followed for 3 months. Optimal cutoff values were determined using X-tile software to separate the training cohort patients into higher and lower survival groups based on their lipid levels. A survival analysis was conducted using Kaplan-Meier curves and a Cox proportional hazards regression model. A total of 1459 patients with AIS (median age 68.5 years, 58.5% male) were analyzed. Univariate Cox regression analysis confirmed that TG/HDL-C was a significant prognostic factor for 3-month survival. X-tile identified 0.9 as an optimal cutoff for TG/HDL-C. In the univariate analysis, the prognosis of the TG/HDL-C >0.9 group was markedly superior to that of TG/HDL-C ≤0.9 group (P<0.001). A multivariate Cox regression analysis showed that TG/HDL-C was independently correlated with a reduced risk of mortality (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.24-0.62; P<0.001). These results were confirmed in the 453 patients in the test cohort. A nomogram was constructed to predict 3-month case-fatality, and the c-indexes of predictive accuracy were 0.684 and 0.670 in the training and test cohorts, respectively (P<0.01). The serum TG/HDL-C ratio may be useful for predicting short-term mortality after AIS.

Causes of Nonbattle Injury Fatalities Among U.S. Army Soldiers During Operation Enduring Freedom and Operation Iraqi Freedom, 2001-2006

DTIC Science & Technology

2008-07-28

SUPPLEMENTARY NOTES 14. ABSTRACT As with previous military conflicts, nonbattle injuries ( NBls ) are a major cause of mortality in Operations...Enduring (OEF) and Iraqi Freedom (OIF). The purpose of this retrospective analysis was to 1) describe the incidence and rate of fatal NBls in OEF and OIF...from their beginning through December 2006, 2) describe the causes and circumstances of fatal NBls , and 3) compare two Army data systems that report

Air pollution and case fatality of SARS in the People's Republic of China: an ecologic study

PubMed Central

Cui, Yan; Zhang, Zuo-Feng; Froines, John; Zhao, Jinkou; Wang, Hua; Yu, Shun-Zhang; Detels, Roger

2003-01-01

Background Severe acute respiratory syndrome (SARS) has claimed 349 lives with 5,327 probable cases reported in mainland China since November 2002. SARS case fatality has varied across geographical areas, which might be partially explained by air pollution level. Methods Publicly accessible data on SARS morbidity and mortality were utilized in the data analysis. Air pollution was evaluated by air pollution index (API) derived from the concentrations of particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide and ground-level ozone. Ecologic analysis was conducted to explore the association and correlation between air pollution and SARS case fatality via model fitting. Partially ecologic studies were performed to assess the effects of long-term and short-term exposures on the risk of dying from SARS. Results Ecologic analysis conducted among 5 regions with 100 or more SARS cases showed that case fatality rate increased with the increment of API (case fatality = - 0.063 + 0.001 * API). Partially ecologic study based on short-term exposure demonstrated that SARS patients from regions with moderate APIs had an 84% increased risk of dying from SARS compared to those from regions with low APIs (RR = 1.84, 95% CI: 1.41–2.40). Similarly, SARS patients from regions with high APIs were twice as likely to die from SARS compared to those from regions with low APIs. (RR = 2.18, 95% CI: 1.31–3.65). Partially ecologic analysis based on long-term exposure to ambient air pollution showed the similar association. Conclusion Our studies demonstrated a positive association between air pollution and SARS case fatality in Chinese population by utilizing publicly accessible data on SARS statistics and air pollution indices. Although ecologic fallacy and uncontrolled confounding effect might have biased the results, the possibility of a detrimental effect of air pollution on the prognosis of SARS patients deserves further investigation. PMID:14629774

A 43-year systematic review and meta-analysis: case-fatality and risk of death among adults with tuberculous meningitis in Africa.

PubMed

Woldeamanuel, Yohannes W; Girma, Belaineh

2014-05-01

Tuberculous meningitis (TBM) is a preventable and curable common health problem among African adults. Poor nutrition, poverty, household crowding, drug resistant tuberculosis (TB) strains, AIDS, and malfunctioning TB control programs are important risk factors. We conducted a systematic review and meta-analysis of published literature reporting case-fatalities of TBM among adults in African countries from 1970 till date. A PubMed search identified relevant papers. Employed terms include 'adult tuberculous meningitis' AND 'tuberculosis Africa'. PRISMA review guidelines were applied. Adult TBM case-fatalities, odds ratio (OR), relative risk (RR), forest-plot meta-analysis for weighted OR and RR, funnel plots, L'Abbé plots, meta-regressed bubble plots, and inter-study homogeneity were computed. Among 15 studies included, adult TBM occurred in up to 28 % of all meningitis forms with case-fatality of 60 % (inverse-variance weighted 54 %). Fixed-effect meta-analysis revealed weighted OR and RR of adult TBM fatalities to be 4.37 (95 % CI 3.92, 4.88) and 2.53 (95 % CI 2.38, 2.69), respectively. Inter-study homogeneity was reliable, regional representativeness was adequate allowing generalizability, and funnel-plots behaved symmetrically with insignificant inconsistency. All cases were initiated with anti-TB medication, while some had 'breakthrough' TBM. In Africa, adult TBM has a significant public health importance with a very high fatality which has remained stagnant for the past half-century. This reflects ongoing low quality of medical care at facilities where lengthy referrals end up. Community-based studies can reveal higher unaccounted morbidity, accrued disability, and larger mortality. Improving access points for early TB management at community-level, developing health infra-structure for comprehensive case management at facility-level, and poverty reduction can help combat this multi-faceted problem--whose reduction can in return help fight poverty.

Two Fatal Intoxications Due to Tramadol Alone: Autopsy Case Reports and Review of the Literature.

PubMed

Gioia, Sara; Lancia, Massimo; Bacci, Mauro; Suadoni, Fabio

2017-12-01

Since tramadol was marketed, it has been widely prescribed as a pain killer because of its relatively safe profile among opioids.Nevertheless, intoxication can occur: overdose can lead to fatal outcomes mostly in association with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased central nervous system (CNS) depression.Fatal outcomes only attributable to tramadol are a rare entity. In this case report, 2 fatal cases are described due to tramadol stand-alone intoxication with peculiar characteristics.In case 1, gas chromatography - mass spectrometry analysis detected tramadol in all specimens (32 μg/mL in the heart blood, 23.9 μg/mL in the femoral blood, 3.3 μg/mL in the bile, and 1.4 μg/mL in the urine). No other CNS depressants were detected by toxicological analysis.In case 2, gas chromatography - mass spectrometry analysis detected tramadol in all specimens (7.5 μg/mL in the heart blood, 5.8 μg/mL in the femoral blood, and 18 μg/mL in the urine). No other CNS depressants were detected by toxicological analysis.Review of the literature was performed to clarify the actual knowledge on this topic.

Personality traits and coping styles explain anxiety in lung cancer patients to a greater extent than other factors.

PubMed

Shimizu, Ken; Nakaya, Naoki; Saito-Nakaya, Kumi; Akechi, Tatsuo; Ogawa, Asao; Fujisawa, Daisuke; Sone, Toshimasa; Yoshiuchi, Kazuhiro; Goto, Koichi; Iwasaki, Motoki; Tsugane, Shoichiro; Uchitomi, Yosuke

2015-05-01

Although various factors thought to be correlated with anxiety in cancer patients, relative importance of each factors were unknown. We tested our hypothesis that personality traits and coping styles explain anxiety in lung cancer patients to a greater extent than other factors. A total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, demographic characteristics, health behaviors, physical symptoms and psychological factors consisting of personality traits and coping styles were obtained. The participants were divided into groups with or without a significant anxiety using the Hospital Anxiety and Depression Scale-Anxiety, and a binary logistic regression analysis was used to identify factors correlated with significant anxiety using a multivariate model. Among the recruited patients, 440 (33.0%) had significant anxiety. The binary logistic regression analysis revealed a coefficient of determination (overall R(2)) of 39.0%, and the explanation for psychological factors was much higher (30.7%) than those for cancer-related variables (1.1%), demographic characteristics (2.1%), health behaviors (0.8%) and physical symptoms (4.3%). Four specific factors remained significant in a multivariate model. A neurotic personality trait, a coping style of helplessness/hopelessness, and a female sex were positively correlated with significant anxiety, while a coping style of fatalism was negatively correlated. Our hypothesis was supported, and anxiety was strongly linked with personality trait and coping style. As a clinical implication, the use of screening instruments to identify these factors and intervention for psychological crisis may be needed. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Impact of Paclitaxel-Eluting Balloons Compared to Second-Generation Drug-Eluting Stents for of In-Stent Restenosis in a Primarily Acute Coronary Syndrome Population

PubMed Central

Marquis-Gravel, Guillaume; Matteau, Alexis; Potter, Brian J; Gobeil, François; Noiseux, Nicolas; Stevens, Louis-Mathieu; Mansour, Samer

2017-01-01

Background The place of drug-eluting balloons (DEB) in the treatment of in-stent restenosis (ISR) is not well-defined, particularly in a population of all-comers with acute coronary syndromes (ACS). Objective Compare the clinical outcomes of DEB with second-generation drug-eluting stents (DES) for the treatment of ISR in a real-world population with a high proportion of ACS. Methods A retrospective analysis of consecutive patients with ISR treated with a DEB compared to patients treated with a second-generation DES was performed. The primary endpoint was a composite of major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, and target lesion revascularization). Comparisons were performed using Cox proportional hazards multivariate adjustment and Kaplan-Meier analysis with log-rank. Results The cohort included 91 patients treated with a DEB and 89 patients treated with a DES (74% ACS). Median follow-up was 26 months. MACE occurred in 33 patients (36%) in the DEB group, compared to 17 patients (19%) in the DES group (p log-rank = 0.02). After multivariate adjustment, there was no significant difference between the groups (HR for DEB = 1.45 [95%CI: 0.75-2.83]; p = 0.27). Mortality rates at 1 year were 11% with DEB, and 3% with DES (p = 0.04; adjusted HR = 2.85 [95%CI: 0.98-8.32]; p = 0.06). Conclusion In a population with a high proportion of ACS, a non-significant numerical signal towards increased rates of MACE with DEB compared to second-generation DES for the treatment of ISR was observed, mainly driven by a higher mortality rate. An adequately-powered randomized controlled trial is necessary to confirm these findings. PMID:28977052

Coverage and parental perceptions of influenza vaccination among parents of children aged 6 to 23 months in Hong Kong

PubMed Central

2013-01-01

Background The impact of influenza on young children can be severe and even fatal. Influenza vaccination (IV) has been shown to be effective in reducing complications of influenza among children. This study investigated the prevalence and factors of IV among children aged 6-23 months in Hong Kong. Methods A sample of 401 Chinese parents of children aged 6-23 months were interviewed at local Maternal and Child Health Centers. Socio-demographic information, variables related to Health Belief Model, including perceptions about the child’s chance of contracting influenza, perceived harm of influenza on children, perceived benefits and side-effects of IV, having received recommendations from health professionals to uptake IV, and IV behaviors of the children were measured. Multivariate analysis was used to examine factors associated with IV behaviors of children. Results Only 9% of the children had ever been vaccinated. Among those parents who had heard of IV (92.0%), substantial proportions perceived that IV could reduce the risk of influenza-induced complications (70.5%), hospitalization (70.5%) and death (65.9%). Relatively few of the participants believed that IV had no side effects (17.1%) and even less had been recommended by health care professionals to uptake IV (10.6%). Results from multivariate analysis showed that physician recommendations were associated with a higher likelihood for IV among younger children, whilst parental perceptions of the side effects of IV was associated with a lower likelihood for IV. Conclusion The prevalence of IV among children aged 6-23 months in Hong Kong was very low. Promotion of IV with the component of physician recommendations and parents’ knowledge about IV safety for this group is warranted. PMID:24171947

Comparison of the characteristics of fire and non-fire households in the 2004-2005 survey of fire department-attended and unattended fires.

PubMed

Greene, Michael A

2012-06-01

Comparison of characteristics of fire with non-fire households to determine factors differentially associated with fire households (fire risk factors). National household telephone survey in 2004-2005 by the US Consumer Product Safety Commission with 916 fire households and a comparison sample of 2161 non-fire households. There were an estimated 7.4 million fires (96.6% not reported to fire departments) with 130,000 injuries. Bivariate analysis and multivariate logistic regression analyses to assess differences in household characteristics. Significant factors associated with fire households were renting vs. owning (OR 1.988 p<0.0001); household members under 18 year of age (OR 1.277 p<0.0001); lack of residents over 64 years old (OR 0.552 p=0.0007); and college or higher education (some college OR 1.444 p=0.0360, college graduate OR 1.873, p<0.0001, postgraduate OR 2.156 p<0.0001). Not significant were age of house; race; ethnicity; and income. Number of smokers was borderline significant (OR 1.132 p=0.1019) but was significant in the subset of fire households with non-cooking fires (OR 1.383 p=0.0011). Single family houses were associated with non-fire households in the bivariate analysis but not in the multivariate analyses. Renting, household members under 18 years old and smokers are risk factors for unattended fires, similar to the literature for fatal and injury fires. Differences included household members over 65 years old (associated with non-fire households), college/postgraduate education (associated with fire households) and lack of significance of income. Preventing cooking fires (64% of survey incidents), smoking prevention efforts and fire prevention education for families with young children have the potential for reducing unattended fires and injuries.

Lethality by pneumonia and factors associated to death.

PubMed

Ferreira, Sidnei; Sant'anna, Clemax C; March, Maria de Fátima B P; Santos, Marilene Augusta R C; Cunha, Antonio Jose Ledo A

2014-01-01

To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic and clinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric inpatients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Risk factors and outcomes of acute lower gastrointestinal bleeding in intestinal Behçet's disease.

PubMed

Park, Jihye; Cheon, Jae Hee; Park, Yong Eun; Lee, Yoon Jee; Lee, Hyun Jung; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho

2017-05-01

Intestinal Behçet's disease (BD) can cause acute lower gastrointestinal bleeding, which is sometimes fatal. We aimed to identify the risk factors and outcomes of acute lower gastrointestinal bleeding and factors associated with rebleeding in intestinal BD patients. Of the total of 588 intestinal BD patients, we retrospectively reviewed the medical records of 66 (11.2%) patients with acute lower gastrointestinal bleeding and compared them with those of 132 matched patients without bleeding. The baseline characteristics were comparable between the bleeding group (n = 66) and the non-bleeding group (n = 132). On multivariate analysis, the independent factors significantly associated with lower gastrointestinal bleeding were older age (>52 years) (hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.058-4.684, p = 0.035) and a nodular ulcer margin (HR 7.1, 95% CI 2.084-24.189, p = 0.002). Rebleeding occurred in 23 patients (34.8%). Female patients (p = 0.044) and those with previous use of corticosteroids or azathioprine (p = 0.034) were more likely to develop rebleeding. On multivariate analysis, only use of steroids or azathioprine was significantly associated with rebleeding (HR 3.2, 95% CI 1.070-9.462, p = 0.037). Age >52 years and the presence of a nodular margin of the ulcer were found to be related to increased risk of bleeding in patients with intestinal BD. Rebleeding is not uncommon and not effectively prevented with currently available medications. Further studies are warranted to identify effective measures to decrease rebleeding in intestinal BD.

Identification of alcohol-pedestrian crash problems among selected racial/ethnic groups

DOT National Transportation Integrated Search

1997-09-01

Pedestrians who had been drinking make up about half of all adult pedestrian crash fatalities. About one-third of all adult pedestrian victims were at BACs of 15% or more (NHTSA's Fatality Analysis Reporting System (FARS), 1984-1993). This study exam...

An analysis of seatbelt use decision making among part-time users.

DOT National Transportation Integrated Search

2011-04-01

"Young people, in particular young males, are overrepresented in fatal crashes. In part, this elevated fatal crash rate results from the lack of seatbelt use among teen drivers and passengers. A recent review of more than 200 teen-targeted programs f...

Statistical Analysis to Assess Effectiveness of Rumble Stripes on Highway Safety

DOT National Transportation Integrated Search

2011-01-01

Although traffic deaths are caused by an array of factors, in the United States more than half of all roadway fatalities are caused by roadway departures [FHWA 2006]. In 2003, there were 25,562 roadway departure fatalities, accounting for 55 percent ...

Owner-operator versus company-driver safety performance analysis : tech transfer summaries.

DOT National Transportation Integrated Search

2016-01-01

The Federal Motor Carrier Safety Administration (FMCSA) reported : that, in 2013, more than 3,800 fatal crashes and 385,000 non-fatal : crashes across the US involved at least one large truck or bus. While : the FMCSA has implemented safety practices...

Owner-operator versus company-driver safety performance analysis : [tech transfer summary].

DOT National Transportation Integrated Search

2016-01-01

The Federal Motor Carrier Safety Administration (FMCSA) reported : that, in 2013, more than 3,800 fatal crashes and 385,000 non-fatal : crashes across the US involved at least one large truck or bus. While : the FMCSA has implemented safety practices...

Sex differences in case fatality before and after admission to hospital after acute cardiac events: analysis of community based coronary heart disease register.

PubMed Central

Sonke, G. S.; Beaglehole, R.; Stewart, A. W.; Jackson, R.; Stewart, F. M.

1996-01-01

OBJECTIVE: To determine whether the reported higher case fatality in hospital after an acute cardiac event in women can be explained by sex differences in mortality before admission and in baseline risk factors. DESIGN: Analyses of data from a community based coronary heart disease register. SETTING: Auckland region, New Zealand. SUBJECTS: 5106 patients aged 25-64 years with an acute cardiac event leading to coronary death or definite myocardial infarction within 28 days of onset, occurring between 1986 and 1992. MAIN OUTCOME MEASURES: Case fatality before admission, 28 day case fatality for patients in hospital, and total case fatality after an acute cardiac event. RESULTS: Despite a more unfavourable risk profile women tended to have lower case fatality before admission than men (crude odds ratio 0.88; 95% confidence interval 0.77 to 1.02). Adjustment for age, living arrangements, smoking, medical history, and treatment increased the effect of sex (0.72; 0.60 to 0.86). After admission to hospital, women had a higher case fatality than men (1.76; 1.43 to 2.17), but after adjustment for confounders this was reduced to 1.18 (0.89 to 1.58). Total case fatality 28 days after an acute cardiac event showed no significant difference between men and women (0.85; 0.70 to 1.02) CONCLUSIONS: The higher case fatality after an acute cardiac event in women admitted to hospital is largely explained by differences in living status, history, and medical treatment and is balanced by a lower case fatality before admission. PMID:8870571

Flash floods, hydro-geomorphic response and risk management

NASA Astrophysics Data System (ADS)

Braud, Isabelle; Borga, Marco; Gourley, Jonathan; Hürlimann, Marcel; Zappa, Massimilano; Gallart, Francesc

2016-10-01

Each year, natural disasters are responsible for fatalities and economic losses worldwide with 101 billion USD in economic losses and 7000 fatalities reported for 2014 (SwissRE, 2015). Even if earthquakes are responsible for most of these fatalities, flash floods and landslides are recognized as a significant source of threat to human lives (SwissRE, 2015). Jonkman (2005), in a global assessment of flood-related casualties, showed that flash floods lead to the highest mortality (number of fatalities divided by the number of affected people). They are also often associated with shallow landslides and geomorphic processes that can increase threat to human lives. Analysis of a global data set of fatalities from non-seismically triggered landslides (Petley, 2012) shows that 2620 fatal landslides were recorded worldwide in the period 2004-2010, causing a total of 32,322 recorded fatalities. In addition, heavy precipitation events, at the origin of flash floods and shallow landsliding are expected to increase in the future (e.g. Scoccimarro et al., 2016 for a recent study in Europe). Progress in flash floods and landslides understanding, forecasting and warning is therefore still needed to disentangle the complex interactions between hazards, exposure and vulnerability and to increase resilience (Borga et al., 2014).

Disaster victim identification of military aircrew, 1945-2002.

PubMed

Smith, Adrian

2003-11-01

Aviation accident fatalities are characterized by substantial tissue disruption and fragmentation, limiting the usefulness of traditional identification methods. This study examines the success of disaster victim identification (DVI) in military aviation accident fatalities in the Australian Defense Force (ADF). Accident reports and autopsy records of aircrew fatalities during the period 1945-2002 were examined to identify difficulties experienced during the DVI process or injuries that would prevent identification of remains using non-DNA methods. The ADF had 301 aircraft fatalities sustained in 144 accidents during the period 1945-2002. The autopsy reports for 117 fatalities were reviewed (covering 73.7% of aircrew fatalities from 1960-2002). Of the 117 victims, 38 (32.4%) sustained injuries which were severe enough to prevent identification by traditional (non-DNA) comparative scientific DVI techniques of fingerprint and dental analysis. Many of the ADF fatalities who could not be positively identified in the past could be identified today through the use of DNA techniques. Successful DNA identification, however, depends on having a reference DNA profile. This paper recommends the establishment of a DNA repository to store reference blood samples to facilitate the identification of ADF aircrew remains without causing additional distress to family members.

The impact of raising the minimum drinking age on driver fatalities.

PubMed

MacKinnon, D P; Woodward, J A

1986-12-01

Time series analysis was used to obtain statistical tests of the impact of raising the drinking age on monthly driver fatalities in Illinois, Michigan, and Massachusetts. A control series design permitted comparison between younger drivers (21 or less years) and older drivers (25 and older) within states where the minimum drinking age was raised. Since the two groups share the same driving conditions, it was important to demonstrate that any reduction in fatalities was limited to the young age group within which the drinking age change occurred. In addition, control states were selected to permit a comparison between driver fatalities of the young age group (21 or less) in states with the law change and young drivers in states without the law change. Significant immediate reductions in fatalities among 21 and younger drivers in Illinois and Michigan were observed after these states raised their minimum drinking age. No significant reductions in any control series were observed. A linear decrease in young driver fatalities was observed after the drinking age was raised in Massachusetts. There was also a significant linear decrease in young driver fatalities in the Connecticut control series, perhaps due to increasing awareness among young drivers of the dangers of drinking and driving.

The role of alcohol use on recent trends in distracted driving.

PubMed

Wilson, Fernando A; Stimpson, Jim P; Tibbits, Melissa K

2013-11-01

Distracted driving is now an increasingly deadly threat to road safety. We provide evidence that intoxicated driving is increasingly responsible for recent increases in fatalities from distracted driving crashes. This study describes trends in deaths on U.S. public roads caused by alcohol-involved and distracted drivers using the Fatality Analysis Reporting System (FARS)-a census of fatal crashes on U.S. public roads. Fatality rates per vehicle-miles traveled are calculated using data from the Federal Highway Administration. Alcohol-involved drivers who are simultaneously distracted were responsible for 1750 deaths in 2009, an increase of more than 63% from 2005 when there were 1072 deaths. Alcohol use while driving is increasingly responsible for a growing number of fatalities from distracted driving, accounting for 32% of deaths from distracted driving in 2009 versus 24% in 2005. The fatality rate from these crashes increased from 35.9 to 59.2 deaths per 100 billion vehicle-miles traveled after 2005. Alcohol use is quickly increasing as an important factor behind distracted driving fatalities. This has implications for policies combating distracted driving that do not address the role of alcohol use in distracted driving. Copyright © 2013 Elsevier Ltd. All rights reserved.

An analysis of fatal and non-fatal injuries and injury severity factors among electric power industry workers.

PubMed

Fordyce, Tiffani A; Leonhard, Megan J; Watson, Heather N; Mezei, Gabor; Vergara, Ximena P; Krishen, Lovely

2016-11-01

The electric power industry represents a unique subset of the U.S. workforce. We aimed to evaluate the relationships between occupational category, nature of injury, and injury severity among electric power industry workers. The Occupational Health and Safety Database (1995-2013) was used to calculate injury rates, assess patterns of injury severity, and identify at-risk occupations in this population. Over the surveillance period, a total of 63,193 injuries were reported. Overall, and severe injury rates were 3.20 and 0.52 per 100 employee-years, respectively. The fatal injury rate was 3.29 per 100,000 employee-years. Line workers experienced the highest risk for fatal injuries and second highest for non-fatal severe injuries, following meter readers. The most severe non-fatal injuries were hernia and rupture; multiple injuries; and CTD/RSI. Fatal injuries were most commonly associated with vehicle collisions and contact with electric current. Industry specific surveillance and interventions tailored to high-risk occupations are needed to further reduce severe injuries in this population. Am. J. Ind. Med. 59:948-958, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Genetic variants in loci 1p13 and 9p21 and fatal coronary heart disease in a Norwegian case-cohort study.

PubMed

Jansen, Mona Dverdal; Knudsen, Gun Peggy; Myhre, Ronny; Høiseth, Gudrun; Mørland, Jørg; Næss, Øyvind; Tambs, Kristian; Magnus, Per

2014-05-01

Single nucleotide polymorphisms (SNPs) in loci 1p13 and 9p21 have previously been found to be associated with incident coronary heart disease (CHD). This study aimed to investigate whether these SNPs show associations with fatal CHD in a population-based cohort study after adjustment for socioeconomic- and lifestyle-related CHD risk factors not commonly included in genetic association studies. Using the population-based Cohort of Norway (CONOR), a nested case-cohort study was set up and DNA from 2,953 subjects (829 cases and 2,124 non-cases) were genotyped. The association with fatal CHD was estimated for four SNPs, three from locus 1p13 and one from locus 9p21. Multivariable Cox regression was used to estimate unstratified and gender-stratified hazard ratios while adjusting for major CHD risk factors. The associations between three SNPs from locus 1p13 and non-HDL cholesterol levels were also estimated. Men homozygous for the risk alleles on rs1333049 (9p21) and rs14000 (1p13) were found to have significantly increased hazard ratios in crude and adjusted models, and the hazard ratios remained statistically significant when both genders were analyzed together. Adjustment for additional socioeconomic- and lifestyle-related CHD risk factors influenced the association estimates only slightly. No significant associations were observed between the other two SNPs in loci 1p13 (rs599839 and rs646776) and CHD mortality in either gender. Both rs599839 and rs646776 showed significant, gradual increases in non-HDL cholesterol levels with increasing number of risk alleles. This study confirms the association between 9p21 (rs1333049) and fatal CHD in a Norwegian population-based cohort. The effect was not influenced by several socioeconomic- and lifestyle-related risk factors. Our results show that 1p13 (rs14000) may also be associated with fatal CHD. SNPs at 1p13 (rs599839 and rs646776) were associated with non-HDL cholesterol levels.

Lost working days, productivity, and restraint use among occupants of motor vehicles that crashed in the United States.

PubMed

Ebel, B E; Mack, C; Diehr, P; Rivara, F P

2004-10-01

In 2001, 6.3 million passengers were involved in motor vehicle crashes. This study aimed to determine the number of work days lost as a result of motor vehicle crashes and factors that influenced people's return to work. This was a retrospective, population based cohort study of occupants in motor vehicles involved in crashes from the 1993-2001 Crashworthiness Data System produced by the National Highway Traffic Safety Administration. The sample population of people aged 18-65 years included two groups: occupants who survived and were working before the crash and occupants who were injured fatally and were estimated to have been working before the crash. Multivariate linear regression was used to analyze the impact of restraint use and injury type on return to work. Overall, 30.1% of occupants of vehicles that crashed missed one or more days of work. A crash resulted in a mean 28.0 (95% confidence interval 15.8 to 40.1) days lost from work, including losses associated with fatalities. The 2.1 million working occupants of vehicles that crashed in 2001 lost a total of 60 million days of work, resulting in annual productivity losses of over $7.5 billion (2964 to 12 075). Unrestrained vehicle occupants accounted for $5.6 billion in lost productivity. Motor vehicle crashes result in large and potentially preventable productive losses that are mostly attributable to fatal injuries.

Sleepiness/fatigue and distraction/inattention as factors for fatal versus nonfatal commercial motor vehicle driver injuries.

PubMed

Bunn, T L; Slavova, S; Struttmann, T W; Browning, S R

2005-09-01

A retrospective population-based case-control study was conducted to determine whether driver sleepiness/fatigue and inattention/distraction increase the likelihood that a commercial motor vehicle collision (CVC) will be fatal. Cases were identified as CVC drivers who died (fatal) and controls were drivers who survived (nonfatal) an injury collision using the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic database from 1998-2002. Cases and controls were matched on unit type and roadway type. Conditional logistic regression was performed. Driver sleepiness/fatigue, distraction/inattention, age of 51 years of age and older, and nonuse of safety belts increase the odds that a CVC will be fatal. Primary safety belt law enactment and enforcement for all states, commercial vehicle driver education addressing fatigue and distraction and other approaches including decreased hours-of-service, rest breaks and policy changes, etc. may decrease the probability that a CVC will be fatal.

Mature Driver Laws and State Predictors of Motor Vehicle Crash Fatality Rates Among the Elderly: A Cross-sectional Ecological Study.

PubMed

Bell, Teresa M; Qiao, Nan; Zarzaur, Ben L

2015-01-01

State-level data have indicated that motor vehicle crash (MVC) fatality rates among the elderly vary widely across states. To date, the majority of states have implemented mature driver laws, which often require more frequent license renewals, in-person renewal, and vision testing for drivers above a certain age. We sought to evaluate the impact of mature driver laws on states' MVC fatality rates among the elderly while examining other state-level determinants of MVC-related deaths. We performed a cross-sectional ecological study and modeled state MVC fatality rates for the population over age 65 as a function of state transportation policies and demographic, health system, population health, travel, and climate characteristics using a general linear model. Principal component analysis was used to reduce dimensionality of the data and overcome multicollinearity of state predictor variables. Higher average temperature, higher gas prices, and a greater number of emergency medicine physicians to population size were significantly associated with lower MVC fatality rates. Positive predictors of MVC fatality rates were percentage of population overweight or obese and percentage with college degree over the age of 65. Having any restriction on elderly drivers was associated with a higher MVC fatality rate and no individual component of mature driver laws (shortened renewal cycle, in-person renewal, and vision testing) was significantly associated with lower fatality MVC rates for adults over 65. Mature driver laws are not associated with lower state MVC fatality rates among the elderly.

Effect of Pokémon GO on incidence of fatal traffic injuries: a population-based quasi-experimental study using the national traffic collisions database in Japan.

PubMed

Ono, Sachiko; Ono, Yosuke; Michihata, Nobuaki; Sasabuchi, Yusuke; Yasunaga, Hideo

2017-10-12

Pokémon GO (Niantic Labs, released on 22 July 2016 in Japan) is an augmented reality game that gained huge popularity worldwide. Despite concern about Pokémon GO-related traffic collisions, the effect of playing Pokémon GO on the incidence of traffic injuries remains unknown. We performed a population-based quasi-experimental study using national data from the Institute for Traffic Accident Research and Data Analysis, Japan. The outcome was incidence of traffic injuries. Of 127 082 000 people in Japan, 886 fatal traffic injuries were observed between 1 June and 31 August in 2016. Regression discontinuity analysis showed a non-significant change in incidence of fatal traffic injuries after the Pokémon GO release (0.017 deaths per million, 95%CI -0.036 to 0.071). This finding was similar to that obtained from a difference-in-differences analysis. Effect of Pokémon GO on fatal traffic injuries may be negligible. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Identification of pulmonary edema in forensic autopsy cases of fatal anaphylactic shock using Fourier transform infrared microspectroscopy.

PubMed

Lin, Hancheng; Luo, Yiwen; Wang, Lei; Deng, Kaifei; Sun, Qiran; Fang, Ruoxi; Wei, Xin; Zha, Shuai; Wang, Zhenyuan; Huang, Ping

2018-03-01

Anaphylaxis is a rapid allergic reaction that may cause sudden death. Currently, postmortem diagnosis of anaphylactic shock is sometimes difficult and often achieved through exclusion. The aim of our study was to investigate whether Fourier transform infrared (FTIR) microspectroscopy combined with pattern recognition methods would be complementary to traditional methods and provide a more accurate postmortem diagnosis of fatal anaphylactic shock. First, the results of spectral peak area analysis showed that the pulmonary edema fluid of the fatal anaphylactic shock group was richer in protein components than the control group, which included mechanical asphyxia, brain injury, and acute cardiac death. Subsequently, principle component analysis (PCA) was performed and showed that the anaphylactic shock group contained more turn and α-helix protein structures as well as less tyrosine-rich proteins than the control group. Ultimately, a partial least-square discriminant analysis (PLS-DA) model combined with a variables selection method called the genetic algorithm (GA) was built and demonstrated good separation between these two groups. This pilot study demonstrates that FTIR microspectroscopy has the potential to be an effective aid for postmortem diagnosis of fatal anaphylactic shock.

Motor vehicle crash deaths related to police pursuits in the United States.

PubMed

Rivara, F P; Mack, C D

2004-04-01

To determine the number and characteristics of motor vehicle crash deaths related to police pursuits in the United States. Analysis of the Fatality Analysis Reporting System and the Crashworthiness Data System of the National Highway Traffic Safety Administration for the years 1994-2002. There were 2654 fatal crashes involving 3965 vehicles and 3146 fatalities during the nine year study period. Of these, 1088 were to people not in the fleeing vehicle. These crashes often occurred at high speed, in the night, on local roads. Most of the pursued drivers had prior motor vehicle related convictions. Many deaths related to police pursuits are to innocent victims. Given that most of the pursued drivers had prior convictions, alternative means of detaining them should be explored.

Worker safety and injury severity analysis of earthmoving equipment accidents.

PubMed

Kazan, Emrah; Usmen, Mumtaz A

2018-06-01

Research on construction worker safety associated with construction equipment has mostly focused on accident type rather than injury severity and the embedded factor relationships. Significant variables and their effects on the degree of injury are examined for earthmoving equipment using data from OSHA. Four types of equipment, backhoe, bulldozer, excavator, and scraper are included in the study. Accidents involving on-foot workers and equipment operators are investigated collectively, as well as separately. Cross tabulation analysis was conducted to establish the associations between selected categorical variables, using degree of injury as a dichotomous dependent variable (fatal vs. nonfatal) and a number of independent variables having different values. Odds ratios were calculated to determine how much a certain variable/factor increases the odds of fatality in an accident, and the odds ratios were ranked to determine the relative impact of a given factor. It was found that twelve variables were significantly associated with injury severity. Rankings based on odds ratios showed that inadequate safety training (2.54), missing equipment protective system (2.38), being a non-union worker (2.26), being an equipment operator (1.93), and being on or around inadequately maintained equipment (1.58) produced higher odds for fatality. A majority of the earthmoving equipment accidents resulted in fatality. Backhoes were the most common equipment involved in accidents and fatalities. Struck-by accidents were the most prevalent and most fatal. Non-OSHA compliant safety training, missing seatbelt, operator not using seatbelt, malfunctioning back-up alarms, and poorly maintained equipment were factors contributing to accidents and fatalities. On-foot workers experienced a higher number of accidents than operators, while fatality odds were higher for the operators. Practical applications: Safety professionals should benefit from our findings in planning and delivering training and providing oversight to workers in earthmoving equipment operations. Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.

Evaluation of injury and fatality risk in rock and ice climbing.

PubMed

Schöffl, Volker; Morrison, Audry; Schwarz, Ulrich; Schöffl, Isabelle; Küpper, Thomas

2010-08-01

Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.

Nighttime seat belt enforcement in Washington state : traffic tech.

DOT National Transportation Integrated Search

2017-04-01

About half of all traffic fatalities occur between the hours of 6 : p.m. and 6 a.m., and about one-quarter occur between 9 p.m. and : 3 a.m. Furthermore, NHTSAs 2014 Fatality Analysis Reporting : System indicates that 57 percent of passenger vehic...

Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis

PubMed Central

Carroll, Robert; Metcalfe, Chris; Gunnell, David

2014-01-01

Background Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Methods and Findings Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. Conclusions One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm. PMID:24587141

Short Sleep Duration is an Independent Predictor of Cardiovascular Events in Japanese Hypertensive Patients

PubMed Central

Eguchi, Kazuo; Pickering, Thomas G.; Schwartz, Joseph E.; Hoshide, Satoshi; Ishikawa, Joji; Ishikawa, Shizukiyo; Shimada, Kazuyuki; Kario, Kazuomi

2013-01-01

Context It is not known whether short duration of sleep is a predictor of future cardiovascular events in hypertensive patients. Objective To test the hypothesis that short duration of sleep is independently associated with incident cardiovascular diseases (CVD). Design, Setting, and Participants We performed ambulatory BP monitoring (ABPM) in 1255 subjects with hypertension (mean age: 70.4±9.9 years) and they were followed for an average of 50±23 months. Short sleep duration was defined as <7.5 hrs (20th percentile). Multivariable Cox hazard models predicting CVD events were used to estimate the adjusted hazard ratio (HR) and 95% CI for short sleep duration. A riser pattern was defined when average nighttime SBP exceeded daytime SBP. Main Outcome Measures The end point was cardiovascular events: stroke, fatal or non-fatal myocardial infarction (MI), and sudden cardiac death. Results In multivariable analyses, short duration of sleep (<7.5 hrs) was associated with incident CVD (HR=1.68; 1.06–2.66, P=.03). A synergistic interaction was observed between short sleep duration and the riser pattern (P=.089). When subjects were categorized on the basis of their sleep time and riser/non-riser patterns, the shorter sleep+riser group had a substantially and significantly higher incidence of CVD than the predominant normal sleep+non-riser group (HR=4.43;2.09–9.39, P<0.001), independent of covariates. Conclusions Short duration of sleep is associated with incident CVD risk, and the combination of riser pattern and short duration of sleep that is most strongly predictive of future CVD, independent of ambulatory BP levels. Physicians should inquire about sleep duration in the risk assessment of hypertensive patients. PMID:19001199

Type 2 Diabetes in Relation to the Risk of Renal Cell Carcinoma Among Men and Women in Two Large Prospective Cohort Studies.

PubMed

Graff, Rebecca E; Sanchez, Alejandro; Tobias, Deirdre K; Rodríguez, Dayron; Barrisford, Glen W; Blute, Michael L; Li, Yanping; Sun, Qi; Preston, Mark A; Wilson, Kathryn M; Cho, Eunyoung

2018-04-20

We assessed whether type 2 diabetes is associated with renal cell carcinoma (RCC), independent of key potential confounders, in two large prospective cohorts with biennially updated covariate data. A total of 117,570 women from the Nurses' Health Study (NHS) and 48,866 men from the Health Professionals Follow-up Study (HPFS) were followed from 1976 and 1986, respectively, through 2014. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs for associations between type 2 diabetes and pathology-confirmed RCC, overall and by stage, grade, and histological subtype. During 38 years of follow-up in the NHS, we confirmed 418 RCC cases, including 120 fatal cases. Over 28 years in the HPFS, we confirmed 302 RCC cases, including 87 fatal cases. Women with type 2 diabetes had a significantly increased risk of RCC compared with women without type 2 diabetes (multivariable HR 1.53; 95% CI 1.14-2.04), with some evidence that the association was stronger for ≤5 (HR 2.15; 95% CI 1.44-3.23) than >5 (HR 1.22; 95% CI 0.84-1.78) years' duration of type 2 diabetes ( P difference 0.03). Among men, type 2 diabetes was not associated with total RCC (HR 0.89; 95% CI 0.56-1.41) or with RCC defined by stage, grade, or subtype. Sample sizes for analyses by stage, grade, and subtype were limited. We found that type 2 diabetes was independently associated with a greater risk of RCC in women but not in men. © 2018 by the American Diabetes Association.

Multi-platform ’Omics Analysis of Human Ebola Virus Disease Pathogenesis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eisfeld, Amie J.; Halfmann, Peter J.; Wendler, Jason P.

The pathogenesis of human Ebola virus disease (EVD) is complex. EVD is characterized by high levels of virus replication and dissemination, dysregulated immune responses, extensive virus- and host-mediated tissue damage, and disordered coagulation. To clarify how host responses contribute to EVD pathophysiology, we performed multi-platform ’omics analysis of peripheral blood mononuclear cells and plasma from EVD patients. Our results indicate that EVD molecular signatures overlap with those of sepsis, imply that pancreatic enzymes contribute to tissue damage in fatal EVD, and suggest that Ebola virus infection may induce aberrant neutrophils whose activity could explain hallmarks of fatal EVD. Moreover, integratedmore » biomarker prediction identified putative biomarkers from different data platforms that differentiated survivors and fatalities early after infection. This work reveals insight into EVD pathogenesis, suggests an effective approach for biomarker identification, and provides an important community resource for further analysis of human EVD severity.« less

Multi-platform 'Omics Analysis of Human Ebola Virus Disease Pathogenesis.

PubMed

Eisfeld, Amie J; Halfmann, Peter J; Wendler, Jason P; Kyle, Jennifer E; Burnum-Johnson, Kristin E; Peralta, Zuleyma; Maemura, Tadashi; Walters, Kevin B; Watanabe, Tokiko; Fukuyama, Satoshi; Yamashita, Makoto; Jacobs, Jon M; Kim, Young-Mo; Casey, Cameron P; Stratton, Kelly G; Webb-Robertson, Bobbie-Jo M; Gritsenko, Marina A; Monroe, Matthew E; Weitz, Karl K; Shukla, Anil K; Tian, Mingyuan; Neumann, Gabriele; Reed, Jennifer L; van Bakel, Harm; Metz, Thomas O; Smith, Richard D; Waters, Katrina M; N'jai, Alhaji; Sahr, Foday; Kawaoka, Yoshihiro

2017-12-13

The pathogenesis of human Ebola virus disease (EVD) is complex. EVD is characterized by high levels of virus replication and dissemination, dysregulated immune responses, extensive virus- and host-mediated tissue damage, and disordered coagulation. To clarify how host responses contribute to EVD pathophysiology, we performed multi-platform 'omics analysis of peripheral blood mononuclear cells and plasma from EVD patients. Our results indicate that EVD molecular signatures overlap with those of sepsis, imply that pancreatic enzymes contribute to tissue damage in fatal EVD, and suggest that Ebola virus infection may induce aberrant neutrophils whose activity could explain hallmarks of fatal EVD. Moreover, integrated biomarker prediction identified putative biomarkers from different data platforms that differentiated survivors and fatalities early after infection. This work reveals insight into EVD pathogenesis, suggests an effective approach for biomarker identification, and provides an important community resource for further analysis of human EVD severity. Copyright © 2017 Elsevier Inc. All rights reserved.

Appalachian versus non-Appalachian US traffic fatalities, 2008-2010

PubMed Central

Zhu, Motao; Zhao, Songzhu; Gurka, Kelly K.; Kandati, Sahiti; Coben, Jeffrey H.

2013-01-01

Purpose Though myriad health disparities exist in Appalachia, limited research has examined traffic fatalities in the region. This study compared traffic-fatality rates in Appalachia and the non-Appalachian US. Methods Fatality Analysis Reporting System and Census data from 2008-2010 were used to calculate traffic-fatality rates. Poisson models were used to estimate unadjusted (RR) and adjusted rate ratios (aRR), controlling for age, sex, and county-specific population density levels. Results: The Appalachian traffic-fatality rate was 45% (95% CI: 1.42, 1.47) higher than the non-Appalachian rate. Though only 29% of fatalities occur in rural counties in non-Appalachia versus 48% in Appalachia, rates in rural counties were similar (RR=0.97; 95% CI: 0.95, 1.00). However, the rate for urban, Appalachian counties was 42% (95% CI: 1.38, 1.45) higher than among urban, non-Appalachian counties. Appalachian rates were higher for passenger-vehicle drivers, motorcyclists, and all-terrain-vehicle riders, regardless of rurality, as well as for passenger-vehicle passengers overall and for urban counties. Conversely, Appalachia experienced lower rates among pedestrians and bicyclists, regardless of rurality. Conclusions Disparities in traffic fatality rates exist in Appalachia. Though elevated rates are partially explained by the proportion of residents living in rural settings, overall rates in urban Appalachia were consistently higher than in urban non-Appalachia. PMID:23619016

Fatal occupational injuries among non-governmental employees in Malaysia.

PubMed

Abas, Adinegara Bin Lutfi; Mohd Said, Datuk Abd Razzak B; Aziz Mohammed, Mohammed Azman B; Sathiakumar, Nalini

2013-01-01

In Malaysia, surveillance of fatal occupational injuries is fragmented. We therefore analyzed an alternative data source from Malaysia's Social Security organization, the Pertubuhan Keselamatan Sosial (PERKESO). We conducted a secondary data analysis of the PERKESO database comprised of 7 million employees from 2002 to 2006. Overall, the average annual incidence was 9.2 fatal occupational injuries per 100,000 workers. During the 5-year period, there was a decrease in the absolute number of fatal injuries by 16% and the incidence by 34%. The transportation sector reported the highest incidence of fatal injuries (35.1/100,000), followed by agriculture (30.5/100,000) and construction (19.3/100,000) sectors. Persons of Indian ethnicity were more likely to sustain fatal injuries compared to other ethnic groups. Government and industry should develop rigorous strategies to detect hazards in the workplace, especially in sectors that continuously record high injury rates. Targeted interventions emphasizing worker empowerment coupled with systematic monitoring and evaluation is critical to ensure success in prevention and control measures. Copyright © 2012 Wiley Periodicals, Inc.

U.S. road fatalities per population : changes by age from 1958 to 2008.

DOT National Transportation Integrated Search

2011-03-01

This report presents a time-series analysis of changes in road safety in the U.S. from : the public-health point of view. A 50-year period is examined, from 1958 to 2008. The : emphasis is on the changes by decades in fatalities per population across...

Risk of commercial truck fires in the United States : an exploratory data analysis

DOT National Transportation Integrated Search

2012-06-29

Large trucks are involved in only 8 percent of fatal crashes per year, but 17 percent of fatal fires. The scope of the current body of research is limited. Studies have treated truck fires generally as a subset of vehicle fires or in their own right ...

The Fatality Analysis Reporting System as a tool for investigating racial and ethnic determinants of motor vehicle crash fatalities.

PubMed

Briggs, Nathaniel C; Levine, Robert S; Haliburton, William P; Schlundt, David G; Goldzweig, Irwin; Warren, Rueben C

2005-07-01

The Fatality Analysis Reporting System (FARS) is a Department of Transportation database in the public domain that contains detailed information about fatalities resulting from motor vehicle crashes on public roadways in the United States since 1975. However, data on race and Hispanic ethnicity were not collected by FARS until 1999. Since then, completeness of reported racial and ethnic information has varied from State to State. To assess utility of FARS for investigating race- and ethnicity-specific risk factors associated with motor vehicle crash mortality, we examined yearly national and State-specific reporting rates of race and Hispanic ethnicity for 168,863 motor vehicle crash fatalities from 1999 to 2002. In 1999, national reporting was 85% for race and 78% for Hispanic ethnicity. Over the 4-year study period, a significant linear increase in annual reporting for both race and Hispanic ethnicity was evident at the national level, as reporting by individual States improved over time. In 2002, national reporting rates reached 90% for race and 88% for Hispanic ethnicity. Our findings indicate that FARS has become a valuable resource for population-based studies of motor vehicle crash mortality disparities that exist among racial and ethnic subpopulations in the United States.

Cost effectiveness of a dealer's intervention in retrofitting rollover protective structures

PubMed Central

Myers, M; Cole, H; Westneat, S

2005-01-01

Objective: To evaluate the cost effectiveness of a 4.5 year education campaign that promoted farmers' adoption of rollover protective structures (ROPS) to prevent tractor overturn injuries. Design: Randomized controlled trial, decision analysis, and cost effectiveness analysis. Setting: One treatment county and one control county in the State of Kentucky. Intervention: A campaign by a local tractor and equipment dealership to encourage farmers to purchase and install ROPS and seatbelt retrofit kits for older tractors. Main outcome measures: Number of injuries averted and cost per injury averted. Results: The dealership's 4.5 year intervention was shown to potentially reduce both fatal (0.26) and non-fatal (1.50) injuries by 2.6% in its county over the intervention period using a 20 year analytic horizon. When extrapolated statewide, 6.7 lives would be saved and 39 non-fatal injuries would be averted over the combined 24.5 year combined intervention period and analytic horizon. The intervention for this period was cost effective with a "savings" of $35 713 per injury (fatal plus non-fatal) averted at a 4% discount rate. Conclusions: Tractor manufacturer promotions can influence their dealerships to promote ROPS retrofits by their customers. A manufacturer backed dealer ROPS retrofit campaign was cost effective in reducing overturn related injuries. PMID:15933410

Classification scheme and prevention measures for caught-in-between occupational fatalities.

PubMed

Chi, Chia-Fen; Lin, Syuan-Zih

2018-04-01

The current study analyzed 312 caught-in-between fatalities caused by machinery and vehicles. A comprehensive and mutually exclusive coding scheme was developed to analyze and code each caught-in-between fatality in terms of age, gender, experience of the victim, type of industry, source of injury, and causes for these accidents. Boolean algebra analysis was applied on these 312 caught-in-between fatalities to derive minimal cut set (MCS) causes associated with each source of injury. Eventually, contributing factors and common accident patterns associated with (1) special process machinery including textile, printing, packaging machinery, (2) metal, woodworking, and special material machinery, (3) conveyor, (4) vehicle, (5) crane, (6) construction machinery, and (7) elevator can be divided into three major groups through Boolean algebra and MCS analysis. The MCS causes associated with conveyor share the same primary causes as those of the special process machinery including textile, printing, packaging and metal, woodworking, and special material machinery. These fatalities can be eliminated by focusing on the prevention measures associated with lack of safeguards, working on a running machine or process, unintentional activation, unsafe posture or position, unsafe clothing, and defective safeguards. Other precise and effective intervention can be developed based on the identified groups of accident causes associated with each source of injury. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dose-Dependent Pulmonary Toxicity After Postoperative Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rice, David C.; Smythe, W. Roy; Liao Zhongxing

Purpose: To determine the incidence of fatal pulmonary events after extrapleural pneumonectomy and hemithoracic intensity-modulated radiotherapy (IMRT) for malignant pleural mesothelioma. Methods and Materials: We retrospectively reviewed the records of 63 consecutive patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy and IMRT at University of Texas M. D. Anderson Cancer Center. The endpoints studied were pulmonary-related death (PRD) and non-cancer-related death within 6 months of IMRT. Results: Of the 63 patients, 23 (37%) had died within 6 months of IMRT (10 of recurrent cancer, 6 of pulmonary causes [pneumonia in 4 and pneumonitis in 2], and 7 of othermore » noncancer causes [pulmonary embolus in 2, sepsis after bronchopleural fistula in 1, and cause unknown but without pulmonary symptoms or recurrent disease in 4]). On univariate analysis, the factors that predicted for PRD were a lower preoperative ejection fraction (p = 0.021), absolute volume of lung spared at 10 Gy (p = 0.025), percentage of lung volume receiving {>=}20 Gy (V{sub 20}; p 0.002), and mean lung dose (p = 0.013). On multivariate analysis, only V{sub 20} was predictive of PRD (p = 0.017; odds ratio, 1.50; 95% confidence interval, 1.08-2.08) or non-cancer-related death (p = 0.033; odds ratio, 1.21; 95% confidence interval, 1.02-1.45). Conclusion: The results of our study have shown that fatal pulmonary toxicities were associated with radiation to the contralateral lung. V{sub 20} was the only independent determinant for risk of PRD or non-cancer-related death. The mean V{sub 20} of the non-PRD patients was considerably lower than that accepted during standard thoracic radiotherapy, implying that the V{sub 20} should be kept as low as possible after extrapleural pneumonectomy.« less

One-year atherothrombotic vascular events rates in outpatients with recent non-cardioembolic ischemic stroke: the EVEREST (Effective Vascular Event REduction after STroke) registry.

PubMed

Suzuki, Norihiro; Sato, Motoki; Houkin, Kiyohiro; Terayama, Yasuo; Uchiyama, Shinichiro; Daida, Hiroyuki; Shigematsu, Hiroshi; Goto, Shinya; Tanaka, Kortaro; Origasa, Hideki; Miyamoto, Susumu; Minematsu, Kazuo; Matsumoto, Masayasu; Okada, Yasushi

2012-05-01

Patients with recent ischemic stroke may have higher risk of atherothrombosis than stable patients with established vascular events. Our aims were to investigate 1-year atherothrombotic vascular event rates and to assess the risk factors for recurrent ischemic stroke in this population. This prospective cohort study was conducted between January 2007 and July 2009 at 313 hospitals in Japan. Outpatients who were at least 45 years of age and who had received oral antiplatelet therapy were enrolled within 2 weeks to 6 months from the last onset of noncardioembolic ischemic stroke. At 12 ± 3 months after enrollment, data on presence/absence of atherothrombotic vascular events were collected. The primary endpoint was the occurrence of fatal or nonfatal ischemic stroke. A total of 3452 patients were enrolled, and 3411 patients who had baseline data were included in the analysis. The 1-year event rate was 3.81% (95% confidence interval 3.15-4.48%) for fatal or nonfatal ischemic stroke and 0.84% (95% confidence interval 0.52-1.15%) for all-cause mortality. The annual rate of recurrent ischemic stroke was significantly higher in patients who had ischemic stroke at least twice than in patients who had first-ever ischemic stroke (5.02% vs 3.59%; P = .0313). In the multivariable Cox regression analysis, recurrent ischemic stroke was significantly associated with age (P = .0033), the presence of diabetes (P = .0129), and waist circumference ≥80 cm (P = .0056). Patients with recent ischemic stroke have a higher risk of stroke recurrence than stable patients enrolled in the REduction of Atherothrombosis for Continued Health (REACH) registry even though they received antiplatelet therapy. The rigorous management of risk factors is needed. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Physical inactivity as a risk factor for primary and secondary coronary events in Göteborg, Sweden.

PubMed

Johansson, S; Rosengren, A; Tsipogianni, A; Ulvenstam, G; Wiklund, I; Wilhelmsen, L

1988-11-01

Physical activity at work and during leisure time were studied by using a questionnaire in a random sample of 7495 middle-aged men from the Primary Prevention Study in Göteborg and in 1273 able-bodied male patients with a first myocardial infarction, registered in the Infarction Register in the same city over the period 1968-84. Data on coronary risk factors and socio-economic factors were recorded in the population sample as were data on risk factors and known somatic predictors for prognosis in the infarction group. An inverse and graded association was found between leisure time physical activity and mean diastolic blood pressure, total cholesterol, body mass index, tobacco smoking, socio-economic status and mental stress in the random sample. During the approximate 12-year follow-up, low physical activity during leisure time, but not at work, was associated with an increased risk of coronary deaths and non-fatal infarctions in univariate analysis. Inactive subjects had twice the incidence of total coronary events (9.4%) as physically active contemporaries (4.2%). After controlling for major coronary risk factors, occupational class, diabetes, family history of coronary heart disease and mental stress in a multivariate logistic regression analysis, the association between leisure time physical activity and total coronary events disappeared. Physical activity at work and during leisure time estimated for the 12-month period preceding the first infarction was not associated with long-term prognosis after infarction. Infarction patients assessed to be in need of additional rehabilitation due to somatic restrictions, work-related factors and emotional instability, resumed work later and had a higher mortality and non-fatal recurrence rate during follow-up than patients not considered to require additional rehabilitation. Physical inactivity was not a risk factor for primary and secondary coronary events in this study. The inverse direction of the association between leisure time physical activity and coronary risk factors suggests that increased physical activity alters the risk factor profile in a favourable direction.

Opportunities for crash and injury reduction: A multiharm approach for crash data analysis.

PubMed

Mallory, Ann; Kender, Allison; Moorhouse, Kevin

2017-05-29

A multiharm approach for analyzing crash and injury data was developed for the ultimate purpose of getting a richer picture of motor vehicle crash outcomes for identifying research opportunities in crash safety. Methods were illustrated using a retrospective analysis of 69,597 occupant cases from NASS CDS from 2005 to 2015. Occupant cases were analyzed by frequency and severity of outcome: fatality, injury by Abbreviated Injury Scale (AIS), number of cases, attributable fatality, disability, and injury costs. Comparative analysis variables included precrash scenario, impact type, and injured body region. Crash and injury prevention opportunities vary depending on the search parameters. For example, occupants in rear-end crash scenarios were more frequent than in any other precrash configuration, yet there were significantly more fatalities and serious injury cases in control loss, road departure, and opposite direction crashes. Fatality is most frequently associated with head and thorax injury, and disability is primarily associated with extremity injury. Costs attributed to specific body regions are more evenly distributed, dominated by injuries to the head, thorax, and extremities but with contributions from all body regions. Though AIS 3+ can be used as a single measure of harm, an analysis based on multiple measures of harm gives a much more detailed picture of the risk presented by a particular injury or set of crash conditions. The developed methods represent a new approach to crash data mining that is expected to be useful for the identification of research priorities and opportunities for reduction of crashes and injuries. As the pace of crash safety improvement accelerates with innovations in both active and passive safety, these techniques for combining outcome measures for insights beyond fatality and serious injury will be increasingly valuable.

Effects of the Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery-related fatal occupational injury.

PubMed

Bulzacchelli, Maria T; Vernick, Jon S; Webster, Daniel W; Lees, Peter S J

2007-10-01

To evaluate the impact of the United States' federal Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery-related fatal occupational injury. The standard, which took effect in 1990, requires employers in certain industries to establish an energy control program and sets minimum criteria for energy control procedures, training, inspections, and hardware. An interrupted time-series design was used to determine the standard's effect on fatality rates. Machinery-related fatalities, obtained from the National Traumatic Occupational Fatalities surveillance system for 1980 through 2001, were used as a proxy for lockout/tagout-related fatalities. Linear regression was used to control for changes in demographic and economic factors. The average annual crude rate of machinery-related fatalities in manufacturing changed little from 1980 to 1989, but declined by 4.59% per year from 1990 to 2001. However, when controlling for demographic and economic factors, the regression model estimate of the standard's effect is a small, non-significant increase of 0.05 deaths per 100 000 production worker full-time equivalents (95% CI -0.14 to 0.25). When fatality rates in comparison groups that should not have been affected by the standard are incorporated into the analysis, there is still no significant change in the rate of machinery-related fatalities in manufacturing. There is no evidence that the lockout/tagout standard decreased fatality rates relative to other trends in occupational safety over the study period. A possible explanation is voluntary use of lockout/tagout by some employers before introduction of the standard and low compliance by other employers after.

Effects of the Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery‐related fatal occupational injury

PubMed Central

Bulzacchelli, Maria T; Vernick, Jon S; Webster, Daniel W; Lees, Peter S J

2007-01-01

Objective To evaluate the impact of the United States' federal Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery‐related fatal occupational injury. The standard, which took effect in 1990, requires employers in certain industries to establish an energy control program and sets minimum criteria for energy control procedures, training, inspections, and hardware. Design An interrupted time‐series design was used to determine the standard's effect on fatality rates. Machinery‐related fatalities, obtained from the National Traumatic Occupational Fatalities surveillance system for 1980 through 2001, were used as a proxy for lockout/tagout‐related fatalities. Linear regression was used to control for changes in demographic and economic factors. Results The average annual crude rate of machinery‐related fatalities in manufacturing changed little from 1980 to 1989, but declined by 4.59% per year from 1990 to 2001. However, when controlling for demographic and economic factors, the regression model estimate of the standard's effect is a small, non‐significant increase of 0.05 deaths per 100 000 production worker full‐time equivalents (95% CI −0.14 to 0.25). When fatality rates in comparison groups that should not have been affected by the standard are incorporated into the analysis, there is still no significant change in the rate of machinery‐related fatalities in manufacturing. Conclusions There is no evidence that the lockout/tagout standard decreased fatality rates relative to other trends in occupational safety over the study period. A possible explanation is voluntary use of lockout/tagout by some employers before introduction of the standard and low compliance by other employers after. PMID:17916891

Modeling the effect of operator and passenger characteristics on the fatality risk of motorcycle crashes

PubMed Central

Tavakoli Kashani, Ali; Rabieyan, Rahim; Besharati, Mohammad Mehdi

2016-01-01

Abstract: Background: In Iran more than 25% of crash fatalities belong to motorcycle operators and passengers in the recent years, from which about 20% are related to passenger fatalities. Methods: The aim of this study was to investigate the motorcycle operator and passenger characteristics as well as other contributory factors that may affect the fatality risk of motorcyclists involved in traffic crashes. To this end, motorcycle crash data between 2009 and 2012 was extracted from Iran traffic crash database and a logistic regression analysis was performed to obtain odds ratio estimates for each of the study variables. Results: The fatality risk of motorcyclists has a direct relationship with the number of pillion passengers carried. Results also indicate that the amount of increase in the likelihood of having a fatality in a motorcycles crash is considerably higher when the operator is accompanied by a male passenger of the same age. Furthermore, results showed that if the crash is occurred in the darkness, on curves, in rural areas and on highways, then the crash would be more likely to be fatal. Moreover, the head-on collisions, older operators, unlicensed operators and not using a safety helmet were found to increase the likelihood of a fatality in a motorcycle crash. Conclusions: Preventative measures such as, imposing stricter rules regarding safety helmet usage and confining the number of pillion passengers to one, might be implemented to reduce the fatality risk in motorcycle crashes. In addition, more appropriate infrastructures for penalizing offending motorcyclists could also reduce the frequency of law violations such as not wearing helmet or riding without motorcycle license, which in turn, would result into a reduction in the fatality risk of motorcycle crashes. PMID:26420217

Temporal factors in motor-vehicle crash deaths: Ten years later.

PubMed

Weast, Rebecca

2018-06-01

To assess trends in traffic fatalities on several temporal scales: year to year, by month, by day of week, and by time of day, to determine why some times correspond with higher rates of crash deaths, and to assess how these trends relate to age, the role of the deceased, and alcohol consumption. Traffic fatalities were identified using the Fatality Analysis Reporting System (FARS) for 1998 through 2014 and assessed for their time of occurrence. Three days that, on average, contained particularly high numbers of crash deaths were then assessed in greater detail, considering the age of the deceased, role of the deceased (vehicle occupant, bicyclist, motorcyclist, or pedestrian), and the blood alcohol content of either the driver (for passenger vehicle occupants) or the deceased. Annual crash fatality totals were much lower in 2014 than in 1998, but the decrease was not steady; a marked drop in crash deaths occurred after 2007 and continued until 2014. On average the most fatalities per day occurred in July and August (116 per day), followed closely by June, September, and October. During the week, the greatest number of fatalities on average occur on weekend days, and during the day the most fatalities tend to occur between the hours of 3p.m. and 7p.m. Holidays like Independence Day and New Year's Day show elevated crash fatalities, and a greater percentage of these crashes involved alcohol, when compared with adjacent days. Certain days and times of year stand out as posing an elevated crash risk, and even with the decrease in average daily fatalities over the past decade, these days and times of year have remained consistent. These results indicate focused areas for continued efforts to reduce fatal crashes. Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.

Factors associated with the severity of fatal accidents in construction workers.

PubMed

Khodabandeh, Farideh; Kabir-Mokamelkhah, Elaheh; Kahani, Mahsa

2016-01-01

Background: Construction work (building houses, roads, workplaces, and repairing and maintaining infrastructures) is a dangerous land-based job. This includes many hazardous tasks and conditions such as working at the following conditions: Height, excavation, noise, dust, power tools and equipment. Construction work has been increased in developed and underdeveloped countries over the past few years. Occupational fatalities have increased with an increase in this type of work. Occupational fatalities refer to individuals who pass way while on the job or performing work related tasks. In the present study, to identify the factors, personal characteristics and work-related factors associated with fatal occupational mortality were assessed using data for Tehran, Iran, 2014-2016. Methods: We conducted a retrospective study, using 967 postmortem reports from fatal occupational injuries collected through postmortem investigations during 2014-2016. A sampling frame of 967 postmortem reports from fatal occupational injuries was used to draw a total sample of 714 fatal construction accidents for this cross-sectional study. Pearson χ2 test and Kruskal-Wallis tests were used for statistical analysis. Results: Based on the results of this study, male gender (n=714; 100%), age range of 30-39 years (n=183; 25.6%), secondary educational level (n=273; 38.2%), being married (317; 44.4%), causal employee (n=389; 54.5%), unskilled performance (389; 54.5%), no insurance coverage (472; 66.1%), and daytime duty work (287; 40.2%) were identified as risk factors for fatality in the event of construction fatal injury. A significant relationship was found between the type of injury and sociodemographic and work related variables. Conclusion: Workers' characteristics such as age, gender, experience, and educational background, and work related variables such as skill training, safety measurement, and close monitoring could be used to discriminate among different severity levels of occupational fatal accidents.

Spatial Analysis of Earthquake Fatalities in the Middle East, 1970-2008: First Results

NASA Astrophysics Data System (ADS)

Khaleghy Rad, M.; Evans, S. G.; Brenning, A.

2010-12-01

Earthquakes claim the lives of thousands of people each year and the annual number of earthquake fatalities in the Middle East (21 countries) is 20 % of the total yearly fatalities of the World. There have been several attempts to estimate the number of fatalities in a given earthquake. We review the results of previous attempts and present an estimation of fatalities using a new conceptual model for life loss that includes hazard (earthquake magnitude and focal depth), vulnerability (GDP value of countries and elapsed time since 1970 as proxy variables) and exposed population in the affected area of a given earthquake. PAGER_CAT is a global catalog (http://earthquake.usgs.gov/research/data/pager/) that presents information on casualties of earthquakes since 1900. Although, the catalog itself is almost a complete record of fatal earthquakes, the data on number of deaths is not complete. We use PAGER_CAT to assemble a Middle East (the latitude and longitude of 10°-42° N and 24°-64° E respectively) catalog for the period 1970-2008 that includes 202 events with published number of fatalities, including events with zero casualties. We investigated the effect of components of each event, e.g. exposed population, instrumental earthquake magnitude, focal depth, date (year of event) and GDP on earthquake fatalities in Middle East in the 202 events with detailed fatality estimates. To estimate the number of people exposed to each event, we used a fatality threshold for peak ground acceleration of 0.1g to calculate the radius of affected area. The exposed population of each event is the enclosed population of each circle calculated from gridded population data available on SEDAC (http://sedac.ciesin.columbia.edu/gpw/global.jsp) using ArcGIS. Results of our statistical model, using Poisson regression in R statistical software, show that the number of fatalities due to earthquakes is in direct (positive) relation to the exposed population and the magnitude of the earthquake at the epicenter. On the other hand, it is in inverse (negative) relation to elapsed time since 1970, focal depth and GDP of the country affected. These spatial and temporal patterns of life loss are consistent with the patterns expected within our conceptual framework in relationship with hazard, exposed population and proxies of vulnerability. Our findings suggest that for earthquakes with comparable physical characteristics, the number of fatalities has been falling since 1970 in the Middle East region. We interpret this as an overall reduction of vulnerability of the Middle East during 1970-2008. Ongoing research is focusing on more detailed analysis of particular indicators of vulnerability reduction such as the development of earthquake building codes and preparedness, and on the spatial disaggregation of exposed population and the attenuation of earthquake magnitude.

Disparities in road crash mortality among pedestrians using wheelchairs in the USA: results of a capture–recapture analysis

PubMed Central

Kraemer, John D; Benton, Connor S

2015-01-01

Objective This study aims to quantify and describe the burden of fatal pedestrian crashes among persons using wheelchairs in the USA from 2006 to 2012. Design The occurrence of fatal pedestrian crashes among pedestrians using wheelchairs was assessed using two-source capture-recapture. Descriptive analysis of fatal crashes was conducted using customary approaches. Setting Two registries were constructed, both of which likely undercounted fatalities among pedestrians who use wheelchairs. The first used data from the Fatality Analysis Reporting System, and the second used a LexisNexis news search. Outcome measures Mortality rate (per 100 000 person-years) and crash-level, driver-level and pedestrian-level characteristics of fatal crashes. Results This study found that, from 2006 to 2012, the mortality rate for pedestrians using wheelchairs was 2.07/100 000 person-years (95% CI 1.60 to 2.54), which was 36% higher than the overall population pedestrian mortality rate (p=0.02). Men's risk was over fivefold higher than women's risk (p<0.001). Compared to the overall population, persons aged 50–64 using wheelchairs had a 38% increased risk (p=0.04), and men who use wheelchairs aged 50–64 had a 75% increased risk over men of the same age in the overall population (p=0.006). Almost half (47.6%; 95% CI 42.8 to 52.5) of fatal crashes occurred in intersections and 38.7% (95% CI 32.0 to 45.0) of intersection crashes occurred at locations without traffic control devices. Among intersection crashes, 47.5% (95% CI 40.6 to 54.5) involved wheelchair users in a crosswalk; no crosswalk was available for 18.3% (95% CI 13.5 to 24.4). Driver failure to yield right-of-way was noted in 21.4% (95% CI 17.7 to 25.7) of crashes, and no crash avoidance manoeuvers were detected in 76.4% (95% CI 71.0 to 81.2). Conclusions Persons who use wheelchairs experience substantial pedestrian mortality disparities calling for behavioural and built environment interventions. PMID:26589426

One side of the story: Examining newspaper coverage of workplace injury and fatality in Ontario, 2007-2012.

PubMed

Gawley, Tim; Dixon, Shane

2015-01-01

News coverage in popular media can shape public perspectives on occupational issues. Few studies exist concerning how occupational injury and fatality are represented in the news. This study examined how injuries, fatalities and worker characteristics were represented in newspapers compared with official government statistics. It also examined what individuals or organizations were most often included by reporters to provide interpretations of injuries and fatalities. Quantitative content analysis was used to examine 304 newspaper articles from between 2007 and 2012 representing the nine most populous cities in the province of Ontario, Canada. Government data came from reports compiled by the Workplace Safety and Insurance Board (WSIB) of Ontario. Compared to workers' compensation board records, physical characteristics of injuries and fatalities were skewed toward the acute traumatic. Women were dramatically underrepresented in newspaper articles. Age distributions were represented. Goods-producing, transportation and resource extraction occupations were overrepresented while services were underrepresented. Worker voices were largely absent in newspaper accounts compared with law enforcement, the State and management. How workplace injury and fatality are framed, and who contributes to these frames, serves to shape public interpretations of occupational injury and fatality and how occupational health and safety issues might be addressed in the future.

Effect of mobile phone proliferation on crash notification times and fatality rates.

PubMed

Stickles, Jimmy L; Kempema, James M; Brown, Lawrence H

2018-01-01

The purpose of this study was to evaluate whether increased proliferation of mobile telephones has been associated with decreased MVC notification times and/or decreased MVC fatality rates in the United States (US). We used World Bank annual mobile phone market penetration data and US Fatality Analysis Reporting System (FARS) fatal MVC data for 1994-2014. For each year, phone proliferation was measured as mobile phones per 100 population. FARS data were used to calculate MVC notification time (time EMS notified - time MVC occurred) in minutes, and to determine the MVC fatality rate per billion vehicle miles traveled (BVMT). We used basic vector auto-regression modeling to explore relationships between changes in phone proliferation and subsequent changes in median and 90th percentile MVC notification times, as well as MVC fatality rates. From 1994 to 2014, larger year-over-year increases in phone proliferation were associated with larger decreases in 90th percentile notification times for MVCs occurring during daylight hours (p=0.004) and on the national highway system (p=0.046) two years subsequent, and crashes off the national highway system three years subsequent (p=0.023). There were no significant associations between changes in phone proliferation and subsequent changes in median crash notification times, nor with subsequent changes in MVC fatality rates. Between 1994 and 2014 increased mobile phone proliferation in the U.S. was associated with shorter 90th percentile EMS notification times for some subgroups of fatal MVCs, but not with decreases in median notification times or overall MVC fatality rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Case report of a fatal bear attack documented by forensic wildlife genetics.

PubMed

Frosch, Christiane; Dutsov, Aleksandar; Georgiev, Georgi; Nowak, Carsten

2011-08-01

Fatal bear attacks on humans are extremely rare across Europe. Here we report a fatal bear attack on a man in Bulgaria. We used microsatellite analysis for bear individualization based on hair samples found near the man's corpse. The genetic profile of the killing bear was compared to that of a bear shot three days later near the killing scene. Our results show that the wrong bear has been shot. Shortly after our results were reported a second person was attacked by a bear nearby. This case documents the importance of forensic DNA analysis following severe wildlife attacks in order to improve wildlife management actions in regions were direct human-bear conflicts are likely to happen. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Motor vehicle crash deaths related to police pursuits in the United States

PubMed Central

Rivara, F; Mack, C

2004-01-01

Objective: To determine the number and characteristics of motor vehicle crash deaths related to police pursuits in the United States. Methods: Analysis of the Fatality Analysis Reporting System and the Crashworthiness Data System of the National Highway Traffic Safety Administration for the years 1994–2002. Results: There were 2654 fatal crashes involving 3965 vehicles and 3146 fatalities during the nine year study period. Of these, 1088 were to people not in the fleeing vehicle. These crashes often occurred at high speed, in the night, on local roads. Most of the pursued drivers had prior motor vehicle related convictions. Conclusions: Many deaths related to police pursuits are to innocent victims. Given that most of the pursued drivers had prior convictions, alternative means of detaining them should be explored. PMID:15066973

Features of fatal injuries in older cyclists in vehicle-bicycle accidents in Japan.

PubMed

Matsui, Yasuhiro; Oikawa, Shoko; Hitosugi, Masahito

2018-01-02

The purpose of this study was to identify and better understand the features of fatal injuries in cyclists aged 75 years and over involved in collisions with either hood- or van-type vehicles. This study investigated the fatal injuries of cyclists aged 75 years old and over by analyzing accident data. We focused on the body regions to which the fatal injury occurred using vehicle-bicycle accident data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) in Japan. Using data from 2009 to 2013, we examined the frequency of fatally injured body region by gender, age, and actual vehicle travel speed. We investigated any significant differences in distributions of fatal injuries by body region for cyclists aged 75 years and over using chi-square tests to compare with cyclists in other age groups. We also investigated the cause of fatal head injuries, such as impact with a road surface or vehicle. The results indicated that head injuries were the most common cause of fatalities among the study group. At low vehicle travel speeds for both hood- and van-type vehicles, fatalities were most likely to be the result of head impacts against the road surface. The percentage of fatalities following hip injuries was significantly higher for cyclists aged 75 years and over than for those aged 65-74 or 13-59 in impacts with hood-type vehicles. It was also higher for women than men in the over-75 age group in impacts with these vehicles. For cyclists aged 75 years and over, wearing a helmet may be helpful to prevent head injuries in vehicle-to-cyclist accidents. It may also be helpful to introduce some safety measures to prevent hip injuries, given the higher level of fatalities following hip injury among all cyclists aged 75 and over, particularly women.

Case reports of aconite poisoning in mainland China from 2004 to 2015: A retrospective analysis.

PubMed

Li, Haoran; Liu, Liang; Zhu, Shaohua; Liu, Qian

2016-08-01

Aconitum species have long been used in key traditional medicines in China, but cases of fatal aconite poisoning have also been reported. This paper presents a review of 40 single and multi-person cases of fatal aconite poisoning. The cases involved 53 victims in mainland China described in 27 case reports published between January 2004 and September 2015. We summarize the details of the case reports in order to highlight the features of fatal aconite-poisoning cases in China, including victims' sex and age, route of intoxication, clinical symptoms, medicolegal autopsy findings, and results of toxicological analysis. Our results indicate a need for legal medical experts encountering cases of fatal aconite poisoning to pay increased attention to the methods used for collecting biological samples. In addition, prevention strategies should focus on increasing public awareness regarding the potential toxicity of Aconitum, harm caused by medicinal liquors containing aconitine, and possibility of Aconitum alkaloids accumulating in the body. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Idiopathic versus secondary venous thromboembolism. Findings of the RIETE registry.

PubMed

Pedrajas, J M; Garmendia, C; Portillo, J; Gabriel, F; Mainez, C; Yera, C; Monreal, M

2014-10-01

The Computerized Registry of Patients with Venous Thromboembolism (RIETE) is a prospective registry that consecutively includes patients diagnosed with venous thromboembolism. We compared the clinical presentation and response to anticoagulant treatment in patients with idiopathic venous thromboembolism (IVT) versus secondary venous thromboembolism (SVT, associated with a risk factor). We analyzed the differences in clinical characteristics, comorbidity, treatment and events during the first 3months after the diagnosis of venous thromboembolism in patients with IVT or SVT and according to their initial clinical presentation. A total of 39,921 patients with IVT (n=18,029; 45.1%) or SVT (n=21,892; 54.9%) were enrolled. The patients with IVT had a greater history of venous thromboembolism than those diagnosed with SVT (p<.001). The initial treatment was similar for the 2 groups, but more inferior vena cava filters were placed in the SVT group (p<.001). In the long term, low-molecular-weight heparin was used more often in the SVT group than in the IVT group. At 90days, bleeding, death and the recurrence of venous thromboembolism were significantly more frequent in the SVT group. The multivariate analysis confirmed that IVT was associated with fewer major (OR, 0.60; 95%CI, 0.50-0.61; p<.001) and fatal (OR, 0.41; 95%CI, 0.29-0.62; p<.001) bleedings, fewer relapses (OR, 0.58; 95%CI, 0.39-0.78; p<.001) and fewer fatal pulmonary embolisms (OR, 0.29; 95%CI, 0.12-0.52; p<.001). These differences were maintained in patients whose venous thromboembolism started with a pulmonary embolism or with deep vein thrombosis. IVT has a better prognosis than SVT at 90days of the diagnosis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Potential associations between fecal shedding of Salmonella in feedlot cattle treated for apparent respiratory disease and subsequent adverse health outcomes

PubMed Central

Jahangir Alam, Mohammad; Renter, David G.; Ives, Samuel E.; Thomson, Daniel U.; Sanderson, Michael W.; Hollis, Larry C.; Nagaraja, Tiruvoor G.

2009-01-01

A prospective cohort study was used to assess whether Salmonella fecal shedding in commercial feedlot cattle treated with antimicrobials for respiratory disease was associated with subsequent adverse health outcomes. Feces were collected per rectum from cattle that were examined for apparent respiratory disease, had a rectal temperature ≥40 °C, and subsequently received antimicrobial treatment. Salmonella were recovered from 918 (73.7%) of 1 245 fecal samples and weekly prevalence estimates ranged from 49 to 100% over the 3-month study. Genotypic and phenotypic characteristics of Salmonella strains in the population were determined. Serogroup E Salmonella were most common (73.3%), followed by C1 (11.0%), C3 (8.6%), and B (1.1%). Predominant serotypes were Orion (46.5%), Anatum (19.8%), Kentucky (8.7%), Montevideo (7.5%), and Senftenberg (4.9%). Few isolates (36/918) were positive for antimicrobial resistance-associated integron gene intI1. Phenotypic susceptibility was associated with isolate intI1 status. Crude re-pull, re-treatment and case fatality risks were higher for cattle that were Salmonella-positive versus -negative at initial treatment, but not statistically different on multivariable analysis. However, case fatality risk was higher for cattle shedding Group B Salmonella than for cattle shedding other serogroups. Lots (groups) with a higher Salmonella prevalence at first treatment had a higher proportion of mortalities occur in a hospital pen, higher overall re-treatment risks, and were more likely to be sampled later in the study. Results indicate a high prevalence of Salmonella in this population of cattle treated for apparent respiratory disease, but that effects associated with clinical outcomes may depend on the Salmonella strain. PMID:18817722

The burden of infectious and cardiovascular diseases in India from 2004 to 2014.

PubMed

Banerjee, Kajori; Dwivedi, Laxmi Kant

2016-01-01

In India, both communicable and non-communicable diseases have been argued to disproportionately affect certain socioeconomic strata of the population. Using the 60th (2004) and 71st (2014) rounds of the National Sample Survey, this study assessed the balance between infectious diseases and cardiovascular diseases (CVD) from 2004 to 2014, as well as changes in the disease burden in various socioeconomic and demographic subpopulations. Prevalence rates, hospitalization rates, case fatality rates, and share of in-patients deaths were estimated to compare the disease burdens at these time points. Logistic regression and multivariate decomposition were used to evaluate changes in disease burden across various socio-demographic and socioeconomic groups. Evidence of stagnation in the infectious disease burden and rapid increase in the CVD burden was observed. Along with the drastic increase in case fatality rate, share of in-patients deaths became more skewed towards CVD from 2004 to 2014. Logistic regression analysis demonstrated a significant shift of the chance of succumbing to CVD from the privileged class, comprising non-Scheduled Castes and Tribes, more highly educated individuals, and households with higher monthly expenditures, towards the underprivileged population. Decomposition indicated that a change in the probability of suffering from CVD among the subcategories of age, social groups, educational status, and monthly household expenditures contributed to the increase in CVD prevalence more than compositional changes of the population from 2004 to 2014. This study provides evidence of the ongoing tendency of CVD to occur in older population segments, and also confirms the theory of diffusion, according to which an increased probability of suffering from CVD has trickled down the socioeconomic gradient.

Sweetened Beverage Consumption, Incident Coronary Heart Disease and Biomarkers of Risk in Men

PubMed Central

de Koning, Lawrence; Malik, Vasanti S.; Kellogg, Mark D.; Rimm, Eric B.; Willett, Walter C.; Hu, Frank B.

2012-01-01

Background Sugar-sweetened beverage consumption is associated with weight gain and risk of type 2 diabetes. Few studies have tested for a relationship with coronary heart disease (CHD), or intermediate biomarkers. The role of artificially sweetened beverages is also unclear. Methods and Results We performed an analysis of the Health Professionals Follow-up study, a prospective cohort study including 42 883 men. Associations of cumulatively averaged sugar-sweetened (e.g. sodas) and artificially sweetened (e.g. diet sodas) beverage intake with incident fatal and non-fatal CHD (myocardial infarction) were examined using proportional hazard models. There were 3683 CHD cases over 22 years of follow-up. Participants in the top quartile of sugar-sweetened beverage intake had a 20% higher relative risk of CHD than those in the bottom quartile (RR=1.20, 95% CI: 1.09, 1.33, p for trend < 0.01) after adjusting for age, smoking, physical activity, alcohol, multivitamins, family history, diet quality, energy intake, BMI, pre-enrollment weight change and dieting. Artificially sweetened beverage consumption was not significantly associated with CHD (multivariate RR=1.02, 95% CI: 0.93, 1.12, p for trend = 0.28). Adjustment for self-reported high cholesterol, high triglycerides, high blood pressure and diagnosed type 2 diabetes slightly attenuated these associations. Intake of sugar-sweetened but not artificially sweetened beverages was significantly associated with increased triglycerides, CRP, IL6, TNFr1, TNFr2, decreased HDL, Lp(a), and leptin (p values < 0.02). Conclusions Consumption of sugar-sweetened beverages was associated with increased risk of CHD and some adverse changes in lipids, inflammatory factors, and leptin. Artificially sweetened beverage intake was not associated with CHD risk or biomarkers. PMID:22412070

J-shaped relationship between habitual coffee consumption and 10-year (2002-2012) cardiovascular disease incidence: the ATTICA study.

PubMed

Kouli, Georgia-Maria; Panagiotakos, Demosthenes B; Georgousopoulou, Ekavi N; Mellor, Duane D; Chrysohoou, Christina; Zana, Adela; Tsigos, Constantine; Tousoulis, Dimitrios; Stefanadis, Christodoulos; Pitsavos, Christos

2018-06-01

The purpose of this work was to evaluate the association between coffee consumption and 10-year cardiovascular disease (CVD) incidence in the ATTICA study, and whether this is modified by the presence or absence of metabolic syndrome (MetS) at baseline. During 2001-2002, 3042 healthy adults (1514 men and 1528 women) living in the greater area of Athens were voluntarily recruited to the ATTICA study. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Coffee consumption was assessed by a validated food-frequency questionnaire at baseline (abstention, low, moderate, heavy). Incidence of fatal or non-fatal CVD event was recorded using WHO-ICD-10 criteria and MetS was defined by the National Cholesterol Education Program Adult Treatment panel III (revised) criteria. Overall, after controlling for potential CVD risk factors, the multivariate analysis revealed a J-shaped association between daily coffee drinking and the risk for a first CVD event in a 10-year period. Particularly, the odds ratio for low (<150 ml/day), moderate (150-250 ml/day) and heavy coffee consumption (>250 ml/day), compared to abstention, were 0.44 (95% CI 0.29-0.68), 0.49 (95% CI 0.27-0.92) and 2.48 (95% CI 1.56-1.93), respectively. This inverse association was also verified among participants without MetS at baseline, but not among participants with the MetS. These data support the protective effect of drinking moderate quantities of coffee (equivalent to approximately 1-2 cups daily) against CVD incidents. This protective effect was only significant for participants without MetS at baseline.

High dietary protein intake is associated with an increased body weight and total death risk.

PubMed

Hernández-Alonso, Pablo; Salas-Salvadó, Jordi; Ruiz-Canela, Miguel; Corella, Dolores; Estruch, Ramón; Fitó, Montserrat; Arós, Fernando; Gómez-Gracia, Enrique; Fiol, Miquel; Lapetra, José; Basora, Josep; Serra-Majem, Lluis; Muñoz, Miguel Ángel; Buil-Cosiales, Pilar; Saiz, Carmen; Bulló, Mònica

2016-04-01

High dietary protein diets are widely used to manage overweight and obesity. However, there is a lack of consensus about their long-term efficacy and safety. Therefore, the aim of this study was to assess the effect of long-term high-protein consumption on body weight changes and death outcomes in subjects at high cardiovascular risk. A secondary analysis of the PREDIMED trial was conducted. Dietary protein was assessed using a food-frequency questionnaire during the follow-up. Cox proportional hazard models were used to estimate the multivariate-adjusted hazard ratio (HR) and 95% confidence intervals (95%CI) for protein intake in relation to the risk of body weight and waist circumference changes, cardiovascular disease, cardiovascular death, cancer death and total death. Higher total protein intake, expressed as percentage of energy, was significantly associated with a greater risk of weight gain when protein replaced carbohydrates (HR: 1.90; 95%CI: 1.05, 3.46) but not when replaced fat (HR: 1.69; 95%CI: 0.94, 3.03). However, no association was found between protein intake and waist circumference. Contrary, higher total protein intake was associated with a greater risk of all-cause death in both carbohydrate and fat substitution models (HR: 1.59; 95%CI: 1.08, 2.35; and HR: 1.66; 95%CI: 1.13, 2.43, respectively). A higher consumption of animal protein was associated with an increased risk of fatal and non-fatal outcomes when protein substituted carbohydrates or fat. Higher dietary protein intake is associated with long-term increased risk of body weight gain and overall death in a Mediterranean population at high cardiovascular risk. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Trauma center accessibility for road traffic injuries in Hanoi, Vietnam.

PubMed

Nagata, Takashi; Takamori, Ayako; Kimura, Yoshinari; Kimura, Akio; Hashizume, Makoto; Nakahara, Shinji

2011-09-30

Rapid economic growth in Vietnam over the last decade has led to an increased frequency of road traffic injury (RTI), which now represents one of the leading causes of death in the nation. Various efforts toward injury prevention have not produced a significant decline in the incidence of RTIs. Our study sought to describe the geographic distribution of RTIs in Hanoi, Vietnam and to evaluate the accessibility of trauma centers to those injured in the city. We performed a cross-sectional study using Hanoi city police reports from 2006 to describe the epidemiology of RTIs occurring in Hanoi city. Additionally, we identified geographic patterns and determined the direct distance from injury sites to trauma centers by applying geographical information system (GIS) software. Factors associated with the accessibility of trauma centers were evaluated by multivariate regression analysis. We mapped 1,271 RTIs in Hanoi city. About 40% of RTIs occurred among people 20-29 years of age. Additionally, 63% of RTIs were motorcycle-associated incidents. Two peak times of injury occurrence were observed: 12 am-4 pm and 8 pm-0 am. "Hot spots" of road traffic injuries/fatalities were identified in the city area and on main highways using Kernel density estimation. Interestingly, RTIs occurring along the two north-south main roads were not within easy access of trauma centers. Further, fatal cases, gender and injury mechanism were significantly associated with the distance between injury location and trauma centers. Geographical patterns of RTIs in Hanoi city differed by gender, time, and injury mechanism; such information may be useful for injury prevention. Specifically, RTIs occurring along the two north-south main roads have lower accessibility to trauma centers, thus an emergency medical service system should be established.

Assessing global risk factors for non-fatal injuries from road traffic accidents and falls in adults aged 35-70 years in 17 countries: a cross-sectional analysis of the Prospective Urban Rural Epidemiological (PURE) study.

PubMed

Raina, Parminder; Sohel, Nazmul; Oremus, Mark; Shannon, Harry; Mony, Prem; Kumar, Rajesh; Li, Wei; Wang, Yang; Wang, Xingyu; Yusoff, Khalid; Yusuf, Rita; Iqbal, Romaina; Szuba, Andrzej; Oguz, Aytekin; Rosengren, Annika; Kruger, Annamarie; Chifamba, Jephat; Mohammadifard, Noushin; Darwish, Ebtihal Ahmad; Dagenais, Gilles; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Seron, Pamela; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim

2016-04-01

To assess risk factors associated with non-fatal injuries (NFIs) from road traffic accidents (RTAs) or falls. Our study included 151 609 participants from the Prospective Urban Rural Epidemiological study. Participants reported whether they experienced injuries within the past 12 months that limited normal activities. Additional questions elicited data on risk factors. We employed multivariable logistic regression to analyse data. Overall, 5979 participants (3.9% of 151 609) reported at least one NFI. Total number of NFIs was 6300: 1428 were caused by RTAs (22.7%), 1948 by falls (30.9%) and 2924 by other causes (46.4%). Married/common law status was associated with fewer falls, but not with RTA. Age 65-70 years was associated with fewer RTAs, but more falls; age 55-64 years was associated with more falls. Male versus female was associated with more RTAs and fewer falls. In lower-middle-income countries, rural residence was associated with more RTAs and falls; in low-income countries, rural residence was associated with fewer RTAs. Previous alcohol use was associated with more RTAs and falls; current alcohol use was associated with more falls. Education was not associated with either NFI type. This study of persons aged 35-70 years found that some risk factors for NFI differ according to whether the injury is related to RTA or falls. Policymakers may use these differences to guide the design of prevention policies for RTA-related or fall-related NFI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

PubMed Central

Soldevila, Núria; Toledo, Diana; Torner, Núria; Force, Luis; Pérez, María José; Martín, Vicente; Rodríguez-Rojas, Lourdes; Astray, Jenaro; Egurrola, Mikel; Sanz, Francisco; Castilla, Jesús

2017-01-01

Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013–2014 and 2014–2015. We selected patients aged ≥65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1–30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3–56.9) in all patients, 30.9% (95% CI -32.2–67.4) in immunocompetent patients and 26.9% (95% CI -38.6–64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP. PMID:28187206

Influence of multidrug resistant organisms on the outcome of diabetic foot infection.

PubMed

Saltoglu, Nese; Ergonul, Onder; Tulek, Necla; Yemisen, Mucahit; Kadanali, Ayten; Karagoz, Gul; Batirel, Ayse; Ak, Oznur; Sonmezer, Cagla; Eraksoy, Haluk; Cagatay, Atahan; Surme, Serkan; Nemli, Salih A; Demirdal, Tuna; Coskun, Omer; Ozturk, Derya; Ceran, Nurgul; Pehlivanoglu, Filiz; Sengoz, Gonul; Aslan, Turan; Akkoyunlu, Yasemin; Oncul, Oral; Ay, Hakan; Mulazımoglu, Lutfiye; Erturk, Buket; Yilmaz, Fatma; Yoruk, Gulsen; Uzun, Nuray; Simsek, Funda; Yildirmak, Taner; Yaşar, Kadriye Kart; Sonmezoglu, Meral; Küçükardali, Yasar; Tuna, Nazan; Karabay, Oguz; Ozgunes, Nail; Sargın, Fatma

2018-05-01

We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001). Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Effect of educational level on the prognosis of acute myocardial infarction].

PubMed

Nazzal, Carolina; Corbalán, Ramón; Díaz, Claudia; Sepúlveda, Pablo; Schacht, Eliana

2015-07-01

Socioeconomic status is associated with cardiovascular mortality. To evaluate the effect of educational level, on the prognosis of patients with acute myocardial infarction in Chile. Cohort study of 3,636 patients aged 63.1 ± 13.2 years, 27% women, hospitalized in 16 centers participating in the Chilean Myocardial Infarction Registry (GEMI) between 2009 and 2012. Vital status was obtained from the National Mortality Database. Patients were divided, according to educational level, in four groups, namely none (no formal education), basic (< 8 years), secondary (8-12 years) and tertiary (> 12 years). Crude and adjusted (age, sex, cardiovascular risk factors and treatments) hazard ratios (HR) were estimated using Cox regression models. The distribution by educational level was 3.2% none, 31.8% basic, 43.0% secondary and 22.0% tertiary. During a median follow-up period of 22 months (interquartile range 11-37 years), 631 patients died (17.3%), of whom 198 died during hospitalization (5.5%). The 30 day case-fatality rate according to educational level was 3.4% in tertiary, 4.7% in secondary, 11.9% in basic, 19.1% in none (p < 0.0001). Among patients surviving the first 30 days, the case-fatality rate was 4.4%, 8.6%, 14.6% and 27.0%, respectively (p < 0.0001). The increased risk of death for groups with lower education compared with individuals with tertiary education, persisted in the multivariate analysis with a hazard ratio for secondary education 1.58 (95% confidence intervals (CI), 1.18-2.10); for basic education 1.90 (95% CI, 1.41-2.47) and for none 3.50 (95% CI, 2.35-5.21). A lower educational level was associated with a worse prognosis in patients with myocardial infarction, even after controlling for potential confounding factors.

Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis

PubMed Central

Sabaté, Manel; Kaiser, Christoph; Brugaletta, Salvatore; de la Torre Hernandez, Jose Maria; Galatius, Soeren; Cequier, Angel; Eberli, Franz; de Belder, Adam; Serruys, Patrick W; Ferrante, Giuseppe

2014-01-01

Objectives To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents. Design Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported. Data sources and study selection Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. Primary outcomes The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death. Results The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. Conclusions This meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis. PMID:25378023

Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis.

PubMed

Valgimigli, Marco; Sabaté, Manel; Kaiser, Christoph; Brugaletta, Salvatore; de la Torre Hernandez, Jose Maria; Galatius, Soeren; Cequier, Angel; Eberli, Franz; de Belder, Adam; Serruys, Patrick W; Ferrante, Giuseppe

2014-11-04

To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents. Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported. Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death. The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. This meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis. © Valgimigli et al 2014.

The potential impact of rural mayday systems on vehicular crash fatalities.

PubMed

Evanco, W M

1999-09-01

Rural mayday systems can reduce the time between the occurrence of an accident and the notification of emergency medical services--called the accident notification time. Reductions in this time, in turn, may affect the numbers of fatalities. A statistical analysis is used to estimate the quantitative relationship between fatalities and the accident notification time. The elasticity of rural fatalities with respect to the accident notification time was found to be 0.14. If a rural mayday system were fully implemented (i.e. a 100% market penetration) and the service availability were 100%, then we would expect monetary benefits of about $1.83 billion per year and comprehensive benefits (which includes the monetary value attached to the lost quality of life) of $6.37 billion per year.

Extended-release niacin therapy and risk of ischemic stroke in patients with cardiovascular disease: the Atherothrombosis Intervention in Metabolic Syndrome with low HDL/High Triglycerides: Impact on Global Health Outcome (AIM-HIGH) trial.

PubMed

Teo, Koon K; Goldstein, Larry B; Chaitman, Bernard R; Grant, Shannon; Weintraub, William S; Anderson, David C; Sila, Cathy A; Cruz-Flores, Salvador; Padley, Robert J; Kostuk, William J; Boden, William E

2013-10-01

In Atherothrombosis Intervention in Metabolic Syndrome with low HDL/High Triglycerides: Impact on Global Health Outcomes (AIM-HIGH) trial, addition of extended-release niacin (ERN) to simvastatin in participants with established cardiovascular disease, low high-density lipoprotein cholesterol, and high triglycerides had no incremental benefit, despite increases in high-density lipoprotein cholesterol. Preliminary analysis based on incomplete end point adjudication suggested increased ischemic stroke risk among participants randomized to ERN. This final analysis was conducted after complete AIM-HIGH event ascertainment to further explore potential relationship between niacin therapy and ischemic stroke risk. There was no group difference in trial primary composite end point at a mean 36-month follow-up among 3414 patients (85% men; mean age, 64±9 years) randomized to simvastatin plus ERN (1500-2000 mg/d) versus simvastatin plus matching placebo. In the intention-to-treat analysis, there were 50 fatal or nonfatal ischemic strokes: 18 (1.06%) in placebo arm versus 32 (1.86%) in ERN arm (hazard ratio [HR], 1.78 [95% confidence interval {CI}, 1.00-3.17; P=0.050). Multivariate analysis showed independent associations between ischemic stroke risk and >65 years of age (HR, 3.58; 95% CI, 1.82-7.05; P=0.0002), history of stroke/transient ischemic attack/carotid disease (HR, 2.18; 95% CI, 1.23-3.88; P=0.0079), elevated baseline Lp(a) (HR, 2.80; 95% CI, 1.25-6.27 comparing the middle with the lowest tertile; HR, 2.31; 95% CI, 1.002-5.30 comparing the highest with the lowest tertile; overall P=0.042) but a nonsignificant association with ERN (HR, 1.74; 95% CI, 0.97-3.11; P=0.063). Although there were numerically more ischemic strokes with addition of ERN to simvastatin that reached nominal significance, the number was small, and multivariable analysis accounting for known risk factors did not support a significant association between niacin and ischemic stroke risk. http://www.clinicaltrials.gov. Unique identifier: NCT00120289.

All-terrain vehicle fatalities on paved roads, unpaved roads, and off-road: Evidence for informed roadway safety warnings and legislation.

PubMed

Denning, Gerene M; Jennissen, Charles A

2016-05-18

All-terrain vehicles (ATVs) are designed for off-highway use only, and many of their features create increased risk with roadway travel. Over half of all ATV-related fatalities occur on roadways, and nonfatal roadway crashes result in more serious injuries than those off the road. A number of jurisdictions have passed or have considered legislation allowing ATVs on public roadways, sometimes limiting them to those unpaved, arguing that they are safe for ATVs. However, no studies have determined the epidemiology of ATV-related fatalities on different road surface types. The objective of the study was to compare ATV-related deaths on paved versus unpaved roads and to contrast them with off-road fatalities. Retrospective descriptive and multivariable analyses were performed using U.S. Consumer Product Safety Commission fatality data from 1982 through 2012. After 1998, ATV-related deaths increased at twice the rate on paved versus unpaved roads. Still, 42% of all roadway deaths during the study period occurred on unpaved surfaces. States varied considerably, ranging from 18% to 79% of their ATV-related roadway deaths occurring on unpaved roads. Paved road crashes were more likely than those on unpaved surfaces to involve males, adolescents and younger adults, passengers, and collisions with other vehicles. Both the pattern of other vehicles involved in collisions and which vehicle hit the other were different for the 2 road types. Alcohol use was higher, helmet use was lower, and head injuries were more likely in paved versus unpaved roadway crashes. However, head injuries still occurred in 76% of fatalities on unpaved roads. Helmets were associated with lower proportions of head injuries among riders, regardless of road surface type. Relative to off-road crashes, both paved and unpaved roads were more likely to involve collisions with another vehicle. The vast majority of roadway crashes, however, did not involve a traffic collision on either paved or unpaved roads. Although differences were observed between paved and unpaved roads, our results show that riding on either represented significantly greater dangers than riding off the road. Many vehicle warnings specifically mention the risks of paved but not unpaved roads, yet we found 23 states with half or more of their roadway deaths on unpaved surfaces. Safety warnings should explicitly state the dangers of roadway riding regardless of surface type. These data further support laws/ordinances greatly restricting ATV riding on all types of public roadways.

Circumstances of fatal lockout/tagout-related injuries in manufacturing.

PubMed

Bulzacchelli, Maria T; Vernick, Jon S; Sorock, Gary S; Webster, Daniel W; Lees, Peter S J

2008-10-01

Over the past few decades, hundreds of manufacturing workers have suffered fatal injuries while performing maintenance and servicing on machinery and equipment. Using lockout/tagout procedures could have prevented many of these deaths. A narrative text analysis of OSHA accident investigation report summaries was conducted to describe the circumstances of lockout/tagout-related fatalities occurring in the US manufacturing industry from 1984 to 1997. The most common mechanisms of injury were being caught in or between parts of equipment, electrocution, and being struck by or against objects. Typical scenarios included cleaning a mixer or blender, cleaning a conveyor, and installing or disassembling electrical equipment. Lockout procedures were not even attempted in the majority (at least 58.8%) of fatal incidents reviewed. Lockout/tagout-related fatalities occur under a wide range of circumstances. Enhanced training and equipment designs that facilitate lockout and minimize worker contact with machine parts may prevent many lockout/tagout-related injuries. Published 2008 Wiley-Liss, Inc.

Marketing and alcohol-related traffic fatalities: impact of alcohol advertising targeting minors.

PubMed

Smith, Ryan C; Geller, E Scott

2009-10-01

Alcohol-related youth traffic fatalities continue as a major public-health concern. While state and federal laws can be useful in tackling this problem, the efficacy of many laws has not been empirically demonstrated. We examined the impact of state laws prohibiting alcohol advertising to target minors. Using statistics obtained from the Fatality Analysis Reporting System (FARS), youth alcohol-related, single-vehicle, driver traffic fatalities were compared by state as a function of whether the state has a law prohibiting alcohol advertising that targets minors. Overall, states possessing this law experienced 32.9% fewer of the above specified traffic fatalities. DISCUSSION AND IMPACT ON INDUSTRY: The results suggest that not only are youth drinking rates affected by alcohol advertisements targeting youth, but also drink-driving behaviors. Indeed, we estimate that if this type of legislation were adopted in the 26 states that do not prohibit targeting of minors with alcohol advertising, then 400 youth lives could be saved annually.

Impact of the 1994 alcohol production and sales deregulation policy on traffic crashes and fatalities in Japan.

PubMed

Desapriya, Ediriweera; Fujiwara, Takeo; Dutt, Namrata; Arason, Neil; Pike, Ian

2012-09-01

. Many studies have demonstrated a strong relationship between alcohol availability and traffic crashes involving alcohol-impaired drivers. The present analysis focuses on the evaluation of the impact of alcohol availability on the Japanese population by comparing fatal and nonfatal motor vehicle crash rates before and after implementation of the alcohol deregulation policy in 1994. Participants and method. Poisson regression with robust standard error was used to model the before-to-after change in incidence rate ratios (IRRs) in the population. To control for potential confounders, per capita alcohol consumption, unemployment rate, and vehicle miles travelled (VMT) were also added to the model. The exponents of the fitted coefficients are equivalent to the IRRs. . Implementation of the policy deregulating alcohol sales and production did not appear to increase traffic fatalities and other traffic crashes in Japan. In the overall study results, nighttime fatalities were reduced statistically significantly by 6% since the implementation of the alcohol deregulation policy in 1994. Discussion. Contrary to previous research, the findings of this study demonstrated lower rates of fatalities and higher compliance with alcohol-related driving legislation. Further well-designed, nonaligned studies on alcohol availability and traffic fatalities in other countries are urgently needed.

Motorcycle fatalities among out-of-state riders and the role of universal helmet laws.

PubMed

French, Michael T; Gumus, Gulcin; Homer, Jenny F

2012-11-01

Several studies have demonstrated that universal helmet laws (UHLs) and other motor vehicle policies are effective in reducing fatal and non-fatal motorcycle injuries. Although state policies can improve traffic safety overall, very little is known about how they affect different segments of motorcycle riders. In this paper, we investigate the differential effectiveness of such policies by license state of the rider (i.e., in-state versus out-of-state). From a policy perspective, this information gap is noteworthy because variations in state regulations may influence where individuals choose to ride. We use state-level longitudinal (1988-2008) data on motorcycle fatalities in the United States from the fatality analysis reporting system (FARS). Our results reconfirm the effectiveness of UHLs and offer new evidence suggesting that states without such policies may attract more risky riders from out-of-state. In particular, not having a UHL increases out-of-state rider fatalities by 18 percent and this effect is more pronounced for out-of-state riders who reside in a UHL state. These findings have important implications regarding unintended spillover effects of state-specific motor vehicle policies. Copyright © 2012 Elsevier Ltd. All rights reserved.

Determinant of Road Traffic Crash Fatalities in Iran: A Longitudinal Econometric Analysis.

PubMed

Rezaei, Satar; Bagheri Lankarani, Kamran; Karami Matin, Behzad; Bazyar, Mohammad; Hamzeh, Behrooz; Najafi, Farid

2015-01-01

Injuries and deaths from road traffic crashes are one of the main public health problems throughout the world. This study aimed to identify determinants of fatality traffic accident in Iran for the twenty-span year from 1991 to 2011. A time series analysis (1991-2011) was used to examine the effects of some of the key explanatory factors (GDP per capita, number of doctors per 10,000 populations, degree of urbanization, unemployment rate and motorization rate) on deaths from road traffic in Iran. In order to examine long- and short-run effects of variables, we employed autoregressive distributed lag (ARDL) approach and error correction method (ECM). The data for the study was obtained from the Central Bank of Iran (CBI), Iranian Statistical Center (ISC) and Legal medical organizations (LMO). GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate had a significant impact on fatality from road traffic in Iran. We did not observe any short- and long-term effects of the unemployment rate on fatality from road traffic. GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate were identified as main determinant of fatality from road traffic accidents in Iran. We hope the results of the current study enable health policy-makers to understand better the factors affecting deaths from road traffic accidents in the country.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009.

PubMed

McAndrews, Carolyn; Beyer, Kirsten; Guse, Clare E; Layde, Peter

2013-11-01

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Fatal poisoning in the Department of Toxicology in Poznarn in 2008-2012--preliminary analysis].

PubMed

Łukasik-Głebocka, Magdalena; Adamek, Robert

2013-01-01

This paper presents the results of a preliminary analysis of deaths from acute poisoning, which occurred in the Department of Toxicology in Poznań in 2008-2012. During this period, recorded 31 cases of fatal poisoning, representing 0.38% of all treated cases. In subsequent years the percentage of poisoning deaths ranged from 0.25 to 0.49%. Throughout the period leading cause of fatal poisoning were drugs (38.71%) and non-consumptive alcohols (methanol or ethylene glycol) (38.71%). In subsequent years, however, a decrease in the percentage of drug poisoning (from 75 to 0%) and an increase in the percentage of nonconsumptive alcohol poisoning (from 0% to 100%) were observed. In fatal cases were diagnosed among others olanzapine, carbamazepine, pseudoephedrine, tramadol, benzodiazepines, clozapine, morphine and benzodiazepines, insulin, verapamil, carbon monoxide and smoke fire, cyanide, Amanita phalloides, ethanol and a mixture of drugs with ethanol poisoning. The most common fatal poisoning occurred in people addicted (45.16%), mainly in alcohol dependence syndrome (35.48%). Suicidal poisoning was the cause of 32.26% of the deaths, while accidental of 19.35%. In nine cases, the procedure of diagnosis of death from irreversible cessation of brain stem function was performed in order to qualify donors of organs for transplantation or to terminate the therapy. One of the dead was liver and kidneys, and two were kidneys donors.

Boxing fatalities in relation to rule changes in Japan: secondary data analysis.

PubMed

Teramoto, Masaru; Cross, Chad L; Cushman, Daniel M; Willick, Stuart E

2018-01-18

To examine whether changing weigh-in from the same day of the match to the day before the match and prohibiting 6-oz gloves are associated with fatalities in boxing matches sanctioned by the Japan Boxing Commission (JBC). We analyzed the rates of boxing fatalities before and after the two rule changes above via secondary analysis of data. Demographics and boxing records of deceased boxers were examined using descriptive statistics, exact binomial test the Mann-Whitney-Wilcoxon test and Fisher's exact tests. As of this study, a total of 38 boxers (23.9 ± 3.3 years of age) reportedly died due to injuries sustained in JBC-sanctioned boxing matches since 1952. Changing weigh-in to the day before the match or prohibiting 6-oz gloves was not significantly associated with the rates of boxing fatalities 5 years and 10 years before and after the rule changes (p > 0.05). Deceased boxers after these rule changes were significantly older, completed significantly more rounds in the final match, and were significantly less likely to lose the previous match (prior to the final match) and to do so by knockouts (p < 0.05). Changing weigh-in to the day before the match and prohibiting 6-oz gloves may not result in reducing boxing fatalities.

The Association between Regional Environmental Factors and Road Trauma Rates: A Geospatial Analysis of 10 Years of Road Traffic Crashes in British Columbia, Canada

PubMed Central

Brubacher, Jeffrey R.; Chan, Herbert; Erdelyi, Shannon; Schuurman, Nadine; Amram, Ofer

2016-01-01

Background British Columbia, Canada is a geographically large jurisdiction with varied environmental and socio-cultural contexts. This cross-sectional study examined variation in motor vehicle crash rates across 100 police patrols to investigate the association of crashes with key explanatory factors. Methods Eleven crash outcomes (total crashes, injury crashes, fatal crashes, speed related fatal crashes, total fatalities, single-vehicle night-time crashes, rear-end collisions, and collisions involving heavy vehicles, pedestrians, cyclists, or motorcyclists) were identified from police collision reports and insurance claims and mapped to police patrols. Six potential explanatory factors (intensity of traffic law enforcement, speed limits, climate, remoteness, socio-economic factors, and alcohol consumption) were also mapped to police patrols. We then studied the association between crashes and explanatory factors using negative binomial models with crash count per patrol as the response variable and explanatory factors as covariates. Results Between 2003 and 2012 there were 1,434,239 insurance claim collisions, 386,326 police reported crashes, and 3,404 fatal crashes. Across police patrols, there was marked variation in per capita crash rate and in potential explanatory factors. Several factors were associated with crash rates. Percent roads with speed limits ≤ 60 km/hr was positively associated with total crashes, injury crashes, rear end collisions, and collisions involving pedestrians, cyclists, and heavy vehicles; and negatively associated with single vehicle night-time crashes, fatal crashes, fatal speeding crashes, and total fatalities. Higher winter temperature was associated with lower rates of overall collisions, single vehicle night-time collisions, collisions involving heavy vehicles, and total fatalities. Lower socio-economic status was associated with higher rates of injury collisions, pedestrian collisions, fatal speeding collisions, and fatal collisions. Regions with dedicated traffic officers had fewer fatal crashes and fewer fatal speed related crashes but more rear end crashes and more crashes involving cyclists or pedestrians. The number of traffic citations per 1000 drivers was positively associated with total crashes, fatal crashes, total fatalities, fatal speeding crashes, injury crashes, single vehicle night-time crashes, and heavy vehicle crashes. Possible explanations for these associations are discussed. Conclusions There is wide variation in per capita rates of motor vehicle crashes across BC police patrols. Some variation is explained by factors such as climate, road type, remoteness, socioeconomic variables, and enforcement intensity. The ability of explanatory factors to predict crash rates would be improved if considered with local traffic volume by all travel modes. PMID:27099930

Asian and Hispanic Americans' cancer fatalism and colon cancer screening.

PubMed

Jun, Jungmi; Oh, Kyeung Mi

2013-03-01

To explore fatalistic attributions of colon cancer development among Asian and Hispanic Americans in comparison with non-Hispanic whites; also to examine the impacts of fatalism on adherence to the colon cancer screening guideline. For the analysis, the 2005 Health Information National Trends Survey data were employed. Both Asian and Hispanic Americans were more likely to make fatalistic attribution and were less likely to follow the guideline than whites. Particularly for Asians, fatalism was a significant predictor for not adhering to the guideline. These findings emphasize the need for cultural interventions to disrupt fatalistic attitudes towards colon cancer preventions.

Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

PubMed Central

Dolwani, Sunil; Graziano, J. Michael; Lanas, Angel; Longley, Marcus; Phillips, Ceri J.; Roberts, Stephen E.; Soon, Swee S.; Steward, Will

2016-01-01

Background Aspirin has been shown to lower the incidence and the mortality of vascular disease and cancer but its wider adoption appears to be seriously impeded by concerns about gastrointestinal (GI) bleeding. Unlike heart attacks, stroke and cancer, GI bleeding is an acute event, usually followed by complete recovery. We propose therefore that a more appropriate evaluation of the risk-benefit balance would be based on fatal adverse events, rather than on the incidence of bleeding. We therefore present a literature search and meta-analysis to ascertain fatal events attributable to low-dose aspirin. Methods In a systematic literature review we identified reports of randomised controlled trials of aspirin in which both total GI bleeding events and bleeds that led to death had been reported. Principal investigators of studies in which fatal events had not been adequately described were contacted via email and asked for further details. A meta-analyses was then performed to estimate the risk of fatal gastrointestinal bleeding attributable to low-dose aspirin. Results Eleven randomised trials were identified in the literature search. In these the relative risk (RR) of ‘major’ incident GI bleeding in subjects who had been randomised to low-dose aspirin was 1.55 (95% CI 1.33, 1.83), and the risk of a bleed attributable to aspirin being fatal was 0.45 (95% CI 0.25, 0.80). In all the subjects randomised to aspirin, compared with those randomised not to receive aspirin, there was no significant increase in the risk of a fatal bleed (RR 0.77; 95% CI 0.41, 1.43). Conclusions The majority of the adverse events caused by aspirin are GI bleeds, and there appears to be no valid evidence that the overall frequency of fatal GI bleeds is increased by aspirin. The substantive risk for prophylactic aspirin is therefore cerebral haemorrhage which can be fatal or severely disabling, with an estimated risk of one death and one disabling stroke for every 1,000 people taking aspirin for ten years. These adverse effects of aspirin should be weighed against the reductions in vascular disease and cancer. PMID:27846246

Epidemiology of Road Traffic Injury Fatalities among Car Users; A Study Based on Forensic Medicine Data in East Azerbaijan of Iran

PubMed Central

Sadeghi-Bazargani, Homayoun; Samadirad, Bahram; Shahedifar, Nasrin; Golestani, Mina

2018-01-01

Objective: To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran. Methods: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics (p<0.05) and inferential statistical methods such as Chi-squared test and multivariate logistic regression with p<0.1 were applied.               Results: Of the 7818 road traffic injury (RTI) deaths, 3051 (39%) were car users of whom 71% were male (mean age of 36.7±18.5 years). The majority of accident mechanisms were vehicle-vehicle crashes (63.95%), followed by rollover (26.24%). Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma (in 62.5%). In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses. Conclusion: Decreasing the car users’ fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained. PMID:29719846

76 FR 54163 - Proximity Detection Systems for Continuous Mining Machines in Underground Coal Mines

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-31

... analysis of fatalities and non-fatal accidents during the 1984 through 2010 period indicates that many of... under 30 CFR 18.82 and issued an experimental permit on May 30, 2003. After several revisions, the... Geosteering Tramguard TM System, which MSHA tested in June 2005 under an experimental permit on a remote...

Traffic safety facts 2004 : a compilation of motor vehicle crash data from the fatality analysis reporting system and the general estimates system

DOT National Transportation Integrated Search

2005-01-01

Fatal crash data from FARS and nonfatal crash data from GES are presented in this report in five chapters. Chapter 1, Trends, presents data from all years of FARS (1975 through 2004) and GES (1988 through 2004). The remaining chapters present d...

Evaluating the Effectiveness of an Ultrasonic Acoustic Deterrent for Reducing Bat Fatalities at Wind Turbines.

PubMed

Arnett, Edward B; Hein, Cris D; Schirmacher, Michael R; Huso, Manuela M P; Szewczak, Joseph M

2013-01-01

Large numbers of bats are killed by wind turbines worldwide and minimizing fatalities is critically important to bat conservation and acceptance of wind energy development. We implemented a 2-year study testing the effectiveness of an ultrasonic acoustic deterrent for reducing bat fatalities at a wind energy facility in Pennsylvania. We randomly selected control and treatment turbines that were searched daily in summer and fall 2009 and 2010. Estimates of fatality, corrected for field biases, were compared between treatment and control turbines. In 2009, we estimated 21-51% fewer bats were killed per treatment turbine than per control turbine. In 2010, we determined an approximate 9% inherent difference between treatment and control turbines and when factored into our analysis, variation increased and between 2% more and 64% fewer bats were killed per treatment turbine relative to control turbines. We estimated twice as many hoary bats were killed per control turbine than treatment turbine, and nearly twice as many silver-haired bats in 2009. In 2010, although we estimated nearly twice as many hoary bats and nearly 4 times as many silver-haired bats killed per control turbine than at treatment turbines during the treatment period, these only represented an approximate 20% increase in fatality relative to the pre-treatment period for these species when accounting for inherent differences between turbine sets. Our findings suggest broadband ultrasound broadcasts may reduce bat fatalities by discouraging bats from approaching sound sources. However, effectiveness of ultrasonic deterrents is limited by distance and area ultrasound can be broadcast, in part due to rapid attenuation in humid conditions. We caution that an operational deterrent device is not yet available and further modifications and experimentation are needed. Future efforts must also evaluate cost-effectiveness of deterrents in relation to curtailment strategies to allow a cost-benefit analysis for mitigating bat fatalities.

The influence of fatalistic beliefs on health beliefs among diabetics in Khartoum, Sudan: a comparison between Coptic Christians and Sunni Muslims.

PubMed

Hag Hamed, Dana; Daniel, Marguerite

2017-07-01

Although there are many studies assessing the influence of religious beliefs on health they do not agree on whether the impact is positive or negative. More so, there is no consensus in the available literature on the definition of fatalism and what it means to individuals. In this phenomenological study we attempt to define what religious fatalism means to people living with diabetes in Khartoum, and how it affects their health beliefs, and how those beliefs affect their sense of coherence and generalized resistance resources, since salutogenesis is the guiding theory in this study. Three Copts and five Sunnis living with diabetes were interviewed, as well as a Coptic clergyman and a Sunni scholar. The semi-structured interviews were recorded and transcribed verbatim for analysis. Thematic network analysis was used to code salient concepts into basic themes, organizing themes and global themes. The empirical findings are thus structured as the three global themes: (1) fatalism and free will; (2) health responsibility; (3) acceptance and coping. Fatalism was defined as events beyond an individual's control where it is then the individual's free will to seek healthy behavior. Thus health responsibility was stressed upon by the participants in this study as well as the clergyman and scholar. There is also the concept of 'God doesn't give one what one cannot handle' that the participants relate to coping and acceptance. This study finds that the meaning of religious fatalism held by participants and religious clergy is not disempowering. The participants believe that they are responsible for their health. The meaning derived from fatalism is related to how they can accept what is beyond their control and cope with their health condition. Religious fatalism contributed to comprehensibility, manageability and meaningfulness in our participants' response to diabetes.

Evaluating the Effectiveness of an Ultrasonic Acoustic Deterrent for Reducing Bat Fatalities at Wind Turbines

PubMed Central

Arnett, Edward B.; Hein, Cris D.; Schirmacher, Michael R.; Huso, Manuela M. P.; Szewczak, Joseph M.

2013-01-01

Large numbers of bats are killed by wind turbines worldwide and minimizing fatalities is critically important to bat conservation and acceptance of wind energy development. We implemented a 2-year study testing the effectiveness of an ultrasonic acoustic deterrent for reducing bat fatalities at a wind energy facility in Pennsylvania. We randomly selected control and treatment turbines that were searched daily in summer and fall 2009 and 2010. Estimates of fatality, corrected for field biases, were compared between treatment and control turbines. In 2009, we estimated 21–51% fewer bats were killed per treatment turbine than per control turbine. In 2010, we determined an approximate 9% inherent difference between treatment and control turbines and when factored into our analysis, variation increased and between 2% more and 64% fewer bats were killed per treatment turbine relative to control turbines. We estimated twice as many hoary bats were killed per control turbine than treatment turbine, and nearly twice as many silver-haired bats in 2009. In 2010, although we estimated nearly twice as many hoary bats and nearly 4 times as many silver-haired bats killed per control turbine than at treatment turbines during the treatment period, these only represented an approximate 20% increase in fatality relative to the pre-treatment period for these species when accounting for inherent differences between turbine sets. Our findings suggest broadband ultrasound broadcasts may reduce bat fatalities by discouraging bats from approaching sound sources. However, effectiveness of ultrasonic deterrents is limited by distance and area ultrasound can be broadcast, in part due to rapid attenuation in humid conditions. We caution that an operational deterrent device is not yet available and further modifications and experimentation are needed. Future efforts must also evaluate cost-effectiveness of deterrents in relation to curtailment strategies to allow a cost-benefit analysis for mitigating bat fatalities. PMID:23840369

Evaluating the effectiveness of an ultrasonic acoustic deterrent for reducing bat fatalities at wind turbines

USGS Publications Warehouse

Arnett, Edward B.; Hein, Cris D.; Schirmacher, Michael R.; Huso, Manuela M.P.; Szewczak, Joseph M.

2013-01-01

Large numbers of bats are killed by wind turbines worldwide and minimizing fatalities is critically important to bat conservation and acceptance of wind energy development. We implemented a 2-year study testing the effectiveness of an ultrasonic acoustic deterrent for reducing bat fatalities at a wind energy facility in Pennsylvania. We randomly selected control and treatment turbines that were searched daily in summer and fall 2009 and 2010. Estimates of fatality, corrected for field biases, were compared between treatment and control turbines. In 2009, we estimated 21–51% fewer bats were killed per treatment turbine than per control turbine. In 2010, we determined an approximate 9% inherent difference between treatment and control turbines and when factored into our analysis, variation increased and between 2% more and 64% fewer bats were killed per treatment turbine relative to control turbines. We estimated twice as many hoary bats were killed per control turbine than treatment turbine, and nearly twice as many silver-haired bats in 2009. In 2010, although we estimated nearly twice as many hoary bats and nearly 4 times as many silver-haired bats killed per control turbine than at treatment turbines during the treatment period, these only represented an approximate 20% increase in fatality relative to the pre-treatment period for these species when accounting for inherent differences between turbine sets. Our findings suggest broadband ultrasound broadcasts may reduce bat fatalities by discouraging bats from approaching sound sources. However, effectiveness of ultrasonic deterrents is limited by distance and area ultrasound can be broadcast, in part due to rapid attenuation in humid conditions. We caution that an operational deterrent device is not yet available and further modifications and experimentation are needed. Future efforts must also evaluate cost-effectiveness of deterrents in relation to curtailment strategies to allow a cost-benefit analysis for mitigating bat fatalities.

The High-risk Groups According to the Trends and Characteristics of Fatal Occupational Injuries in Korean Workers Aged 50 Years and Above.

PubMed

Yi, Kwan Hyung

2018-06-01

Due to an increasing number of workers aged 50 years and above, the number of those employed is also on the rise, and those workers aged 50 and over has exceeded 50% of the total fatal occupational injuries. Therefore, it is necessary to implement the selection and concentration by identifying the characteristics of high-risk groups necessary for an effective prevention against and reduction of fatal occupational injuries. This study analyzed the characteristics of high-risk groups and the occupational injury fatality rate per 10,000 workers among the workers aged 50 and over through a multi-dimensional analysis by sex, employment status of workers, industry and occupation by targeting 4,079 persons who died in fatal occupational injuries from January 2007 to December 12. The share of the workers aged 50 years and above is increasing every year in the total fatal occupational injuries occurrence, and the high-risk groups include 'male workers' by sex, 'daily workers' by worker's status, 'craft and related-trades workers' by occupation, and 'mining' by industry. The most frequent causal objects of fatal occupational injuries of the workers aged 50 years and above are found out to be 'installment and dismantlement of temporary equipment and material on work platforms including scaffold' in the construction industry and 'mobile crane, conveyor belt and fork lifts' in the manufacturing industry.

Natural hazard fatalities in Switzerland from 1946 to 2015

NASA Astrophysics Data System (ADS)

Andres, Norina; Badoux, Alexandre; Techel, Frank

2017-04-01

Switzerland, located in the middle of the Alps, is prone to several different natural hazards which regularly cause fatalities. To explore temporal trends as well as demographic and spatial patterns in the number of natural hazard fatalities, a database comprising all natural hazard events causing fatalities was compiled for the years 1946 until 2015. The new database includes avalanche, flood, lightning, windstorm, landslide, debris flow, rockfall, earthquake and ice avalanche processes. Two existing databases were incorporated and the resulting dataset extended by a comprehensive newspaper search. In total the database contains 635 natural hazard events causing 1023 fatalities. The database does not include victims which exposed themselves to an important danger on purpose (e.g. high risk sports). The most common causes of death were snow avalanches (37 %), followed by lightning (16 %), floods (12 %), windstorms (10 %), rockfall (8 %), landslides (7 %) and other processes (9 %). Around 14.6 fatalities occurred on average each year. A distinct decrease of natural hazard fatalities could be shown over the last 70 years, which was mostly due to the decline in the number of avalanche and lightning fatalities. Thus, nearly three times as many people were killed by natural hazard processes from 1946 to 1980 than from 1981 to 2015. Normalisation of fatality data by population resulted in a clearly declining annual crude mortality rate: 3.9 deaths per million persons for the first 35 years and 1.1 deaths per million persons for the second 35 years of the study period. The average age of the victims was approximately 36 years and about 75% were males. Most people were killed in summer (JJA, 42%) and winter (DJF, 32 %). Furthermore, almost two-thirds of the fatalities took place in the afternoon and evening. The spatial distribution of the natural hazard fatalities over Switzerland was quite homogeneous. However, mountainous parts of the country (Prealps, Alps) were somewhat more prone to fatal events compared to the Swiss Plateau and the Jura. It appears that the overall natural hazard mortality rate in Switzerland over the past 70 years has been relatively low in comparison to rates in other countries or rates of other types of fatal accidents in Switzerland. Nevertheless, the collected data provides a valuable base for analysis and helps authorities to better identify higher risk demographic groups and regions, and accordingly target these to reduce the number of victims.

The global role of natural disaster fatalities in decision-making: statistics, trends and analysis from 116 years of disaster data compared to fatality rates from other causes

NASA Astrophysics Data System (ADS)

Daniell, James; Wenzel, Friedemann; McLennan, Amy; Daniell, Katherine; Kunz-Plapp, Tina; Khazai, Bijan; Schaefer, Andreas; Kunz, Michael; Girard, Trevor

2016-04-01

In this study, analysis is undertaken showing disaster fatalities trends from around the world using the CATDAT Natural Disaster and Socioeconomic Indicator databases from 1900-2015. Earthquakes have caused over 2.3 million fatalities since 1900; however absolute numbers of deaths caused by them have remained rather constant over time. However, floods have caused somewhere between 1.7 and 5.4 million fatalities, mostly in the earlier half of the 20th century (depending on the 1931 China floods). Storm and storm surges (ca. 1.3 million fatalities), on the other hand, have shown an opposite trend with increasing fatalities over the century (or a lack of records in the early 1900s). Earthquakes due to their sporadic nature, do not inspire investment pre-disaster. When looking at the investment in flood control vs. earthquakes, there is a marked difference in the total investment, which has resulted in a much larger reduction in fatalities. However, a key consideration for decision-makers in different countries around the world when choosing to implement disaster sensitive design is the risk of a natural disaster death, compared to other types of deaths in their country. The creation of empirical annualised ratios of earthquake, flood and storm fatalities from the year 1900 onwards vs. other methods of fatalities (cancer, diseases, accidents etc.) for each country using the CATDAT damaging natural disasters database is undertaken. On an annualised level, very few countries show earthquakes and other disaster types to be one of the highest probability methods for death. However, in particular years with large events, annual rates can easily exceed the total death count for a particular country. An example of this is Haiti, with the equivalent earthquake death rate in 2010 exceeding the total all-cause death rate in the country. Globally, fatality rates due to disasters are generally at least 1 order of magnitude lower than other causes such as heart disease. However, in some locations in countries such as Armenia, Turkmenistan, Peru and Guatemala, the annual probability of being killed in an earthquake is as high as that of being killed due to heart disease. In this study, around 50 countries have been shown to have at least one single event year for earthquake exceeding that of all traffic fatalities, and 15 countries higher than the equivalent total death rate of the country. China has shown very high death rates due to flood, however, with from 1900-2015, this rate has reduced significantly. Floods are generally an order of magnitude less than traffic accidents measured in micromorts likely due to improved flood risk reduction. However, recent events in Philippines and Myanmar show mortality reduction due to storm surge and cyclones still require much effort. The role of life safety is increasing with risk-based disaster resistant codes becoming more commonplace globally. An examination of government funding around the world shows the correlation between retrofitting investment and disaster fatality reduction. New methods of presenting disaster statistics for political use have been used to present the information upon which such decisions are made.

Effects of statins on stroke prevention in patients with and without coronary heart disease: a meta-analysis of randomized controlled trials.

PubMed

Briel, Matthias; Studer, Marco; Glass, Tracy R; Bucher, Heiner C

2004-10-15

To assess if lipid-lowering interventions (statins, fibrates, resins, n-3 fatty acids, diet) prevent nonfatal and fatal strokes in patients with and without coronary heart disease. We systematically searched the literature up to August 2002 to retrieve all randomized controlled trials of lipid-lowering interventions that reported nonfatal and fatal stroke and mortality data. The search yielded 65 trials with 200,607 patients for a meta-analysis to determine whether treatment effects differed between types of lipid-lowering interventions and between patient samples with and without coronary heart disease. The risk ratio for nonfatal and fatal stroke for statins as compared with control interventions was 0.82 (95% confidence interval [CI]: 0.76 to 0.90). The corresponding risk ratios for statins as compared with control were 0.75 (95% CI: 0.65 to 0.87) for patients with coronary heart disease and 0.77 (95% CI: 0.62 to 0.95) for those without coronary heart disease. The confidence intervals of risk ratios for nonfatal and fatal stroke associated with fibrates, resins, n-3 fatty acids, and diet all included 1, as did the confidence intervals for these interventions in patients with and without coronary heart disease. Weighted meta-regression analysis suggested a stronger association of stroke reduction with statin treatment than with the extent of cholesterol reduction. This meta-analysis suggests that statins reduce the incidence of stroke in patients with and without coronary heart disease.

Graduated licensing laws and fatal crashes of teenage drivers: a national study.

PubMed

McCartt, Anne T; Teoh, Eric R; Fields, Michele; Braitman, Keli A; Hellinga, Laurie A

2010-06-01

The objective of the current study was to quantify the effects of the strength of US state graduated driver licensing laws and specific licensing components on the rate of teenage driver fatal crash involvements per 100,000 teenagers during 1996-2007. The strengths of state laws were rated good, fair, marginal, or poor based on a system developed previously by the Insurance Institute for Highway Safety. Analysis was based on quarterly counts of drivers involved in fatal crashes. Associations of overall ratings and individual licensing components with teenage crash rates were evaluated using Poisson regression, with the corresponding fatal crash rate for drivers ages 30-59 controlling for state- or time-dependent influences on crash rates unrelated to graduated licensing laws. Compared with licensing laws rated poor, laws rated good were associated with 30 percent lower fatal crash rates among 15- to 17-year-olds. Laws rated fair yielded fatal crash rates 11 percent lower. The longer the permit age was delayed, or the longer the licensing age was delayed, the lower the estimated fatal crash rates among 15- to 17-year-olds. Stronger nighttime restrictions were associated with larger reductions, and reductions were larger for laws limiting teenage passengers to zero or one than laws allowing two or more teenage passengers or laws without passenger restrictions. After the effects of any related delay in licensure were accounted for, an increase in the minimum learner's permit holding period showed no association with fatal crash rates. An increase in required practice driving hours did not appear to have an independent association with fatal crash rates. Graduated licensing laws that include strong nighttime and passenger restrictions and laws that delay the learner's permit age and licensing age are associated with lower teenage fatal crash rates. States that adopt such laws can expect to achieve substantial reductions in crash deaths.

Factors associated with the severity of fatal accidents in construction workers

PubMed Central

Khodabandeh, Farideh; Kabir-Mokamelkhah, Elaheh; Kahani, Mahsa

2016-01-01

Background: Construction work (building houses, roads, workplaces, and repairing and maintaining infrastructures) is a dangerous land-based job. This includes many hazardous tasks and conditions such as working at the following conditions: Height, excavation, noise, dust, power tools and equipment. Construction work has been increased in developed and underdeveloped countries over the past few years. Occupational fatalities have increased with an increase in this type of work. Occupational fatalities refer to individuals who pass way while on the job or performing work related tasks. In the present study, to identify the factors, personal characteristics and work-related factors associated with fatal occupational mortality were assessed using data for Tehran, Iran, 2014-2016. Methods: We conducted a retrospective study, using 967 postmortem reports from fatal occupational injuries collected through postmortem investigations during 2014-2016. A sampling frame of 967 postmortem reports from fatal occupational injuries was used to draw a total sample of 714 fatal construction accidents for this cross-sectional study. Pearson χ2 test and Kruskal-Wallis tests were used for statistical analysis. Results: Based on the results of this study, male gender (n=714; 100%), age range of 30-39 years (n=183; 25.6%), secondary educational level (n=273; 38.2%), being married (317; 44.4%), causal employee (n=389; 54.5%), unskilled performance (389; 54.5%), no insurance coverage (472; 66.1%), and daytime duty work (287; 40.2%) were identified as risk factors for fatality in the event of construction fatal injury. A significant relationship was found between the type of injury and sociodemographic and work related variables. Conclusion: Workers’ characteristics such as age, gender, experience, and educational background, and work related variables such as skill training, safety measurement, and close monitoring could be used to discriminate among different severity levels of occupational fatal accidents. PMID:28491844

Illness beliefs and the sociocultural context of diabetes self-management in British South Asians: a mixed methods study.

PubMed

Patel, Neesha R; Chew-Graham, Carolyn; Bundy, Christine; Kennedy, Anne; Blickem, Christian; Reeves, David

2015-05-10

British South Asians have a higher incidence of diabetes and poorer health outcomes compared to the general UK population. Beliefs about diabetes are known to play an important role in self-management, yet little is known about the sociocultural context in shaping beliefs. This study aimed to explore the influence of sociocultural context on illness beliefs and diabetes self-management in British South Asians. A mixed methods approach was used. 67 participants recruited using random and purposive sampling, completed a questionnaire measuring illness beliefs, fatalism, health outcomes and demographics; 37 participants completed a social network survey interview and semi-structured interviews. Results were analysed using SPSS and thematic analysis. Quantitative data found certain social network characteristics (emotional and illness work) were related to perceived concern, emotional distress and health outcomes (p < 0.05). After multivariate analysis, emotional work remained a significant predictor of perceived concern and emotional distress related to diabetes (p < 0.05). Analysis of the qualitative data suggest that fatalistic attitudes and beliefs influences self-management practices and alternative food 'therapies' are used which are often recommended by social networks. Diabetes-related illness beliefs and self-management appear to be shaped by the sociocultural context. Better understanding of the contextual determinants of behaviour could facilitate the development of culturally appropriate interventions to modify beliefs and support self-management in this population.

Characteristics of officer-involved vehicle collisions in California

PubMed Central

Wolfe, Scott E.; Rojek, Jeff; Alpert, Geoff; Tiesman, Hope; James, Stephen

2016-01-01

Purpose The purpose of this paper is to examine the situational and individual officer characteristics of officer-involved vehicle collisions that result in fatality, injury, and non-injury outcomes. Design/methodology/approach Data on 35,840 vehicle collisions involving law enforcement officers in California occurring between January 2000 and December 2009 are examined. A descriptive analysis of collision characteristics is presented. Findings There were 39 officers killed by collisions over this study period and 7,684 officers who received some type injury. Incidents involving officers on motorcycles represented 39 percent of officer fatalities and 39 percent of severe injuries. In the case of fatalities, 33 percent of officers were reported as wearing seatbelts, 38 percent were not wearing a seatbelt, and seatbelt use was not stated in 29 percent of car fatalities. Research limitations/implications The findings only represent one state and the analysis is based on an estimated 86 percent of collisions that occurred during the study period due to missing data. Nonetheless, the results are based on a robust sample and address key limitations in the existing literature. Practical implications During the study period in California the estimated financial impact of collisions reached into the hundreds of millions of dollars when considering related fatality, injury, and vehicle damage costs combined. These impacts highlight the need for the law enforcement community to give greater attention to this issue. Originality/value At the time of this writing there was no published independent research that compares the situational and officer characteristics across fatality, injury, and non-injury outcomes in these events. The findings reported here will help inform emerging interest in this issue within the law enforcement, academic, and policy-making communities. PMID:26877704

Fatalities among oil and gas extraction workers--United States, 2003-2006.

PubMed

2008-04-25

Oil and gas extraction (i.e., removing oil and natural gas from the ground) is a growing industry in the United States, employing approximately 380,000 workers in 2006. In recent years, activity in this industry has increased substantially, from an average of 800 actively drilling rigs in the United States during the 1990s to approximately 1,300 during 2003-2006. In August 2005, the U.S. Department of Labor's Bureau of Labor Statistics (BLS) asked CDC to investigate a 15% increase in fatalities among oil and gas extraction workers (from 85 fatalities in 2003 to 98 in 2004). CDC analyzed data from the BLS Census of Fatal Occupational Injuries (CFOI) for the period 2003-2006. This report describes the results of that analysis, which indicated that increases in oil and gas extraction activity were correlated with an increase in the rate of fatal occupational injuries in this industry, with an annual fatality rate of 30.5 per 100,000 workers (404 fatalities) during 2003-2006, approximately seven times the rate for all workers (4.0 per 100,000 workers). Nearly half of all fatal injuries among these workers were attributed to highway motor-vehicle crashes and workers being struck by machinery or equipment. Employers should work with existing industry groups and federal, state, and local government agencies to promote seatbelt use. In addition, researchers and public health officials should collaborate with industry groups to establish engineering and process controls that remove workers from potentially dangerous machinery while drilling and servicing oil and gas wells.

Fatal crash involvement of unlicensed young drivers: county level differences according to material deprivation and urbanicity in the United States.

PubMed

Hanna, Christian L; Laflamme, Lucie; Bingham, C Raymond

2012-03-01

This study assessed the association between county level material deprivation and urbanization with fatal road traffic crashes involving young unlicensed drivers in the United States (US). Road traffic crashes have been positively associated with area deprivation and low population density but thus far few studies have been concerned specifically with young drivers, especially those that are unlicensed. A county material deprivation index was derived from the Townsend Material Deprivation Index, with variables extracted from the US Census (2000). An urbanicity scale was adapted from the US Department of Agriculture's Rural-Urban Continuum Codes (2003). Data on fatal crashes involving a young unlicensed driver during a seven-year period (2000-2006; n=3059) were extracted from the Fatality Analysis Reporting System. The effect of deprivation and urbanicity on the odds of the occurrence of at least one fatal crash at the county level was modeled by conditional and unconditional logistic regression. The conditional model found a positive association between material deprivation and a fatal crash involving a young unlicensed driver (OR=1.19, 95% CI 1.17, 1.21). The interaction between urbanicity and material deprivation was negatively associated in suburban counties for fatal crashes (OR=0.92, 95% CI 0.90, 0.95). An association with material deprivation and the likelihood of a fatal crash involving a young unlicensed driver is a new finding. It can be used to inform specific county-level interventions and promote state licensing policies to provide equity in young people's mobility regardless of where they live. Copyright © 2011. Published by Elsevier Ltd.

Incidence of paediatric fatal and non-fatal low speed vehicle run over events in Queensland, Australia: eleven year analysis

PubMed Central

2014-01-01

Background The purpose of this study was to estimate the incidence of fatal and non-fatal Low Speed Vehicle Run Over (LSVRO) events among children aged 0–15 years in Queensland, Australia, at a population level. Methods Fatal and non-fatal LSVRO events that occurred in children resident in Queensland over eleven calendar years (1999-2009) were identified using ICD codes, text description, word searches and medical notes clarification, obtained from five health related data bases across the continuum of care (pre-hospital to fatality). Data were manually linked. Population data provided by the Australian Bureau of Statistics were used to calculate crude incidence rates for fatal and non-fatal LSVRO events. Results There were 1611 LSVROs between 1999–2009 (IR = 16.87/100,000/annum). Incidence of non-fatal events (IR = 16.60/100,000/annum) was 61.5 times higher than fatal events (IR = 0.27/100,000/annum). LSVRO events were more common in boys (IR = 20.97/100,000/annum) than girls (IR = 12.55/100,000/annum), and among younger children aged 0–4 years (IR = 21.45/100000/annum; 39% or all events) than older children (5–9 years: IR = 16.47/100,000/annum; 10–15 years IR = 13.59/100,000/annum). A total of 896 (56.8%) children were admitted to hospital for 24 hours of more following an LSVRO event (IR = 9.38/100,000/annum). Total LSVROs increased from 1999 (IR = 14.79/100,000) to 2009 (IR = 18.56/100,000), but not significantly. Over the 11 year period, there was a slight (non –significant) increase in fatalities (IR = 0.37-0.42/100,000/annum); a significant decrease in admissions (IR = 12.39–5.36/100,000/annum), and significant increase in non-admissions (IR = 2.02-12.77/100,000/annum). Trends over time differed by age, gender and severity. Conclusion This is the most comprehensive, population-based epidemiological study on fatal and non-fatal LSVRO events to date. Results from this study indicate that LSVROs incur a substantial burden. Further research is required on the characteristics and risk factors associated with these events, in order to adequately inform injury prevention. Strategies are urgently required in order to prevent these events, especially among young children aged 0–4 years. PMID:24618226

Bayesian inference on risk differences: an application to multivariate meta-analysis of adverse events in clinical trials.

PubMed

Chen, Yong; Luo, Sheng; Chu, Haitao; Wei, Peng

2013-05-01

Multivariate meta-analysis is useful in combining evidence from independent studies which involve several comparisons among groups based on a single outcome. For binary outcomes, the commonly used statistical models for multivariate meta-analysis are multivariate generalized linear mixed effects models which assume risks, after some transformation, follow a multivariate normal distribution with possible correlations. In this article, we consider an alternative model for multivariate meta-analysis where the risks are modeled by the multivariate beta distribution proposed by Sarmanov (1966). This model have several attractive features compared to the conventional multivariate generalized linear mixed effects models, including simplicity of likelihood function, no need to specify a link function, and has a closed-form expression of distribution functions for study-specific risk differences. We investigate the finite sample performance of this model by simulation studies and illustrate its use with an application to multivariate meta-analysis of adverse events of tricyclic antidepressants treatment in clinical trials.

Economic growth, motorization, and road traffic injuries in the Sultanate of Oman, 1985-2009.

PubMed

Al-Reesi, Hamed; Ganguly, Shyam Sunder; Al-Adawi, Samir; Laflamme, Lucie; Hasselberg, Marie; Al-Maniri, Abdullah

2013-01-01

Recent affluence, assisted by exploitation of hydrocarbon, has sparked unprecedented economic growth and influx of all façades of modernity in Oman. Different statistical models have examined the relationship between economic growth, motorization rates, and road traffic fatalities. However, such a relationship in Oman has never been described. To describe and analyze the trend of road traffic injuries (RTIs) in relation to motorization rates and economic growth during the period from 1985 to 2009 using Smeed's (1949) model and Koren and Borsos's (2010) model. The study is based on national data reported between 1985 and 2009. Data on the population and gross domestic product (GDP) per capita in U.S. dollars were gathered from the Ministry of National Economy reports. Data on the number of vehicles and road traffic crashes, fatalities, and injuries were gathered from the Royal Oman Police (ROP) reports. Crash, fatality, and injury rates per 1000 vehicles and per 100,000 population were computed. Linear regression analysis was carried out to estimate the average annual changes in the rates. Smeed's (1949) and Koren and Borsos's (2010) models were used to predict the relations between motorization and road traffic fatalities in Oman. In addition, a cross-sectional analysis of year 2007 data for a number of Arab countries was carried out. The GDP per capita increased from US$6551 in 1985 to US$25,110 in 2009 with an annual increase of UR$547 per capita. The motorization rates increased by 36 percent from 1745 per 10,000 population in 1985 to 2382 per 10,000 population in 2009. Both Smeed's (1949) and Koren and Borsos's (2010) models had a high goodness of fit, with R(2) greater than 0.70. This indicated that road traffic fatalities in Oman may have a direct relationship with increased motorization. The cross-sectional analysis showed that the relation between crash fatalities and motorization rates in Oman and the United Arab Emirates can be better explained by Koren and Borsos's (2010) model than other countries. Recent economic growth in Oman was associated with an increase in motorization rates, which in turn has resulted in an increased burden of road traffic fatalities and injuries.

The Effects of Fatal Vision Goggles on Drinking and Driving Intentions in College Students

ERIC Educational Resources Information Center

Hennessy, Dwight A.; Lanni-Manley, Elizabeth; Maiorana, Nicole

2006-01-01

The present study was designed to examine the effectiveness of Fatal Vision Goggles in reducing intentions to drink and drive. Participants performed a field sobriety task and drove in a traffic simulator while wearing the goggles. A regression analysis was performed in order to predict changes in intentions to drink and drive, using typical…

A novel risk assessment method for landfill slope failure: Case study application for Bhalswa Dumpsite, India.

PubMed

Jahanfar, Ali; Amirmojahedi, Mohsen; Gharabaghi, Bahram; Dubey, Brajesh; McBean, Edward; Kumar, Dinesh

2017-03-01

Rapid population growth of major urban centres in many developing countries has created massive landfills with extraordinary heights and steep side-slopes, which are frequently surrounded by illegal low-income residential settlements developed too close to landfills. These extraordinary landfills are facing high risks of catastrophic failure with potentially large numbers of fatalities. This study presents a novel method for risk assessment of landfill slope failure, using probabilistic analysis of potential failure scenarios and associated fatalities. The conceptual framework of the method includes selecting appropriate statistical distributions for the municipal solid waste (MSW) material shear strength and rheological properties for potential failure scenario analysis. The MSW material properties for a given scenario is then used to analyse the probability of slope failure and the resulting run-out length to calculate the potential risk of fatalities. In comparison with existing methods, which are solely based on the probability of slope failure, this method provides a more accurate estimate of the risk of fatalities associated with a given landfill slope failure. The application of the new risk assessment method is demonstrated with a case study for a landfill located within a heavily populated area of New Delhi, India.

Modeling the injury prevention impact of mandatory alcohol ignition interlock installation in all new US vehicles.

PubMed

Carter, Patrick M; Flannagan, Carol A C; Bingham, C Raymond; Cunningham, Rebecca M; Rupp, Jonathan D

2015-05-01

We estimated the injury prevention impact and cost savings associated with alcohol interlock installation in all new US vehicles. We identified fatal and nonfatal injuries associated with drinking driver vehicle crashes from the Fatality Analysis Reporting System and National Automotive Sampling System's General Estimates System data sets (2006-2010). We derived the estimated impact of universal interlock installation using an estimate of the proportion of alcohol-related crashes that were preventable in vehicles < 1 year-old. We repeated this analysis for each subsequent year, assuming a 15-year implementation. We applied existing crash-induced injury cost metrics to approximate economic savings, and we used a sensitivity analysis to examine results with varying device effectiveness. Over 15 years, 85% of crash fatalities (> 59 000) and 84% to 88% of nonfatal injuries (> 1.25 million) attributed to drinking drivers would be prevented, saving an estimated $342 billion in injury-related costs, with the greatest injury and cost benefit realized among recently legal drinking drivers. Cost savings outweighed installation costs after 3 years, with the policy remaining cost effective provided device effectiveness remained above approximately 25%. Alcohol interlock installation in all new vehicles is likely a cost-effective primary prevention policy that will substantially reduce alcohol-involved crash fatalities and injuries, especially among young vulnerable drivers.

Modeling the Injury Prevention Impact of Mandatory Alcohol Ignition Interlock Installation in All New US Vehicles

PubMed Central

Flannagan, Carol A. C.; Bingham, C. Raymond; Cunningham, Rebecca M.; Rupp, Jonathan D.

2015-01-01

Objectives. We estimated the injury prevention impact and cost savings associated with alcohol interlock installation in all new US vehicles. Methods. We identified fatal and nonfatal injuries associated with drinking driver vehicle crashes from the Fatality Analysis Reporting System and National Automotive Sampling System’s General Estimates System data sets (2006–2010). We derived the estimated impact of universal interlock installation using an estimate of the proportion of alcohol-related crashes that were preventable in vehicles < 1 year-old. We repeated this analysis for each subsequent year, assuming a 15-year implementation. We applied existing crash-induced injury cost metrics to approximate economic savings, and we used a sensitivity analysis to examine results with varying device effectiveness. Results. Over 15 years, 85% of crash fatalities (> 59 000) and 84% to 88% of nonfatal injuries (> 1.25 million) attributed to drinking drivers would be prevented, saving an estimated $342 billion in injury-related costs, with the greatest injury and cost benefit realized among recently legal drinking drivers. Cost savings outweighed installation costs after 3 years, with the policy remaining cost effective provided device effectiveness remained above approximately 25%. Conclusions. Alcohol interlock installation in all new vehicles is likely a cost-effective primary prevention policy that will substantially reduce alcohol-involved crash fatalities and injuries, especially among young vulnerable drivers. PMID:25790385

Occupational injury and fatality investigations: the application of forensic nursing science.

PubMed

Harris, Colin

2013-01-01

The forensic evaluation of trauma in occupational injuries and fatalities can provide the benefit of a more thorough analysis of incident causation. Forensic nursing science applied during workplace investigations can assist investigators to determine otherwise unknown crucial aspects of the incident circumstances that are important to event reconstruction, the enforcement of occupational health and safety requirements, and the direction of workplace prevention initiatives. Currently, a medical and forensic medical knowledge gap exists in the subject-matter expertise associated with occupational accident investigations. This gap can be bridged with the integration of forensic nursing in the investigation of workplace fatalities and serious injuries.

Effect of Using Different Vehicle Weight Groups on the Estimated Relationship Between Mass Reduction and U.S. Societal Fatality Risk per Vehicle Miles of Travel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wenzel, Tom P.

This report recalculates the estimated relationship between vehicle mass and societal fatality risk, using alternative groupings by vehicle weight, to test whether the trend of decreasing fatality risk from mass reduction as case vehicle mass increases, holds over smaller increments of the range in case vehicle masses. The NHTSA baseline regression model estimates the relationship using for two weight groups for cars and light trucks; we re-estimated the mass reduction coefficients using four, six, and eight bins of vehicle mass. The estimated effect of mass reduction on societal fatality risk was not consistent over the range in vehicle masses inmore » these weight bins. These results suggest that the relationship indicated by the NHTSA baseline model is a result of other, unmeasured attributes of the mix of vehicles in the lighter vs. heavier weight bins, and not necessarily the result of a correlation between mass reduction and societal fatality risk. An analysis of the average vehicle, driver, and crash characteristics across the various weight groupings did not reveal any strong trends that might explain the lack of a consistent trend of decreasing fatality risk from mass reduction in heavier vehicles.« less

Fatalities among volunteer and career firefighters--United States, 1994-2004.

PubMed

2006-04-28

Approximately 800,000 firefighters in the United States are volunteer firefighters and 300,000 are career firefighters. Volunteer firefighters primarily serve communities with fewer than 25,000 inhabitants, whereas most career firefighters serve communities of more than 25,000 persons. To characterize fatalities among volunteer and career firefighters, CDC analyzed data from the U.S. Fire Administration (USFA). This report summarizes the results of that analysis and, to illustrate the most common types of volunteer and career firefighter fatalities, describes two cases investigated by the National Institute for Occupational Safety and Health (NIOSH) Firefighter Fatality Investigation and Prevention Program. Fifty-three percent (610 of 1,141) of U.S. firefighters who died while on duty during 1994-2004 were volunteers, and 32% (368) were career firefighters. The remaining 15% (163) of deaths were among other firefighters (e.g., wildland, paid on-call, and part-time paid firefighters). Among volunteer firefighters, sudden cardiac death (e.g., from myocardial infarction or arrhythmia) and motor vehicle (MV) crashes during emergency response were the leading causes of fatality. Among career firefighters, sudden cardiac death and asphyxiation were leading causes of death. Adoption and enforcement of existing fire-service recommendations regarding fitness standards, mandatory medical evaluations with appropriate work restrictions, and emergency vehicle response protocols are needed to prevent these fatalities among firefighters.

Chlorine truck attack consequences and mitigation.

PubMed

Barrett, Anthony Michael; Adams, Peter J

2011-08-01

We develop and apply an integrated modeling system to estimate fatalities from intentional release of 17 tons of chlorine from a tank truck in a generic urban area. A public response model specifies locations and actions of the populace. A chemical source term model predicts initial characteristics of the chlorine vapor and aerosol cloud. An atmospheric dispersion model predicts cloud spreading and movement. A building air exchange model simulates movement of chlorine from outdoors into buildings at each location. A dose-response model translates chlorine exposures into predicted fatalities. Important parameters outside defender control include wind speed, atmospheric stability class, amount of chlorine released, and dose-response model parameters. Without fast and effective defense response, with 2.5 m/sec wind and stability class F, we estimate approximately 4,000 (half within ∼10 minutes) to 30,000 fatalities (half within ∼20 minutes), depending on dose-response model. Although we assume 7% of the population was outdoors, they represent 60-90% of fatalities. Changing weather conditions result in approximately 50-90% lower total fatalities. Measures such as sheltering in place, evacuation, and use of security barriers and cryogenic storage can reduce fatalities, sometimes by 50% or more, depending on response speed and other factors. © 2011 Society for Risk Analysis.

An investigation on fatality of drivers in vehicle-fixed object accidents on expressways in China: Using multinomial logistic regression model.

PubMed

Peng, Yong; Peng, Shuangling; Wang, Xinghua; Tan, Shiyang

2018-06-01

This study aims to identify the effects of characteristics of vehicle, roadway, driver, and environment on fatality of drivers in vehicle-fixed object accidents on expressways in Changsha-Zhuzhou-Xiangtan district of Hunan province in China by developing multinomial logistic regression models. For this purpose, 121 vehicle-fixed object accidents from 2011-2017 are included in the modeling process. First, descriptive statistical analysis is made to understand the main characteristics of the vehicle-fixed object crashes. Then, 19 explanatory variables are selected, and correlation analysis of each two variables is conducted to choose the variables to be concluded. Finally, five multinomial logistic regression models including different independent variables are compared, and the model with best fitting and prediction capability is chosen as the final model. The results showed that the turning direction in avoiding fixed objects raised the possibility that drivers would die. About 64% of drivers died in the accident were found being ejected out of the car, of which 50% did not use a seatbelt before the fatal accidents. Drivers are likely to die when they encounter bad weather on the expressway. Drivers with less than 10 years of driving experience are more likely to die in these accidents. Fatigue or distracted driving is also a significant factor in fatality of drivers. Findings from this research provide an insight into reducing fatality of drivers in vehicle-fixed object accidents.

Evaluation of a nationally funded state-based programme to reduce fatal occupational injuries

PubMed Central

Menendez, Cammie Chaumont; Castillo, Dawn; Rosenman, Kenneth; Harrison, Robert; Hendricks, Scott

2015-01-01

Background The Fatality Assessment and Control Evaluation (FACE) programme was established by the National Institute for Occupational Safety and Health to help prevent occupational traumatic fatalities by funding states to conduct targeted fatality investigations within cause-specific focus areas and associated prevention efforts. Purpose To investigate the impact of the state-based FACE programme on two previous focus areas. Methods A longitudinal time-series analysis spanning 22 years compared state fatality rates for occupational falls and electrocutions before and after FACE programme funding with states not receiving FACE programme funding. Lag periods were utilised to allow time for the programme to have an effect, and rates were adjusted for a variety of covariates. Separate analyses were conducted for each injury outcome. Results A reduction in fall fatality rates that was of borderline significance (1-year lag adjRR=0.92 (0.84 to 1.00)) and a non-significant reduction in electrocution fatality rates (3-year lag adjRR=0.92 (0.82 to 1.03)) were observed in states with FACE programme funding, Best-fit models presented two separate lag periods. Conclusions While it is challenging to quantitatively evaluate effectiveness of programmes such as FACE, the data suggest the FACE programme may be effective in preventing occupational injury deaths within its outcome focus areas throughout the state. It is important to look for ways to measure intermediate effects more precisely, as well as ways to maintain effects over time. PMID:22864251

Construction equipment and motor vehicle related injuries on construction sites in Turkey.

PubMed

Gürcanli, G Emre; Müngen, Ugur; Akad, Murat

2008-08-01

Research on occupational accidents on construction sites in Turkey is very few. Moreover, research on motor vehicle and equipment accidents also do not exist. Investigation in the scope of this study shows that after falls and contact with electricity, accidents involving heavy equipment and motor vehicles rank third and fourth, respectively. This study aims to reveal the characteristics of these types of accidents, deduct the prominent causes that lead to fatalities as well as permanent disabilities using the present data. With the aid of obtained results, recommendations are made for safety experts on how to derive data from insufficient sources in Turkey and to evaluate these data for prevention and mitigation of the risks that construction workers are exposed to. 168 fatal and 38 non-fatal traffic accident-caused incidents as well as 206 fatal and 97 non-fatal construction equipment accidents, which were selected from official statistics and expert reports, were taken into consideration. Analysis and classification of these accidents were done according to the way they happened, the type of construction site and the occupation of the victims. Moreover, the leading causes of fatal and non-fatal injuries, to which drivers, operators and co-operators are exposed, are presented. Critical findings concerning prominent ways of occurrence, type of construction work and occupation are presented; and a number of measures for reducing the present risks are suggested. Some approaches for analysing relevant data are proposed for further research.

[Morphological findings in fatal cases of hantavirus cardiopulmonary syndrome. Report of 7 autopsies].

PubMed

Guzmán G, Pablo; Tapia E, Oscar; Villaseca H, Miguel; Araya O, Juan; Antonio P, Lilia; Lee O, Bolívar; Roa S, Juan

2010-10-01

Hantavirus cardiopulmonary syndrome (HCPS) is an acute infectious disease characterized by sudden cardiorespiratory failure and high mortality, caused by a RNA virus of the genus Hantavirus, family Bunyaviridae, 15% of Chilean cases have been detected in the Araucania Region. To determine in fatal cases of HCPS, clinical and morphological characteristics. Descriptive-retrospective analysis of seven fatal cases with postmortem study of HCPS, attended between 1997 and 2009 at the Hospital of Temuco, Chile. Cases were young patients from rural areas, and presented as an illness of progressive respiratory failure, with leukocytosis, thrombocytopenia and bilateral interstitial pulmonary infiltrates. Main morphological findings were marked intersticial and intraalveolar pulmonary edema, with minimal epithelial injury and mononuclear cell intersticial infiltrate and mild edematous intersticial inflamatory process. Epidemiological, clinical and laboratory background allow to suspect HCPS. In fatal cases, the autopsy makes possible to discard other similar pathologies and provide tissue for confirmation of the disease.

The role of mobile computed tomography in mass fatality incidents.

PubMed

Rutty, Guy N; Robinson, Claire E; BouHaidar, Ralph; Jeffery, Amanda J; Morgan, Bruno

2007-11-01

Mobile multi-detector computed tomography (MDCT) scanners are potentially available to temporary mortuaries and can be operational within 20 min of arrival. We describe, to our knowledge, the first use of mobile MDCT for a mass fatality incident. A mobile MDCT scanner attended the disaster mortuary after a five vehicle road traffic incident. Five out of six bodies were successfully imaged by MDCT in c. 15 min per body. Subsequent full radiological analysis took c. 1 h per case. The results were compared to the autopsy examinations. We discuss the advantages and disadvantages of imaging with mobile MDCT in relation to mass fatality work, illustrating the body pathway process, and its role in the identification of the pathology, personal effects, and health and safety hazards. We propose that the adoption of a single modality of mobile MDCT could replace the current use of multiple radiological sources within a mass fatality mortuary.

Flow diagram analysis of electrical fatalities in construction industry.

PubMed

Chi, Chia-Fen; Lin, Yuan-Yuan; Ikhwan, Mohamad

2012-01-01

The current study reanalyzed 250 electrical fatalities in the construction industry from 1996 to 2002 into seven patterns based on source of electricity (power line, energized equipment, improperly installed or damaged equipment), direct contact or indirect contact through some source of injury (boom vehicle, metal bar or pipe, and other conductive material). Each fatality was coded in terms of age, company size, experience, performing tasks, source of injury, accident cause and hazard pattern. The Chi-square Automatic Interaction Detector (CHAID) was applied to the coded data of the fatal electrocution to find a subset of predictors that might derive meaningful classifications or accidents scenarios. A series of Flow Diagrams was constructed based on CHAID result to illustrate the flow of electricity travelling from electrical source to human body. Each of the flow diagrams can be directly linked with feasible prevention strategies by cutting the flow of electricity.

History of kidney stones and the risk of coronary heart disease.

PubMed

Ferraro, Pietro Manuel; Taylor, Eric N; Eisner, Brian H; Gambaro, Giovanni; Rimm, Eric B; Mukamal, Kenneth J; Curhan, Gary C

2013-07-24

Kidney stone disease is common and may be associated with an increased risk of coronary heart disease (CHD). Previous studies of the association between kidney stones and CHD have often not controlled for important risk factors, and the results have been inconsistent. To examine the association between a history of kidney stones and the risk of CHD in 3 large prospective cohorts. A prospective study of 45,748 men and 196,357 women in the United States without a history of CHD at baseline who were participants in the Health Professionals Follow-up Study (HPFS) (45,748 men aged 40-75 years; follow-up from 1986 to 2010), Nurses' Health Study I (NHS I) (90,235 women aged 30-55 years; follow-up from 1992 to 2010), and Nurses' Health Study II (NHS II) (106,122 women aged 25-42 years; follow-up from 1991 to 2009). The diagnoses of kidney stones and CHD were updated biennially during follow-up. Coronary heart disease was defined as fatal or nonfatal myocardial infarction (MI) or coronary revascularization. The outcome was identified by biennial questionnaires and confirmed through review of medical records. RESULTS Of a total of 242,105 participants, 19,678 reported a history of kidney stones. After up to 24 years of follow-up in men and 18 years in women, 16,838 incident cases of CHD occurred. After adjusting for potential confounders, among women, those with a reported history of kidney stones had an increased risk of CHD than those without a history of kidney stones in NHS I (incidence rate [IR], 754 vs 514 per 100,000 person-years; multivariable hazard ratio [HR], 1.18 [95% CI, 1.08-1.28]) and NHS II (IR, 144 vs 55 per 100,000 person-years; multivariable HR, 1.48 [95% CI, 1.23-1.78]). There was no significant association in men (IR, 1355 vs 1022 per 100,000 person-years; multivariable HR, 1.06 [95% CI, 0.99-1.13]). Similar results were found when analyzing the individual end points (fatal and nonfatal MI and revascularization). Among the 2 cohorts of women, a history of kidney stones was associated with a modest but statistically significantly increased risk of CHD; there was no significant association in a separate cohort of men. Further research is needed to determine whether the association is sex-specific.

A nested case-control study of fatal work related injuries among Brazilian steel workers.

PubMed Central

Barreto, S M; Swerdlow, A J; Smith, P G; Higgins, C D

1997-01-01

OBJECTIVES: To estimate the relative risk of death from work related injury in a steelworks, associated with exposure to various occupational hazards, sociodemographic factors, and medical history. MATERIAL AND METHODS: The study was a nested case-control design. It was based on a cohort of men employed in the steel plant of USIMINAS, Brazil between January 1977 and August 1990, who were followed up to November 1992. The cases were defined as all workers in the cohort who died from injury in the study period and whose death had been notified to the Brazilian Ministry of Labour as being related to work. Four controls per case, matched to cases on year of birth, were randomly selected from among workers employed in the plant at the time of death of the matching case. Data on potential risk factors for occupational injury were extracted from company records; for the controls these data were abstracted for the period preceding the death of the matching case. RESULTS: There were 37 deaths related to work injuries during the study period. Four surviving workers were selected as controls for each case, but for eight the personnel records were incomplete, leaving 140 controls in all. Significantly increased risk of fatal injury related to work was associated with exposure to noise, heat, dust and fumes, gases and vapours, rotating shift work, being a manual worker, and working in the steel mill, coke ovens, blast furnaces, and energy and water supply areas. Risk of fatal injury related to work increased with intensity of exposure to noise (P (trend) = 0.004) and heat (P < 0.001), and increased greatly with a hazard score that combined information on noise, heat, dust, and gas exposure (P < 0.001). Number of years of schooling (P = 0.03) and salary level (P = 0.03) were both negatively associated with risk. In a multivariate analysis including all these significant factors, only hazard score and area of work remained associated with death from injury related to work. The highest risks were for men exposed to all four environmental hazards (odds ratio (OR) 19.4; 95% confidence interval (95% CI) 1.1 to 352.1) and those working in the energy supply area (OR 18.0; 1.6 to 198.1). CONCLUSIONS: The study identified parts of the steelworks and types of hazard associated with greatly increased risk of fatal accident. Research and measures to prevent accidents need to concentrate on these areas and the people working in them. The use of a hazard score was successful in identifying high risk, and similar scoring might prove useful in other industrial situations. PMID:9326164

Alcohol Policies and Alcohol-Related Motor Vehicle Crash Fatalities Among Young People in the US.

PubMed

Hadland, Scott E; Xuan, Ziming; Sarda, Vishnudas; Blanchette, Jason; Swahn, Monica H; Heeren, Timothy C; Voas, Robert B; Naimi, Timothy S

2017-03-01

Motor vehicle crashes (MVCs) are a leading cause of death among young people in the United States. We examined the relationship between states' alcohol policy environments and alcohol-related MVC fatalities among children, adolescents, and young adults under the minimum legal drinking age of 21 years. We used the Alcohol Policy Scale (APS), an assessment of 29 alcohol policies across 50 states and Washington, DC, developed with the assistance of an interdisciplinary Delphi panel. Using the Fatality Analysis Reporting System, we examined APS scores in relation to fatalities of people ≤20 years old from 2000 to 2013 occurring in crashes in which ≥1 involved driver had a blood alcohol content ≥0.08%. Logistic regression was used with a 1-year lag between policies and MVC fatalities and adjusted for potential confounders. Of 84 756 MVC fatalities of those ≤20 years old during the study period, 23 757 (28.0%) were alcohol related, including deaths of 11 006 (46.3%) drivers, 10 212 (43.0%) passengers, and 2539 (10.7%) pedestrians, cyclists, and others. People killed in alcohol-related MVCs were predominantly male (72.7%) and older (65.5% were 18-20 years old), and 51.2% were non-Hispanic white. Restrictive policy environments were associated with fewer fatalities (adjusted odds ratio, 0.91 per 10-percentage-point increase in APS score; 95% confidence interval, 0.89-0.94). The association was observed for drivers and passengers, male and female decendents, and children, adolescents, and young adults. More restrictive alcohol policies are associated with reduced alcohol-related MVC mortality among young people. Studies should scrutinize the relationship between policies and fatalities to highlight mechanisms. Copyright © 2017 by the American Academy of Pediatrics.

Trends in Arkansas motorcycle trauma after helmet law repeal.

PubMed

Bledsoe, Gregory H; Li, Guohua

2005-04-01

This study aimed to assess the impact of the 1997 Arkansas helmet law repeal on motorcycle registrations, crash and fatality risks, and alcohol involvement in motorcycle crashes. Annual motorcycle registration data for the years 1990 through 2001 were obtained from the Arkansas Department of Finance and Administration. These motorcycle registration data were complemented by the motorcycle crash data from the Arkansas State Police Highway Safety Office and motorcycle fatality data for the state of Arkansas from the Fatality Analysis Reporting System. The impact of the repeal on crash rates, helmet usage, and alcohol involvement was assessed through comparisons of data from before (1993 to 1996) and after (1998 to 2001) the repeal. After the repeal, an increase in motorcycle registrations correlated with a marked rise in the total number of crashes and fatalities; however, fatalities per crash remained virtually the same. The proportion of motorcycle fatalities that were not wearing a helmet increased from 47.0% (47/100) before the repeal to 78.2% (104/133) after the repeal (P = 0.001). The overall percentage of fatal motorcycle crashes involving alcohol use remained unchanged after the repeal (37.6% [29/77] to 38.5% [40/104], P = 0.91), but the percentage of fatal crashes involving drinking nonhelmeted drivers increased from 14.2% (11/77) to 33.6% (35/104) (P = 0.003). Inebriated motorcyclists killed in crashes were overwhelmingly non-helmeted (87.5%, 35/40) after the repeal, up from 37.9% (11/29) before the repeal (P < 0.001). These findings suggest that the repeal of the mandatory helmet law in Arkansas has had a significant adverse effect on road safety.

The role of depression and social support in non-fatal drug overdose among a cohort of injection drug users in a Canadian setting

PubMed Central

Pabayo, Roman; Alcantara, Carmela; Kawachi, Ichiro; Wood, Evan; Kerr, Thomas

2013-01-01

Objectives Non-fatal overdose remains a significant source of morbidity among people who inject drugs (IDU). Although depression and social support are important in shaping the health of IDU, little is known about the relationship between these factors and overdose. Therefore, we sought to determine whether depressive symptoms and social support predicted non-fatal overdose among IDU in a Canadian setting. Methods Data were derived from three prospective cohorts of people who use drugs: the Vancouver Injection Drug Users Study (VIDUS), the ACCESS Cohort, and the At-Risk Youth Study (ARYS). Multilevel modeling was used to determine if depression and social support were significant predictors of non-fatal overdose across time. Analyses were stratified by sex. Results There were 1,931 participants included in this analysis, including 653 (33.8%) females and 69 (3.6%) youth 20 years old or younger. Depressed men (Adjusted odds ratio [AOR] =1.53, 95% confidence intervals [CI] =1.25, 1.87) and women (Adjusted odds ratio [AOR] =2.23, 95% confidence intervals [CI] =1.65, 3.00) were more likely to experience a non-fatal overdose. Further, among women, those who reported having 3 or more persons they could rely upon for social support were less likely to experience a non-fatal overdose (AOR=0.54, 95% 0.31, 0.93). Conclusion Although depression was a significant predictor of non-fatal drug overdose, social support was a significant predictor among women only. Possible strategies to prevent non-fatal overdose may include identifying IDU experiencing severe depressive symptoms and providing targeted mental health treatments and mobilizing interpersonal social support among IDU, especially among women. PMID:23647731

Reducing fatalities and severe injuries on Florida's high-speed multi-lane arterial corridors : part III, county level and roadway level GIS safety analysis of state multilane corridors in Florida, final report, April 2009

DOT National Transportation Integrated Search

2009-04-28

This part of the study examines the locations of high trends of severe crashes (incapacitating and fatal crashes) on multilane corridors in the state of Florida at two levels, county level and roadway level. The Geographic Information System (GIS) to...

Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial.

PubMed

Hofmeijer, Jeannette; Kappelle, L Jaap; Algra, Ale; Amelink, G Johan; van Gijn, Jan; van der Worp, H Bart

2009-04-01

Patients with space-occupying hemispheric infarctions have a poor prognosis, with case fatality rates of up to 80%. In a pooled analysis of randomised trials, surgical decompression within 48 h of stroke onset reduced case fatality and improved functional outcome; however, the effect of surgery after longer intervals is unknown. The aim of HAMLET was to assess the effect of decompressive surgery within 4 days of the onset of symptoms in patients with space-occupying hemispheric infarction. Patients with space-occupying hemispheric infarction were randomly assigned within 4 days of stroke onset to surgical decompression or best medical treatment. The primary outcome measure was the modified Rankin scale (mRS) score at 1 year, which was dichotomised between good (0-3) and poor (4-6) outcome. Other outcome measures were the dichotomy of mRS score between 4 and 5, case fatality, quality of life, and symptoms of depression. Analysis was by intention to treat. This trial is registered, ISRCTN94237756. Between November, 2002, and October, 2007, 64 patients were included; 32 were randomly assigned to surgical decompression and 32 to best medical treatment. Surgical decompression had no effect on the primary outcome measure (absolute risk reduction [ARR] 0%, 95% CI -21 to 21) but did reduce case fatality (ARR 38%, 15 to 60). In a meta-analysis of patients in DECIMAL (DEcompressive Craniectomy In MALignant middle cerebral artery infarction), DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY), and HAMLET who were randomised within 48 h of stroke onset, surgical decompression reduced poor outcome (ARR 16%, -0.1 to 33) and case fatality (ARR 50%, 34 to 66). Surgical decompression reduces case fatality and poor outcome in patients with space-occupying infarctions who are treated within 48 h of stroke onset. There is no evidence that this operation improves functional outcome when it is delayed for up to 96 h after stroke onset. The decision to perform the operation should depend on the emphasis patients and relatives attribute to survival and dependency.

The effects of electronic stability control (ESC) on crashes--an update.

PubMed

Høye, Alena

2011-05-01

The present study is an update of the meta-analysis by Erke (Erke, A., 2008. Effects of Electronic Stability Control (ESC) on accidents: a review of empirical evidence. Accident Analysis & Prevention, 40 (1), 167-173). Results from 12 studies of the effects of Electronic Stability Control (ESC) on the number of different types of crashes were summarized by means of meta-analysis. The results indicate that ESC prevents about 40% of all crashes involving loss of control. The greatest reductions were found for rollover crashes (-50%), followed by run-off-road (-40%) and single vehicle crashes (-25%). These results are however likely to be somewhat overestimated, especially for non-fatal crashes. Multiple vehicle crashes were found to be largely unchanged. Reductions were found for some types of multiple vehicle crashes. Rear-end collisions are unchanged or may increase. Fatal crashes involving pedestrians, bicycles or animals were found to increase as well. ESC was found to be more effective in preventing fatal crashes than non-fatal crashes. ESC is often found to be more effective in Sports Utility Vehicles (SUVs) than in passenger cars. This may be due to differences between drivers of SUVs and passenger cars. The results from meta-analysis indicate that drivers of ESC-equipped vehicles are likely to be safer drivers than other drivers. All the same, ESC may lead to behavioural adaptation in some cases, but it is not likely that behavioural adaptation offsets the positive safety effects. This may be due to a lack of knowledge about ESC. Copyright © 2010 Elsevier Ltd. All rights reserved.

"If I know I am on the pill and I get pregnant, it's an act of God": women's views on fatalism, agency and pregnancy.

PubMed

Jones, Rachel K; Frohwirth, Lori F; Blades, Nakeisha M

2016-06-01

Fatalism is the idea that outside forces have control over events. Pregnancy and pregnancy prevention play a prominent role in many women's lives, and we sought to understand if and how fatalism informed their thinking about these issues. We conducted in-depth interviews with 52 unmarried women between the ages of 18 and 30. We used NVivo to analyze the transcripts. The current analysis focuses on the ways that women discussed fatalism and pregnancy both in response to a direct question and as it came up spontaneously. The majority of respondents expressed a mix of fatalistic and non-fatalistic views about pregnancy. Many related that "fate," "destiny" and/or God play a role in pregnancy, but most also asserted that pregnancy risk could be substantially reduced, most commonly by using contraception. Fatalism sometimes served a positive function, for example as a mechanism to deal with an unintended pregnancy. Having a fatalistic outlook did not preclude contraceptive use. Rather, some women using highly effective methods related that if they were to become pregnant, they would interpret it as a sign that the pregnancy was "meant to happen." Finally some women related that there was no guarantee a woman could get pregnant when she wanted to, suggesting that some degree of fatalism may be inevitable when it comes to pregnancy. Fatalism and agency should not be viewed as opposing outlooks when it comes to pregnancy and pregnancy prevention; having fatalistic views about pregnancy does not preclude contraceptive use. Given that women do not have total control over attainment of a wanted pregnancy or even prevention of pregnancy, some amount of fatalism about fertility is a logical and pragmatic response. Both research and clinical practice need to recognize that fatalism and contraceptive use are often not in conflict. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

“If I know I am on the pill and I get pregnant, it’s an act of God”: women’s views on fatalism, agency and pregnancy

PubMed Central

Jones, Rachel K.; Frohwirth, Lori F.; Blades, Nakeisha M.

2016-01-01

Objectives Fatalism is the idea that outside forces have control over events. Pregnancy and pregnancy prevention play a prominent role in many women’s lives, and we sought to understand if and how fatalism informed their thinking about these issues. Study design We conducted in-depth interviews with 52 unmarried women between the ages of 18 and 30. We used NVivo to analyze the transcripts. The current analysis focuses on the ways that women discussed fatalism and pregnancy both in response to a direct question and as it came up spontaneously. Results The majority of respondents expressed a mix of fatalistic and non-fatalistic views about pregnancy. Many related that “fate,” “destiny” and/or God play a role in pregnancy, but most also asserted that pregnancy risk could be substantially reduced, most commonly by using contraception. Fatalism sometimes served a positive function, for example as a mechanism to deal with an unintended pregnancy. Having a fatalistic outlook did not preclude contraceptive use. Rather, some women using highly effective methods related that if they were to become pregnant, they would interpret it as a sign that the pregnancy was “meant to happen.” Finally some women related that there was no guarantee a woman could get pregnant when she wanted to, suggesting that some degree of fatalism may be inevitable when it comes to pregnancy. Conclusions Fatalism and agency should not be viewed as opposing outlooks when it comes to pregnancy and pregnancy prevention; having fatalistic views about pregnancy does not preclude contraceptive use. Implications Given that women do not have total control over attainment of a wanted pregnancy or even prevention of pregnancy, some amount of fatalism about fertility is a logical and pragmatic response. Both research and clinical practice need to recognize that fatalism and contraceptive use are often not in conflict. PMID:26872719

Heart rate is a prognostic risk factor for myocardial infarction: a post hoc analysis in the PERFORM (Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack) study population.

PubMed

Fox, Kim; Bousser, Marie-Germaine; Amarenco, Pierre; Chamorro, Angel; Fisher, Marc; Ford, Ian; Hennerici, Michael G; Mattle, Heinrich P; Rothwell, Peter M

2013-10-09

Elevated resting heart rate is known to be detrimental to morbidity and mortality in cardiovascular disease, though its effect in patients with ischemic stroke is unclear. We analyzed the effect of baseline resting heart rate on myocardial infarction (MI) in patients with a recent noncardioembolic cerebral ischemic event participating in PERFORM. We compared fatal or nonfatal MI using adjusted Cox proportional hazards models for PERFORM patients with baseline heart rate <70 bpm (n=8178) or ≥70 bpm (n=10,802). In addition, heart rate was analyzed as a continuous variable. Other cerebrovascular and cardiovascular outcomes were also explored. Heart rate ≥70 bpm was associated with increased relative risk for fatal or nonfatal MI (HR 1.32, 95% CI 1.03-1.69, P=0.029). For every 5-bpm increase in heart rate, there was an increase in relative risk for fatal and nonfatal MI (11.3%, P=0.0002). Heart rate ≥70 bpm was also associated with increased relative risk for a composite of fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (excluding hemorrhagic death) (P<0001); vascular death (P<0001); all-cause mortality (P<0001); and fatal or nonfatal stroke (P=0.04). For every 5-bpm increase in heart rate, there were increases in relative risk for fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (4.7%, P<0.0001), vascular death (11.0%, P<0.0001), all-cause mortality (8.0%, P<0.0001), and fatal and nonfatal stroke (2.4%, P=0.057). Elevated heart rate ≥70 bpm places patients with a noncardioembolic cerebral ischemic event at increased risk for MI. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Is the societal burden of fatal occupational injury different among NORA industry sectors?

PubMed

Biddle, Elyce Anne

2013-02-01

Since the implementation of the Occupational Safety and Health Act, safety and health in the work environment has seen marked improvement. Although these improvements are laudable, workplace hazards continue to plague the American worker. Understanding the economic burden of fatalities by industry sector is important to setting broad occupational safety and health research priorities. Cost estimates provide additional information about how fatal injuries affect society and hence can improve injury prevention program planning, policy analysis, evaluation, and advocacy. This study estimated the total, mean, and median societal costs by worker and case characteristic in 2003-2006 for the industry sectors identified in the National Institute for Occupational Safety and Health National Occupational Research Agenda (NORA). Analyses were conducted with restricted access to the Bureau of Labor Statistics Census of Fatal Occupational Injuries data. These data exclude military personnel, decedents with unknown age or sex, and fatalities occurring in New York City. Societal costs were estimated using the cost-of-illness approach, which combines direct and indirect costs to yield an overall cost of an fatal occupational injury. During this period, the cost of the 22,197 fatal occupational injuries exceeded $21 billion. The mean and median costs of these fatalities were $960,000 and $944,000 respectively. Total societal costs by NORA sector ranged from a high of $5.8 billion in Services to a low of $530 million in Healthcare and Social Assistance with mean costs ranging from the nearly $800,000 in Agriculture, Forestry, and Fishing to almost $1.1 million in Mining. The societal costs-total, mean, and median costs-of case and worker characteristics for occupational fatal injuries varied within each NORA sector. To have the greatest societal impact, these costs can be used to target resources for public and private sector research by industry. Published by Elsevier Ltd.

Restraint use in motor vehicle crash fatalities in children 0 year to 9 years old.

PubMed

Lee, Lois K; Farrell, Caitlin A; Mannix, Rebekah

2015-09-01

Despite improvements in child passenger safety legislation and equipment, motor vehicle crashes (MVCs) continue to be the leading cause of death in children younger than 10 years. The objective of this study was to describe factors associated with restraint use in fatal MVC in children 0 year to 9 years old. The Fatality Analysis Reporting System, maintained by the National Highway Transportation Safety Administration, was used to obtain data on MVC fatalities from 2001 to 2010 in children 0 year to 9 years old. The main outcome was restraint use. Demographic information (age, sex, and race) and crash characteristics including vehicle type (sedan, van, truck, sports utility vehicle) and seat position in the vehicle were analyzed with the χ statistic to evaluate these factors for any restraint use compared with no restraint use in MVC fatalities. There were 7,625 MVC fatalities in children 0 year to 9 years old from 2001 to 2010.Among these fatalities, 4,041 (53%) had any restraint use. Front seat passengers accounted for 20.9% (1,595 of 7,625) of the fatalities. Children 0 year to 3 years old had a higher proportion of restraint use than children 4 years to 9 years old (p < 0.001). White children compared with black children had higher use of restraints (p < 0.001). Children riding in sedans/vans compared with sport utility vehicles/trucks and those riding in the rear seats of the vehicle compared with those in front seats were significantly more likely to use restraints (p < 0.001). Overall, only half of children 0 year to 9 years old who died in an MVC were wearing any child restraint in the vehicle, and 20% were sitting in the front seat. Continued efforts must be made to enforce legislation and educate the public about best practices regarding child passenger safety to improve proper restraint use and to decrease MVC fatalities in children. Prognostic/epidemiologic study, level II.

Different features of Vδ2 T and NK cells in fatal and non-fatal human Ebola infections.

PubMed

Cimini, Eleonora; Viola, Domenico; Cabeza-Cabrerizo, Mar; Romanelli, Antonella; Tumino, Nicola; Sacchi, Alessandra; Bordoni, Veronica; Casetti, Rita; Turchi, Federica; Martini, Federico; Bore, Joseph A; Koundouno, Fara Raymond; Duraffour, Sophie; Michel, Janine; Holm, Tobias; Zekeng, Elsa Gayle; Cowley, Lauren; Garcia Dorival, Isabel; Doerrbecker, Juliane; Hetzelt, Nicole; Baum, Jonathan H J; Portmann, Jasmine; Wölfel, Roman; Gabriel, Martin; Miranda, Osvaldo; Díaz, Graciliano; Díaz, José E; Fleites, Yoel A; Piñeiro, Carlos A; Castro, Carlos M; Koivogui, Lamine; Magassouba, N'Faly; Diallo, Boubacar; Ruibal, Paula; Oestereich, Lisa; Wozniak, David M; Lüdtke, Anja; Becker-Ziaja, Beate; Capobianchi, Maria R; Ippolito, Giuseppe; Carroll, Miles W; Günther, Stephan; Di Caro, Antonino; Muñoz-Fontela, César; Agrati, Chiara

2017-05-01

Human Ebola infection is characterized by a paralysis of the immune system. A signature of αβ T cells in fatal Ebola infection has been recently proposed, while the involvement of innate immune cells in the protection/pathogenesis of Ebola infection is unknown. Aim of this study was to analyze γδ T and NK cells in patients from the Ebola outbreak of 2014-2015 occurred in West Africa, and to assess their association with the clinical outcome. Nineteen Ebola-infected patients were enrolled at the time of admission to the Ebola Treatment Centre in Guinea. Patients were divided in two groups on the basis of the clinical outcome. The analysis was performed by using multiparametric flow cytometry established by the European Mobile Laboratory in the field. A low frequency of Vδ2 T-cells was observed during Ebola infection, independently from the clinical outcome. Moreover, Vδ2 T-cells from Ebola patients massively expressed CD95 apoptotic marker, suggesting the involvement of apoptotic mechanisms in Vδ2 T-cell loss. Interestingly, Vδ2 T-cells from survivors expressed an effector phenotype and presented a lower expression of the CTLA-4 exhaustion marker than fatalities, suggesting a role of effector Vδ2 T-cells in the protection. Furthermore, patients with fatal Ebola infection were characterized by a lower NK cell frequency than patients with non fatal infection. In particular, both CD56bright and CD56dim NK frequency were very low both in fatal and non fatal infections, while a higher frequency of CD56neg NK cells was associated to non-fatal infections. Finally, NK activation and expression of NKp46 and CD158a were independent from clinical outcome. Altogether, the data suggest that both effector Vδ2 T-cells and NK cells may play a role in the complex network of protective response to EBOV infection. Further studies are required to characterize the protective effector functions of Vδ2 and NK cells.

Is the Societal burden of fatal occupational injury different among NORA industry sectors?

PubMed Central

Biddle, Elyce Anne

2015-01-01

Problem Since the implementation of the Occupational Safety and Health Act, safety and health in the work environment has seen marked improvement. Although these improvements are laudable, workplace hazards continue to plague the American worker. Understanding the economic burden of fatalities by industry sector is important to setting broad occupational safety and health research priorities. Cost estimates provide additional information about how fatal injuries affect society and hence can improve injury prevention program planning, policy analysis, evaluation, and advocacy. Method This study estimated the total, mean, and median societal costs by worker and case characteristic in 2003–2006 for the industry sectors identified in the National Institute for Occupational Safety and Health National Occupational Research Agenda (NORA). Analyses were conducted with restricted access to the Bureau of Labor Statistics Census of Fatal Occupational Injuries data. These data exclude military personnel, decedents with unknown age or sex, and fatalities occurring in New York City. Societal costs were estimated using the cost-of-illness approach, which combines direct and indirect costs to yield an overall cost of an fatal occupational injury. Results During this period, the cost of the 22,197 fatal occupational injuries exceeded $21 billion. The mean and median costs of these fatalities were $960,000 and $944,000 respectively. Total societal costs by NORA sector ranged from a high of $5.8 billion in Services to a low of $530 million in Healthcare and Social Assistance with mean costs ranging from the nearly $800,000 in Agriculture, Forestry, and Fishing to almost $1.1 million in Mining. Discussion The societal costs—total, mean, and median costs—of case and worker characteristics for occupational fatal injuries varied within each NORA sector. Impact on Industry To have the greatest societal impact, these costs can be used to target resources for public and private sector research by industry. PMID:23398699

Multivariate analysis in thoracic research.

PubMed

Mengual-Macenlle, Noemí; Marcos, Pedro J; Golpe, Rafael; González-Rivas, Diego

2015-03-01

Multivariate analysis is based in observation and analysis of more than one statistical outcome variable at a time. In design and analysis, the technique is used to perform trade studies across multiple dimensions while taking into account the effects of all variables on the responses of interest. The development of multivariate methods emerged to analyze large databases and increasingly complex data. Since the best way to represent the knowledge of reality is the modeling, we should use multivariate statistical methods. Multivariate methods are designed to simultaneously analyze data sets, i.e., the analysis of different variables for each person or object studied. Keep in mind at all times that all variables must be treated accurately reflect the reality of the problem addressed. There are different types of multivariate analysis and each one should be employed according to the type of variables to analyze: dependent, interdependence and structural methods. In conclusion, multivariate methods are ideal for the analysis of large data sets and to find the cause and effect relationships between variables; there is a wide range of analysis types that we can use.

Beta-blocker use is associated with improved outcomes in adult trauma patients.

PubMed

Arbabi, Saman; Campion, Eric M; Hemmila, Mark R; Barker, Melissa; Dimo, Mary; Ahrns, Karla S; Niederbichler, Andreas D; Ipaktchi, Kyros; Wahl, Wendy L

2007-01-01

Beta-adrenoreceptor blocker (beta-blocker) therapy may improve outcomes in surgical patients by decreasing cardiac oxygen consumption and hypermetabolism. Because beta-blockers can lower the systemic blood pressure and cerebral perfusion pressure, there is concern regarding their use in patients with head injury. However, beta-blockers may protect beta-receptor rich brain cells by attenuating cerebral oxygen consumption and metabolism. We hypothesized that beta-blockers are safe in trauma patients, even if they have suffered a significant head injury. Using pharmacy and trauma registry data of a Level I trauma center, we identified a cohort of trauma patients who received beta-blockers during their hospital stay (beta-cohort). Trauma admissions who did not receive beta-blockers were in the control cohort. beta-blocker status, in combination with other variables associated with mortality, were placed in a stepwise multivariate logistic regression to identify independent predictors of fatal outcome. In all, 303 (7%) of 4,117 trauma patients received beta-blockers. In the beta-cohort, 45% of patients were on beta-blockers preinjury. The most common reason to initiate beta-blocker therapy was blood pressure (60%) and heart rate (20%) control. The overall mortality rate was 5.6% and head injury was considered to be the major cause of death. After adjusting for age, Injury Severity Scale score, blood pressure, Glasgow Coma Scale score, respiratory status, and mechanism of injury, the odds ratio for fatal outcome was 0.3 (p < 0.001) for beta-cohort as compared with control. Decreased risk of fatal outcome was more pronounced in patients with a significant head injury. beta-blocker therapy is safe and may be beneficial in selected trauma patients with or without head injury. Further studies looking at beta-blocker therapy in trauma patients and their effect on cerebral metabolism are warranted.

Correlative and multivariate analysis of increased radon concentration in underground laboratory.

PubMed

Maletić, Dimitrije M; Udovičić, Vladimir I; Banjanac, Radomir M; Joković, Dejan R; Dragić, Aleksandar L; Veselinović, Nikola B; Filipović, Jelena

2014-11-01

The results of analysis using correlative and multivariate methods, as developed for data analysis in high-energy physics and implemented in the Toolkit for Multivariate Analysis software package, of the relations of the variation of increased radon concentration with climate variables in shallow underground laboratory is presented. Multivariate regression analysis identified a number of multivariate methods which can give a good evaluation of increased radon concentrations based on climate variables. The use of the multivariate regression methods will enable the investigation of the relations of specific climate variable with increased radon concentrations by analysis of regression methods resulting in 'mapped' underlying functional behaviour of radon concentrations depending on a wide spectrum of climate variables. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Trends and characteristics of animal-vehicle collisions in the United States.

PubMed

Sullivan, John M

2011-02-01

Since 1990, fatal animal-vehicle collisions (AVCs) in the United States have more than doubled. This paper examines annual AVC trends in the United States over a 19-year period, seasonal and diurnal patterns of AVC risk, the geographic distribution of crash risk by state, and the association between posted speed limit and AVC crash risk in darkness. AVCs were compiled from the Fatality Analysis Reporting System (FARS) and the General Estimates System (GES) for the years 1990-2008 to examine annual crash trends for fatal and nonfatal crashes. Seasonal trends for fatal AVCs were examined with the aggregated FARS dataset; seasonal trends for fatal and nonfatal AVCs were also examined by aggregating four years of Michigan crash data. State-by-state distributions of fatal AVCs were also described with the aggregated FARS dataset. Finally, the relationship between posted speed limit and the odds that a fatal or nonfatal AVC occurred in darkness were examined with logistic regressions using the aggregated FARS and Michigan datasets. Between 1990 and 2008, fatal AVCs increased by 104% and by 1.3 crashes per trillion vehicle miles travelled per year. Although not all AVCs involve deer, daily and seasonal AVC crash trends follow the general activity pattern of deer populations, consistent with prior reports. The odds that a fatal AVC occurred in darkness were also found to increase by 2.3% for each mile-per-hour increase in speed; a similar, albeit smaller, effect was also observed in the aggregated Michigan dataset, among nonfatal crashes. AVCs represent a small but increasing share of crashes in the United States. Seasonal and daily variation in the pattern of AVCs seem to follow variation in deer exposure and ambient light level. Finally, the relative risk that a fatal and nonfatal AVC occurred in darkness is influenced by posted speed limit, suggesting that a driver's limited forward vision at night plays a role in AVCs, as it does in pedestrian collisions. The association between speed limit and crash risk in darkness suggests that AVC risk might be reduced with countermeasures that improve a driver's forward view of the road. Copyright © 2010 Elsevier Ltd. All rights reserved.

Assaults against U.S. law enforcement officers in the line-of-duty: situational context and predictors of lethality.

PubMed

Crifasi, Cassandra K; Pollack, Keshia M; Webster, Daniel W

2016-12-01

Research on occupational safety of law enforcement officers (LEOs) has primarily focused on fatal assaults. Nonfatal assaults, however, have received little attention. The goal of this study was to describe the situational contexts in which LEOs are assaulted, and compare these contexts and risks between fatal and nonfatal assaults in the U.S. Analyzing both types of assaults provides a more complete understanding of occupational safety and opportunities for intervention. This study includes a descriptive epidemiology of fatal and nonfatal assaults of LEOs in the U.S. and a pooled cross-sectional analysis of risk factors contributing to the odds of lethal assault. Data were collected from the Law Enforcement Officers Killed and Assaulted database. Descriptive statistics were used to characterize fatal and nonfatal assaults. Odds ratios were generated to understand the odds that an assault would result in a fatality. Between 1998 and 2013, there were 791 fatal assaults and 2,022 nonfatal assaults of LEOs. Nearly 60% of primary wounds in fatal assaults were received to the head, neck, or throat while nearly 50% of primary wounds in nonfatal assaults were received to the arms/hands or below the waist. The odds that an assault resulted in a fatality decreased by 57% (OR 0.43, 95% CI 0.32 to 0.58) when a LEO was wearing body armor. LEOs experiencing an ambush or unprovoked attack had significantly increased odds of an assault resulting in a fatality (OR 3.27, 95% CI 1.83 to 5.85 and OR 2.24, 95% CI 1.44 to 3.47 respectively). LEOs that were disarmed during an encounter with a suspect had more than 2-fold increased odds of an assault resulting in a fatality (OR 2.24, 95% CI 1.48 to 3.38). There are specific situational and encounter characteristics that influence the lethality of an assault, which suggest strategies for prevention. Mandatory wear policies for the use of body armor could significantly reduce mortality among assaulted LEOs.

Multivariate Methods for Meta-Analysis of Genetic Association Studies.

PubMed

Dimou, Niki L; Pantavou, Katerina G; Braliou, Georgia G; Bagos, Pantelis G

2018-01-01

Multivariate meta-analysis of genetic association studies and genome-wide association studies has received a remarkable attention as it improves the precision of the analysis. Here, we review, summarize and present in a unified framework methods for multivariate meta-analysis of genetic association studies and genome-wide association studies. Starting with the statistical methods used for robust analysis and genetic model selection, we present in brief univariate methods for meta-analysis and we then scrutinize multivariate methodologies. Multivariate models of meta-analysis for a single gene-disease association studies, including models for haplotype association studies, multiple linked polymorphisms and multiple outcomes are discussed. The popular Mendelian randomization approach and special cases of meta-analysis addressing issues such as the assumption of the mode of inheritance, deviation from Hardy-Weinberg Equilibrium and gene-environment interactions are also presented. All available methods are enriched with practical applications and methodologies that could be developed in the future are discussed. Links for all available software implementing multivariate meta-analysis methods are also provided.

Objectifying when to halt a boxing match: a video analysis of fatalities.

PubMed

Miele, Vincent J; Bailes, Julian E

2007-02-01

Although numerous prestigious medical organizations have called for its abolishment, participation in the sport of boxing has reached an all-time high among both men and women, and its elimination is unlikely in the near future. Physicians should strive to increase boxing safety by improving the rules of competition, which have evolved minimally over the past two centuries. Currently, subjective criteria are used to determine whether or not a contest should be halted. Developing a standardized, objective method of determining when a contest should be halted would be a significant paradigm shift and could increase the safety of the sport's participants. This study analyzed the number and types of punches landed in a typical professional match, in bouts considered to be competitive and in those that ended in fatalities, to determine whether or not this would be a practical method of differentiating between these groups. Three groups of professional boxing matches were defined at the beginning of the study: 1) a "fatal" group, consisting of bouts that resulted in the death of a participant; 2) a "classic" group that represented competitive matches; and 3) a "control" group of 4000 professional boxing matches representing the average bout. A computer program known as Punchstat (Compubox, Inc., Manorville, NY) was used in the objective analysis of these matches via videotape playback. Several statistically significant differences were discovered between matches that resulted in fatalities and the control group. These include the number of punches landed per round, the number of power punches landed per round, and the number of power punches thrown per round by losing boxers. However, when the fatal bouts were compared with the most competitive bouts, these differences were no longer evident. Based on the data analyzed between the control and fatal-bout groups, a computerized method of counting landed blows at ringside could provide sufficient data to stop matches that might result in fatalities. However, such a process would become less effective as matches become more competitive, and implementing such a change would significantly decrease the competitive nature of the sport. Therefore, other methods of quantifying acceleration-deceleration brain injuries are necessary to improve the safety of boxing.

Identification and characterization of near-fatal asthma phenotypes by cluster analysis.

PubMed

Serrano-Pariente, J; Rodrigo, G; Fiz, J A; Crespo, A; Plaza, V

2015-09-01

Near-fatal asthma (NFA) is a heterogeneous clinical entity and several profiles of patients have been described according to different clinical, pathophysiological and histological features. However, there are no previous studies that identify in a unbiased way--using statistical methods such as clusters analysis--different phenotypes of NFA. Therefore, the aim of the present study was to identify and to characterize phenotypes of near fatal asthma using a cluster analysis. Over a period of 2 years, 33 Spanish hospitals enrolled 179 asthmatics admitted for an episode of NFA. A cluster analysis using two-steps algorithm was performed from data of 84 of these cases. The analysis defined three clusters of patients with NFA: cluster 1, the largest, including older patients with clinical and therapeutic criteria of severe asthma; cluster 2, with an high proportion of respiratory arrest (68%), impaired consciousness level (82%) and mechanical ventilation (93%); and cluster 3, which included younger patients, characterized by an insufficient anti-inflammatory treatment and frequent sensitization to Alternaria alternata and soybean. These results identify specific asthma phenotypes involved in NFA, confirming in part previous findings observed in studies with a clinical approach. The identification of patients with a specific NFA phenotype could suggest interventions to prevent future severe asthma exacerbations. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A retrospective study of ketamine administration and the development of acute or post-traumatic stress disorder in 274 war-wounded soldiers.

PubMed

Mion, G; Le Masson, J; Granier, C; Hoffmann, C

2017-12-01

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post-traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post-traumatic stress disorder and 89 (32%) had received ketamine. Fifty-four patients (55%) in the post-traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3-13 [1-26]) vs. 3 (2-4 [1-6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post-traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post-traumatic stress disorder in the military trauma setting. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Predictive Risk Factors in the Development of Intraoperative Hyperkalemia in Adult Living Donor Liver Transplantation.

PubMed

Juang, S-E; Huang, C-E; Chen, C-L; Wang, C-H; Huang, C-J; Cheng, K-W; Wu, S-C; Shih, T-H; Yang, S-C; Wong, Z-W; Jawan, B; Lee, Y-E

2016-05-01

Hyperkalemia, defined as a serum potassium level higher than 5 mEq/L, is common in the liver transplantation setting. Severe hyperkalemia may induce fatal cardiac arrhythmias; therefore, it should be monitored and treated accordingly. The aim of the current retrospective study is to evaluate and indentify the predictive risk factors of hyperkalemia during living-donor liver transplantation (LDLT). Four hundred eighty-seven adult LDLT patients were included in the study. Intraoperative serum potassium levels were monitored at least five times during LDLT; patients with a potassium level higher than 5 mEq/L were included in group 1, and the others with normokalemia in group 2. Patients' categorical characteristics and intraoperative numeric variables with a P value <.1 were selected into a multiple binary logistic regression model. In multivariate analysis, a P value of <.05 is regarded as a risk factor in the development of hyperkalemia. Fifty-one of 487 (10.4%) patients had hyperkalemia with a serum potassium level higher than 5.0 mEq/L during LDLT. Predictive factors with P < .1 in univariate analysis (Table 1), such as anesthesia time, preoperative albumin level, Model for End-stage Liver Disease score, preoperative bilirubin level, amount of blood loss, red blood cell (RBC) and fresh frozen plasma transfused, 5% albumin administered, hemoglobin at the end of surgery, and the amount of furosemide used, were further analyzed by multivariate binary regression. Results show that the anesthesia time, preoperative serum albumin level, and RBC count are determinant risk factors in the development of the hyperkalemia in our LDLT serials. Prolonged anesthesia time, preoperative serum albumin level, and intraoperative RBC transfusion are three determinant factors in the development of intraoperative hyperkalemia, and close monitoring of serum potassium levels in patients with abovementioned risk factors are recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

Prediction of road accidents: A Bayesian hierarchical approach.

PubMed

Deublein, Markus; Schubert, Matthias; Adey, Bryan T; Köhler, Jochen; Faber, Michael H

2013-03-01

In this paper a novel methodology for the prediction of the occurrence of road accidents is presented. The methodology utilizes a combination of three statistical methods: (1) gamma-updating of the occurrence rates of injury accidents and injured road users, (2) hierarchical multivariate Poisson-lognormal regression analysis taking into account correlations amongst multiple dependent model response variables and effects of discrete accident count data e.g. over-dispersion, and (3) Bayesian inference algorithms, which are applied by means of data mining techniques supported by Bayesian Probabilistic Networks in order to represent non-linearity between risk indicating and model response variables, as well as different types of uncertainties which might be present in the development of the specific models. Prior Bayesian Probabilistic Networks are first established by means of multivariate regression analysis of the observed frequencies of the model response variables, e.g. the occurrence of an accident, and observed values of the risk indicating variables, e.g. degree of road curvature. Subsequently, parameter learning is done using updating algorithms, to determine the posterior predictive probability distributions of the model response variables, conditional on the values of the risk indicating variables. The methodology is illustrated through a case study using data of the Austrian rural motorway network. In the case study, on randomly selected road segments the methodology is used to produce a model to predict the expected number of accidents in which an injury has occurred and the expected number of light, severe and fatally injured road users. Additionally, the methodology is used for geo-referenced identification of road sections with increased occurrence probabilities of injury accident events on a road link between two Austrian cities. It is shown that the proposed methodology can be used to develop models to estimate the occurrence of road accidents for any road network provided that the required data are available. Copyright © 2012 Elsevier Ltd. All rights reserved.

Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition.

PubMed

Reardon, Joseph M; Harmon, Katherine J; Schult, Genevieve C; Staton, Catherine A; Waller, Anna E

2016-02-08

Although fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time. We determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02 and 965.09 (poisoning by opiates and related narcotics) and/or an external cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and related narcotics), and developed a novel case definition to determine in which cases opioid poisoning prompted the ED visit. We calculated the percentage of visits coded for opioid poisoning that were clinically significant and compared it to the percentage of visits coded for poisoning by non-opioid agents in which there was actually poisoning by an opioid agent. We created a multivariate regression model to determine if other collected triage data can improve the positive predictive value of diagnosis codes alone for detecting clinically significant opioid poisoning. 70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were primarily prompted by opioid poisoning. The remainder of visits represented opioid exposure in the setting of other primary diseases. Among non-opioid poisoning codes reviewed, up to 36 % were reclassified as an opioid poisoning. In multivariate analysis, only naloxone use improved the positive predictive value of ICD-9-CM codes for identifying clinically significant opioid poisoning, but was associated with a high false negative rate. This surveillance mechanism identifies many clinically significant opioid overdoses with a high positive predictive value. With further validation, it may help target control measures such as prescriber education and pharmacy monitoring.

High-Dose-Rate Brachytherapy for Non-Small-Cell Lung Carcinoma: A Retrospective Study of 226 Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aumont-le Guilcher, Maud; Prevost, Bernard; Sunyach, Marie Pierre

Purpose: To evaluate the efficacy and toxicity of high-dose-rate (HDR) brachytherapy in patients with inoperable endobronchial carcinoma. Methods and Materials: We retrospectively reviewed the records (April 1991-May 2004) of patients with non-small-cell carcinoma, with no extrabronchial spread on computed tomography scans, who underwent HDR brachytherapy because of contraindications to surgery and external beam radiation therapy. Kaplan-Meier survival curves were compared by the log-rank test. Prognostic factors were analyzed by multivariate analysis. Results: 226 patients (223 men, 3 women, mean age: 62.2 years (range, 40-84)) were included. Of those, 217 (97%) had squamous cell carcinoma (Tis/T1/T2/Tx: 60/153/9/4). Dose was prescribed atmore » 1 cm from the radius (24-35 Gy in 4-6 fractions). Mean follow-up was 30.4 months (range, 9-116). Complete endoscopic response rate was 93.6% at 3 months. One hundred twenty-eight patients (56%) died of intercurrent disease (n = 45), local failure (n = 36), metastasis (n = 10), local failure and metastasis (n = 11), complications (n = 13), and other causes (n = 12). The 2-year and 5-year survival rates were, respectively, 57% and 29% (overall) (median, 28.6 months), 81% and 56% (cancer-specific), and 68% and 50% (local disease-free). Acute toxicity included pneumothorax (1.5%) and mucosal inflammation (10%). Late complications were hemoptysis (6.6% with 5% of fatalities), bronchitis (19.5%), and necrosis (3.5%). In multivariate analysis, a distal tumor location and the use of two catheters were associated with improved local disease-free survival (p = 0.003 and p = 0.007, respectively) and a distal tumor location with improved overall survival (p = 0.0001). Conclusions: This large retrospective study confirms that HDR brachytherapy is an efficient and safe treatment in patients with inoperable endobronchial carcinoma.« less

Risk factors for death from canine parvoviral-related disease in Australia.

PubMed

Ling, Monika; Norris, Jacqueline M; Kelman, Mark; Ward, Michael P

2012-08-17

Canine parvovirus (CPV) is a highly contagious cause of serious and often fatal disease in dogs worldwide despite the availability of safe and efficacious vaccines. Although a number of studies have focussed on identifying risk factors in disease development, risk factors associated with death from CPV are largely unknown. In this study we analysed a total of 1451 CPV cases reported from an Australian surveillance system - using univariate and multivariate techniques - to determine significant risk factors associated with death and euthanasia. A crude case fatality rate of 42.3% was estimated - higher than has been reported previously. We found that 3.3% of CPV cases had a history of vaccination in the previous 12 months, despite having completed the primary puppy vaccination course. The majority (89.5%) of these cases occurred in dogs <12 months of age, indicating failure of the primary vaccination course to provide protective immunity (most likely due to interference of the vaccine antigen with maternal antibodies but other reasons are discussed). Extending the age at which the final puppy vaccination is administered might be one of several strategies to consider. The final multivariate model showed that in non-litter CPV cases, risk of death was significantly associated with season of diagnosis (summer) and pedigree type (hounds and non-sporting dogs). Euthanasia in non-litter CPV cases was significantly associated with season of diagnosis (summer), state of residence (Northern Territory/South Australia/Tasmania combined), age (

Estimation and Psychometric Analysis of Component Profile Scores via Multivariate Generalizability Theory

ERIC Educational Resources Information Center

Grochowalski, Joseph H.

2015-01-01

Component Universe Score Profile analysis (CUSP) is introduced in this paper as a psychometric alternative to multivariate profile analysis. The theoretical foundations of CUSP analysis are reviewed, which include multivariate generalizability theory and constrained principal components analysis. Because CUSP is a combination of generalizability…

First Report of a Fatal Case Associated with EV-D68 Infection in Hong Kong and Emergence of an Interclade Recombinant in China Revealed by Genome Analysis.

PubMed

Yip, Cyril C Y; Lo, Janice Y C; Sridhar, Siddharth; Lung, David C; Luk, Shik; Chan, Kwok-Hung; Chan, Jasper F W; Cheng, Vincent C C; Woo, Patrick C Y; Yuen, Kwok-Yung; Lau, Susanna K P

2017-05-16

A fatal case associated with enterovirus D68 (EV-D68) infection affecting a 10-year-old boy was reported in Hong Kong in 2014. To examine if a new strain has emerged in Hong Kong, we sequenced the partial genome of the EV-D68 strain identified from the fatal case and the complete VP1, and partial 5'UTR and 2C sequences of nine additional EV-D68 strains isolated from patients in Hong Kong. Sequence analysis indicated that a cluster of strains including the previously recognized A2 strains should belong to a separate clade, clade D, which is further divided into subclades D1 and D2. Among the 10 EV-D68 strains, 7 (including the fatal case) belonged to the previously described, newly emerged subclade B3, 2 belonged to subclade B1, and 1 belonged to subclade D1. Three EV-D68 strains, each from subclades B1, B3, and D1, were selected for complete genome sequencing and recombination analysis. While no evidence of recombination was noted among local strains, interclade recombination was identified in subclade D2 strains detected in mainland China in 2008 with VP2 acquired from clade A. This study supports the reclassification of subclade A2 into clade D1, and demonstrates interclade recombination between clades A and D2 in EV-D68 strains from China.

Patterns of ectopy leading to increased risk of fatal or near-fatal cardiac arrhythmia in patients with depressed left ventricular function after an acute myocardial infarction.

PubMed

Lerma, Claudia; Gorelick, Alexander; Ghanem, Raja N; Glass, Leon; Huikuri, Heikki V

2013-09-01

To identify potential new markers for assessing the risk of sudden arrhythmic events based on a method that captures features of premature ventricular complexes (PVCs) in relation to sinus RR intervals in Holter recordings (heartprint). Holter recordings obtained 6 weeks after acute myocardial infarction from 227 patients with reduced ventricular function (left ventricular ejection fraction ≤ 40%) were used to produce heartprints. Measured indices were: PVCs per hour, standard deviation of coupling interval (SDCI), and the number of occurrences of the most prevalent form of PVCs (SNIB). Predictive values, survival analysis, and Cox regression with adjustment for clinical variables were performed based on primary endpoint, defined as an electrocardiogram-documented fatal or near-fatal arrhythmic event, death from any cause, and cardiac death. High ectopy (PVCs per hour ≥10) was a predictor of all endpoints. Repeating forms of PVCs (SNIB ≥ 83) was a predictor of primary endpoint, hazard ratio = 3.5 (1.3-9.5), and all-cause death, hazard ratio = 2.8 (1.1-7.3), but not cardiac death. SDCI ≤ 80 ms was a predictor of all-cause death and cardiac death, but not of primary endpoint. High ectopy, prevalence of repeating forms of PVCs, and low coupling interval variability are potentially useful risk markers of fatal or near-fatal arrhythmias after myocardial infarction.

Internet & branding: a perfect match or a fatal attraction? Analysis of fifty states of the U.S. official tourism websites

Treesearch

Gyehee Lee; Liping A. Cai; Everette Mills; Joseph T. O' Leary

2002-01-01

Internet plays a significant role in generating new business and facilitating customers' need for a better way to plan and book their trips. From a marketers' perspective, one of the seemingly "fatal attractions" of the Internet for DMOs is that it can be an extremely effective tool in terms of both cost effectiveness and market penetration compared...

Fatal passenger vehicle crashes 1999 to 2004 with drivers under age 15: the impact in Texas and other southern and southwestern states.

PubMed

Frisch, Larry

2007-03-01

Texas has more fatal crashes involving unlicensed drivers under age 15 than does any other US state. Numbers and rates of such crashes are also above the national mean in many southern and Southwest states. Data on fatal passenger vehicle crashes from 1999 through 2004 were obtained from the online Fatality Analysis Reporting System (FARS). During the study period, there were 51 fatal passenger vehicle crashes in Texas in which drivers were under age 15. These crashes accounted for 12.3% of the US total. Nine southern states, including Texas, together accounted for 44% of all fatal crashes involving drivers under 15. Unlicensed crash rates per million inhabitants were higher in Texas than in other states with comparable populations but were much lower than those in other southern, southwest, and north central states. While Texas has recently improved its compliance with proposed graduated licensing models, state law explicitly prohibits police from stopping drivers based solely on age-related probable cause. This restriction may be a major barrier to effective detection and interdiction of under-age unlicensed driving. Because of the relatively high number of fatal crashes involving drivers under age 15 occurring in Texas, preventive efforts targeted to this state could modestly reduce the national burden of deaths due to very young unlicensed drivers. Expanding these efforts to other southern and southwest states could further reduce numbers and rates of such crashes. Expanded use of graduated licensing and increased public awareness are likely to prove effective tools in this public health effort.

The Alternative Healthy Eating Index Is Associated with a Lower Risk of Fatal and Nonfatal Acute Myocardial Infarction in a Chinese Adult Population123

PubMed Central

Neelakantan, Nithya; Naidoo, Nasheen; Koh, Woon-Puay; Yuan, Jian-Min; van Dam, Rob M

2016-01-01

Background: Indexes to quantify adherence to recommended dietary patterns have been developed for Western populations, but it is unclear whether these indexes can predict acute myocardial infarction (AMI) in Asian populations. Objectives: We aimed to investigate the association between the Alternative Healthy Eating Index (AHEI)–2010 and risk of AMI and to evaluate potential mediation by traditional cardiovascular risk factors in a Chinese population. Methods: A nested case-control study in 751 incident cases of AMI (564 nonfatal and 288 fatal) and 1443 matched controls was conducted within the prospective Singapore Chinese Health Study, a cohort of ethnic Chinese men and women aged 45–75 y. At baseline, habitual diet was assessed by using a validated, semiquantitative food-frequency questionnaire. AMI cases were ascertained via linkage with nationwide hospital databases (confirmed through medical record review) and the Singapore Birth and Death Registry. We evaluated the association between the AHEI-2010 and cardiovascular risk factors, including glycated hemoglobin, high-sensitivity C-reactive protein, creatinine, plasma lipids (LDL and HDL cholesterol, triglycerides), and blood pressure. ORs and 95% CIs were computed by using multivariable-adjusted conditional logistic regression models. Results: Higher AHEI-2010 scores were associated with a lower risk of AMI (OR for the highest quartile compared with the lowest quartile: 0.62; 95% CI: 0.47, 0.81; P-trend < 0.001), with similar associations for fatal (OR: 0.60; 95% CI: 0.39, 0.94; P-trend = 0.009) and nonfatal (OR: 0.59; 95% CI: 0.43, 0.81; P-trend = 0.002) AMI. This association was only slightly attenuated after adjustment for potential biological intermediates (OR: 0.64; 95% CI: 0.48, 0.86; P-trend = 0.003). Conclusions: Adherence to dietary recommendations as reflected in the AHEI-2010 was associated with a substantially lower risk of fatal and nonfatal AMI in an Asian population, and this association was largely independent of traditional cardiovascular risk factors. PMID:27306893

Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin: ROCKET AF Trial.

PubMed

Sherwood, Matthew W; Nessel, Christopher C; Hellkamp, Anne S; Mahaffey, Kenneth W; Piccini, Jonathan P; Suh, Eun-Young; Becker, Richard C; Singer, Daniel E; Halperin, Jonathan L; Hankey, Graeme J; Berkowitz, Scott D; Fox, Keith A A; Patel, Manesh R

2015-12-01

Gastrointestinal (GI) bleeding is a common complication of oral anticoagulation. This study evaluated GI bleeding in patients who received at least 1 dose of the study drug in the on-treatment arm of the ROCKET AF (Rivaroxaban Once-daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial. The primary outcome was adjudicated GI bleeding reported from first to last drug dose + 2 days. Multivariable modeling was performed with pre-specified candidate predictors. Of 14,236 patients, 684 experienced GI bleeding during follow-up. These patients were older (median age 75 years vs. 73 years) and less often female. GI bleeding events occurred in the upper GI tract (48%), lower GI tract (23%), and rectum (29%) without differences between treatment arms. There was a significantly higher rate of major or nonmajor clinical GI bleeding in rivaroxaban- versus warfarin-treated patients (3.61 events/100 patient-years vs. 2.60 events/100 patient-years; hazard ratio: 1.42; 95% confidence interval: 1.22 to 1.66). Severe GI bleeding rates were similar between treatment arms (0.47 events/100 patient-years vs. 0.41 events/100 patient-years; p = 0.39; 0.01 events/100 patient-years vs. 0.04 events/100 patient-years; p = 0.15, respectively), and fatal GI bleeding events were rare (0.01 events/100 patient-years vs. 0.04 events/100 patient-years; 1 fatal events vs. 5 fatal events total). Independent clinical factors most strongly associated with GI bleeding were baseline anemia, history of GI bleeding, and long-term aspirin use. In the ROCKET AF trial, rivaroxaban increased GI bleeding compared with warfarin. The absolute fatality rate from GI bleeding was low and similar in both treatment arms. Our results further illustrate the need for minimizing modifiable risk factors for GI bleeding in patients on oral anticoagulation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Evaluation of Seven Publicized Enforcement Demonstration Programs to Reduce Impaired Driving: Georgia, Louisiana, Pennsylvania, Tennessee, Texas, Indiana, and Michigan

PubMed Central

Fell, James C.; Tippetts, A. Scott; Levy, Marvin

2008-01-01

Between 2000 and 2003, the National Highway Traffic Safety Administration (NHTSA) of the United States Department of Transportation (USDOT) funded demonstration projects designed to reduce impaired driving through well-publicized and frequent enforcement in seven States: Georgia, Louisiana, Pennsylvania, Tennessee, Texas, Indiana, and Michigan. Significant reductions in fatal crashes in the intervention States relative to surrounding States were obtained in Georgia, Tennessee, Indiana and Michigan when an interrupted time-series analysis of Fatality Analysis Reporting System (FARS) data was used comparing the ratio of drinking to non-drinking drivers in fatal crashes. Significant reductions in a second measure, alcohol-related fatalities per 100 million vehicle miles traveled (VMT), were also obtained in Indiana and Michigan. The other three States showed only marginal, non-significant changes relative to their comparison jurisdictions or States. As compared to surrounding States, fatal crash reductions in Georgia, Tennessee, Indiana, and Michigan ranged from 11 to 20 percent. In these four States, the programs were estimated to have saved lives ranging from 25 in Indiana to 43 in Tennessee to 57 in Michigan to 60 in Georgia. Some common features of the programs that experienced significant reductions included the use of paid media to publicize the enforcement (in three States), using a statewide model rather than selected portions of the State (all four States), and the use of highly visible and frequent sobriety checkpoints (in three States). In summary, it appears that a variety of media and enforcement procedures that supplement ongoing statewide efforts can yield meaningful crash reduction effects among alcohol impaired drivers. PMID:19026220

The effect of intensive glucose control on all-cause and cardiovascular mortality, myocardial infarction and stroke in persons with type 2 diabetes mellitus: a systematic review and meta-analysis.

PubMed

Marso, Steven P; Kennedy, Kevin F; House, John A; McGuire, Darren K

2010-04-01

We performed a meta-analysis of studies evaluating the effect of intensive glucose control on major adverse cardiovascular events in patients with type 2 diabetes from 1990 to 2009. A search of the published literature and the Cochran Central Register for Controlled Trials was performed using pre-specified inclusion criteria consisting of randomised controlled trials evaluating intensive glycaemic control and reporting the individual endpoints of all-cause mortality, non-fatal myocardial infarction, and non-fatal stroke. Incident rate ratios for these endpoints were calculated using standard meta-analytic techniques of pooled data from eligible trials. Six reports from four randomised trials including 27,544 patients met the pre-specified inclusion criteria. Mean follow-up was 5.4 years; haemoglobin A(1C) at study end was 6.6% vs. 7.4% in patients randomised to intensive compared with conventional glucose control. Intensive glucose control did not affect the incident rate ratio for all-cause mortality (1.01, 95% confidence interval 0.86-1.18, p=0.54) or stroke (1.02, 95% confidence interval 0.88-1.20, p=0.62). However, there was a statistically significant 14% reduction in non-fatal myocardial infarction in patients randomised to intensive glucose control (0.86, 95% confidence interval 0.77-0.97, p=0.015). Although intensification of glucose control did not affect mortality or non-fatal stroke, the risk for non-fatal myocardial infarction was significantly reduced in patients with type 2 diabetes.

Motor vehicle fatal crash profiles of 13-15-year-olds.

PubMed

Williams, Allan F; Tison, Julie

2012-04-01

The goal was to provide a description of fatal crashes involving 13-15-year-old drivers and passengers. Information was obtained from the Fatality Analysis Reporting System for 2005-2009. The 1,994 passenger deaths during the 2005-2009 period far exceeded the number of driver deaths (299) or the number of drivers in fatal crashes (744). Passenger deaths occurring with teenage drivers, particularly 16-17-year-olds, increased with passenger age. Most 13-15-year-old drivers in crashes were driving either with no license or permit (63%), or with a permit but without required adult presence (10 percent). Fatal crashes involving illegal driving were most likely to involve high-risk actions such as speeding and nonuse of belts. Supervised learners were few in number (about 12 per year) and had the lowest rates of high-risk actions. The main issues for 13-15-year-olds' motor vehicle deaths are passenger deaths and driving without a license or adult supervision. Parents, pediatricians, and others need to recognize the increase in motor vehicle occupant deaths that occurs in the early teen years. Copyright © 2012 National Safety Council and Elsevier Ltd. All rights reserved.

Hyperbaric and hypobaric chamber fires: a 73-year analysis.

PubMed

Sheffield, P J; Desautels, D A

1997-09-01

Fire can be catastrophic in the confined space of a hyperbaric chamber. From 1923 to 1996, 77 human fatalities occurred in 35 hyperbaric chamber fires, three human fatalities in a pressurized Apollo Command Module, and two human fatalities in three hypobaric chamber fires reported in Asia, Europe, and North America. Two fires occurred in diving bells, eight occurred in recompression (or decompression) chambers, and 25 occurred in clinical hyperbaric chambers. No fire fatalities were reported in the clinical hyperbaric chambers of North America. Chamber fires before 1980 were principally caused by electrical ignition. Since 1980, chamber fires have been primarily caused by prohibited sources of ignition that an occupant carried inside the chamber. Each fatal chamber fire has occurred in an enriched oxygen atmosphere (> 28% oxygen) and in the presence of abundant burnable material. Chambers pressurized with air (< 23.5% oxygen) had the only survivors. Information in this report was obtained from the literature and from the Undersea and Hyperbaric Medical Society's Chamber Experience and Mishap Database. This epidemiologic review focuses on information learned from critical analyses of chamber fires and how it can be applied to safe operation of hypobaric and hyperbaric chambers.

[Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak].

PubMed

Matute, Isabel; Olea, Andrea; López, Darío; Loayza, Sergio; Nájera, Manuel; González, Claudia; Poffald, Lucy; Hirmas, Macarena; Delgado, Iris; Pedroni, Elena; Alfaro, Tania; Gormaz, Ana María; Sanhueza, Gabriel; Vial, Pablo; Dabanch, Jeannette; Gallegos, Doris; Aguilera, Ximena

2015-10-01

Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Case series considering 149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihood of dying. 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Association of State Alcohol Policies With Alcohol-Related Motor Vehicle Crash Fatalities Among US Adults.

PubMed

Naimi, Timothy S; Xuan, Ziming; Sarda, Vishnudas; Hadland, Scott E; Lira, Marlene C; Swahn, Monica H; Voas, Robert B; Heeren, Timothy C

2018-05-29

Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and alcohol-related crash fatalities has not been characterized previously to date. To examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States. This investigation was a repeated cross-sectional study in which state alcohol policies (operationalized by the Alcohol Policy Scale [APS]) from 1999 to 2014 were related to motor vehicle crash fatalities from 2000 to 2015 using data from the Fatality Analysis Reporting System (1-year lag). Alternating logistic regression models and generalized estimating equations were used to account for clustering of multiple deaths within a crash and of multiple crashes occurring within states. The study also examined independent associations of mutually exclusive subgroups of policies, including consumption-oriented policies vs driving-oriented policies. The study setting was the 50 US states. Participants were 505 614 decedents aged at least 21 years from motor vehicle crashes from 2000 to 2015. Odds that a crash fatality was alcohol related (fatality stemmed from a crash in which ≥1 driver had a blood alcohol concentration [BAC] ≥0.08%). From 2000 to 2015, there were 505 614 adult motor vehicle crash fatalities in the United States, of which 178 795 (35.4%) were alcohol related. Each 10-percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality (adjusted odds ratio [aOR], 0.90; 95% CI, 0.89-0.91); results were consistent among most demographic and crash-type strata. More restrictive policies also had protective associations with alcohol involvement among crash fatalities associated with BACs from greater than 0.00% to less than 0.08%. After accounting for driving-oriented policies, consumption-oriented policies were independently protective for alcohol-related crash fatalities (aOR, 0.97; 95% CI, 0.96-0.98 based on a 10-percentage point increased APS score). Strengthening alcohol policies, including those that do not specifically target impaired driving, could reduce alcohol-related crash fatalities. Policies may also protect against crash fatalities involving BAC levels below the current legal limit for driving in the United States.

Development of a proto-typology of opiate overdose onset.

PubMed

Neale, Joanne; Bradford, Julia; Strang, John

2017-01-01

The time available to act is a crucial factor affecting the probable success of interventions to manage opiate overdose. We analyse opiate users' accounts of non-fatal overdose incidents to (i) construct a proto-typology of non-fatal opiate overdose onset and (ii) assess the implications for overdose management and prevention of fatalities. Re-analysis of a subset of data from a large qualitative study of non-fatal opiate overdose conducted from 1997 to 1999. Data were generated from semi-structured interviews undertaken with opiate users who had experienced a non-fatal overdose in the previous 24 hours. Forty-four participants (30 men; 14 women; aged 16-47 years) provided sufficient information for in-depth analysis. Data relating to 'memory of the moment of overdose', 'time to loss of consciousness' and 'subjective description of the overdose experience' were scrutinised using iterative categorization. Four types of overdose onset were identified: type A 'amnesic' (n = 8), characterized by no memory, rapid loss of consciousness and no description of the overdose experience; type B 'conscious' (n = 17), characterized by some memory, sustained consciousness and a description of the overdose in terms of feeling unwell and symptomatic; type C 'instant' (n = 14), characterized by some memory, immediate loss of consciousness and no description of the overdose experience; and type D 'enjoyable' (n = 5), characterized by some memory, rapid loss of consciousness and a description of the overdose experience as pleasant or positive. The identification of different types of overdose onset highlights the complexity of overdose events, the need for a range of interventions and the challenges faced in managing incidents and preventing fatalities. Opiate overdose victims who retain consciousness for a sustained period and recognize the negative signs and symptoms of overdosing could summon help or self-administer naloxone, thus indicating that opiate overdose training should incorporate self-management strategies. © 2016 Society for the Study of Addiction.

Alcohol consumption and fatal injuries in Australia before and after major traffic safety initiatives: a time series analysis.

PubMed

Jiang, Heng; Livingston, Michael; Room, Robin

2015-01-01

The associations between population-level alcohol consumption and fatal injuries have been examined in a number of previous studies, but few have considered the external impacts of major policy interventions. This study aims to quantify the associations between per capita alcohol consumption and traffic and nontraffic injury mortality rates in Australia before and after major traffic safety initiatives (the introduction of compulsory seat belt legislation [CSBL] and random breath testing [RBT] in 1970s). Using data from 1924 to 2006, gender- and age-specific traffic and nontraffic mortality rates (15 years and above) were analyzed in relation to per capita alcohol consumption using time series analysis. The external effects of policy interventions were measured by inserting a dummy variable in the time series models. Statistically significant associations between per capita alcohol consumption and both types of fatal injuries were found for both males and females. The results suggest that an increase in per capita alcohol consumption of 1 l was accompanied by an increase in traffic mortality of 3.4 among males and 0.5 among females per 100,000 inhabitants and an increase in nontraffic mortality of 3.0 among males and 0.9 among females. The associations between alcohol consumption and fatal injury rates varied across age groups. The introduction of CSBL and RBT was associated with significant reductions in traffic crash mortality in Australia, particularly for males and young people. The magnitude and distribution of the preventive effects from the reduction in population drinking on fatal injuries vary across different gender and age groups, with the strongest preventive impacts on fatal injuries among people aged 15 to 29 and 70 years and above. The mechanisms behind these effects are unclear from this study, but are likely to be due to the strong association between per capita consumption and heavy drinking. Copyright © 2015 by the Research Society on Alcoholism.

Severe paramethoxymethamphetamine (PMMA) and paramethoxyamphetamine (PMA) outbreak in Israel.

PubMed

Lurie, Yael; Gopher, Asher; Lavon, Ophir; Almog, Shlomo; Sulimani, Liron; Bentur, Yedidia

2012-01-01

Paramethoxymethamphetamine (PMMA) is a hallucinogenic synthetic substituted amphetamine that was not included in the Israeli Controlled Substance Act (CSA). To report a severe PMMA and paramethoxyamphetamine (PMA) outbreak. The Israeli national forensic toxicology laboratory analyzes the body fluids of unnatural deaths by means of screening immunoassays and chromatographic confirmation and quantification. Samples are referred to this laboratory by the Israeli Forensic Medicine Institute and by hospitals following consultation with the Israel Poison Information Center. The forensic toxicology laboratory began determining PMMA and PMA in February 2007. In all fatal cases with a positive immunoassay screen for amphetamines, a chromatographic analysis of PMA and PMMA was performed. The laboratory and demographic data of consecutive patients in whom PMMA or PMA were detected, were collected during 1 year and subjected to descriptive analysis. Of 108 fatal cases with a positive screen for amphetamines, 32 were confirmed. Twenty-four of the 32 cases tested positive for PMMA and PMA--age 27 ± 5 years, 79.2% males, post mortem whole blood PMMA and PMA concentrations 0.35 ± 0.24 and 2.72 ± 1.67 mcg/mL, respectively. Co-exposures were detected in 17 (70.8%) fatalities; including methylenedioxymethamphetamine, methylenedioxyamphetamine, cocaine, cannabinoids, cathinone derivatives, ephedrine/pseudoephedrine, opiates, and ethanol. In addition, five non-fatal male cases were identified; age 32 ± 5 years, four had co-exposures to cocaine, cathinone derivatives, and cannabinoids. These findings led to the inclusion of PMMA in the CSA in July 2007, resulting in only three more fatalities in the following year. We report an outbreak of PMMA and PMA poisoning resulting in 24 fatalities, and the post mortem whole blood and urine concentrations of these two compounds. PMA was probably the result of PMMA metabolism. Stimulant co-exposures may have contributed to the severity of the poisoning. Forensic laboratory and poison center co-operation is important in identifying a new drug of abuse.

Multivariate meta-analysis: potential and promise.

PubMed

Jackson, Dan; Riley, Richard; White, Ian R

2011-09-10

The multivariate random effects model is a generalization of the standard univariate model. Multivariate meta-analysis is becoming more commonly used and the techniques and related computer software, although continually under development, are now in place. In order to raise awareness of the multivariate methods, and discuss their advantages and disadvantages, we organized a one day 'Multivariate meta-analysis' event at the Royal Statistical Society. In addition to disseminating the most recent developments, we also received an abundance of comments, concerns, insights, critiques and encouragement. This article provides a balanced account of the day's discourse. By giving others the opportunity to respond to our assessment, we hope to ensure that the various view points and opinions are aired before multivariate meta-analysis simply becomes another widely used de facto method without any proper consideration of it by the medical statistics community. We describe the areas of application that multivariate meta-analysis has found, the methods available, the difficulties typically encountered and the arguments for and against the multivariate methods, using four representative but contrasting examples. We conclude that the multivariate methods can be useful, and in particular can provide estimates with better statistical properties, but also that these benefits come at the price of making more assumptions which do not result in better inference in every case. Although there is evidence that multivariate meta-analysis has considerable potential, it must be even more carefully applied than its univariate counterpart in practice. Copyright © 2011 John Wiley & Sons, Ltd.

A forensic diving medicine examination of a highly publicised scuba diving fatality.

PubMed

Edmonds, Carl

2012-12-01

A high-profile diving death occurred in 2003 at the site of the wreck of the SS Yongala off the Queensland coast. The victim's buddy, her husband, was accused of her murder and found guilty of manslaughter in an Australian court. A detailed analysis of all the evidence concerning this fatality suggests alternative medical reasons for her death. The value of decompression computers in determining the diving details and of CT scans in clarifying autopsy findings is demonstrated. The victim was medically, physically and psychologically unfit to undertake the fatal dive. She was inexperienced and inadequately supervised. She was over-weighted and exposed for the first time to difficult currents. The analysis of the dive demonstrates how important it is to consider the interaction of all factors and to not make deductions from individual items of information. It also highlights the importance of early liaison between expert divers, technicians, diving clinicians and pathologists, if inappropriate conclusions are to be avoided.

Jurisdictional spillover effects of sprawl on injuries and fatalities.

PubMed

Mohamed, Rayman; Vom Hofe, Rainer; Mazumder, Sangida

2014-11-01

There is a considerable literature on the relationship between sprawl and accidents. However, these studies do not account for the spatially correlated effects of sprawl on accidents. In our analysis of 122 jurisdictions in Southeast Michigan, we use a Bayesian spatial autoregressive model to estimate how injuries and fatalities in one jurisdiction are associated with sprawl in that jurisdiction and sprawl in neighboring jurisdictions; we also correct for heteroskedasticity in the data. Using principal component analysis, we create a sprawl index from five underlying land use characteristics. Our results show that the number of injuries and fatalities in a jurisdiction increases with the magnitude of sprawl in neighboring jurisdictions. We believe that this is because more drivers per capita in sprawled jurisdictions traverse similarly sprawled neighboring jurisdictions for daily activities. Furthermore, driving habits attuned to less defensive driving in sprawled jurisdiction are transferred to similarly designed neighboring jurisdictions, contributing to accidents in the latter. Copyright © 2014 Elsevier Ltd. All rights reserved.

Rabbit model for human EBV-associated hemophagocytic syndrome (HPS): sequential autopsy analysis and characterization of IL-2-dependent cell lines established from herpesvirus papio-induced fatal rabbit lymphoproliferative diseases with HPS.

PubMed

Hayashi, Kazuhiko; Jin, Zaishun; Onoda, Sachiyo; Joko, Hiromasa; Teramoto, Norihiro; Ohara, Nobuya; Oda, Wakako; Tanaka, Takehiro; Liu, Yi-Xuan; Koirala, Tirtha Raj; Oka, Takashi; Kondo, Eisaku; Yoshino, Tadashi; Takahashi, Kiyoshi; Akagi, Tadaatsu

2003-05-01

Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD). To elucidate the true nature of fatal LPD observed in Herpesvirus papio (HVP)-induced rabbit hemophagocytosis, reactive or neoplastic, we analyzed sequential development of HVP-induced rabbit LPD and their cell lines. All of the seven Japanese White rabbits inoculated intravenously with HVP died of fatal LPD 18 to 27 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in five of these seven rabbits. Sequential autopsy revealed splenomegaly and swollen lymph nodes, often accompanied by bleeding, which developed in the last week. Atypical lymphoid cells infiltrated many organs with a "starry sky" pattern, frequently involving the spleen, lymph nodes, and liver. HVP-small RNA-1 expression in these lymphoid cells was clearly demonstrated by a newly developed in situ hybridization (ISH) system. HVP-ISH of immunomagnetically purified lymphoid cells from spleen or lymph nodes revealed HVP-EBER1+ cells in each CD4+, CD8+, or CD79a+ fraction. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by PCR or Southern blot analysis. Clonality analysis of HVP-induced LPD by Southern blotting with TCR gene probe revealed polyclonal bands, suggesting polyclonal proliferation. Six IL-2-dependent rabbit T-cell lines were established from transplanted scid mouse tumors from LPD. These showed latency type I/II HVP infection and had normal karyotypes except for one line, and three of them showed tumorigenicity in nude mice. These data suggest that HVP-induced fatal LPD in rabbits is reactive polyclonally in nature.

Driver air bag effectiveness by severity of the crash.

PubMed Central

Segui-Gomez, M

2000-01-01

OBJECTIVES: This analysis provided effectiveness estimates of the driver-side air bag while controlling for severity of the crash and other potential confounders. METHODS: Data were from the National Automotive Sampling System (1993-1996). Injury severity was described on the basis of the Abbreviated Injury Scale, Injury Severity Score, Functional Capacity Index, and survival. Ordinal, linear, and logistic multivariate regression methods were used. RESULTS: Air bag deployment in frontal or near-frontal crashes decreases the probability of having severe and fatal injuries (e.g., Abbreviated Injury Scale score of 4-6), including those causing a long-lasting high degree of functional limitation. However, air bag deployment in low-severity crashes increases the probability that a driver (particularly a woman) will sustain injuries of Abbreviated Injury Scale level 1 to 3. Air bag deployment exerts a net injurious effect in low-severity crashes and a net protective effect in high-severity crashes. The level of crash severity at which air bags are protective is higher for female than for male drivers. CONCLUSIONS: Air bag improvement should minimize the injuries induced by their deployment. One possibility is to raise their deployment level so that they deploy only in more severe crashes. PMID:11029991

Severity of burn and its related factors: A study from the developing country Pakistan.

PubMed

Adil, Syed Omair; Nisar, Nighat; Ehmer-Al-Ibran; Shafique, Kashif; Baig-Ansari, Naila

2016-06-01

Burns are leading cause of fatal injuries and major cause of morbidity and mortality in developing countries. The major obstacle in controlling severity is factors related to burn. This study determines frequency of burns and the factors related to it in Karachi, Pakistan. A cross-sectional study was conducted and 384 hospitalized adult patients with burns were consecutively interviewed during August 2013 to February 2014. Information was collected on socio-demographic profile, intent of burn, severity of burn, health hazards, physical and psychological characteristics. TBSA burn of >15% was considered as higher severity of burn. Higher severity of burns was found in 76.3% patients. Multivariate analysis showed that higher severity of burns were significantly associated with age less than 25 years (OR 2.7, 95% CI 1.5-4.9), never had been to school (OR 3.1, 95% CI 1.7-5.9) and intentional burn (OR 20.6, 95% CI 5.0-84.9). Majority of patients had higher severity of burn. The intent of injury was intentional, age less than 25 years and no schooling were found significantly associated with higher severity of burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Body fat mass and lean mass as predictors of survival in hemodialysis patients.

PubMed

Kakiya, R; Shoji, T; Tsujimoto, Y; Tatsumi, N; Hatsuda, S; Shinohara, K; Kimoto, E; Tahara, H; Koyama, H; Emoto, M; Ishimura, E; Miki, T; Tabata, T; Nishizawa, Y

2006-08-01

A higher body mass index (BMI) is a predictor of better survival in hemodialysis patients, although the relative importance of body fat and lean mass has not been examined in the dialysis population. We performed an observational cohort study in 808 patients with end-stage renal disease on maintenance hemodialysis. At baseline, fat mass was measured by dual-energy X-ray absorptiometry and expressed as fat mass index (FMI; kg/m2). Lean mass index (LMI) was defined as BMI minus FMI. During the mean follow-up period of 53 months, 147 deaths, including 62 cardiovascular (CV) and 85 non-CV fatal events, were recorded. In univariate analysis, LMI was not significantly associated with CV or non-CV death, whereas a higher FMI was predictive of lower risk for non-CV death. Analyses with multivariate Cox models, which took other confounding variables as covariates, indicated the independent associations between a higher LMI and a lower risk of CV death, as well as between a higher FMI and a lower risk of non-CV death. These results indicate that increased fat mass and lean mass were both conditions associated with better outcomes in the dialysis population.

Performance of advanced air bags based on data William Lehman Injury Research Center and new NASS PSUs.

PubMed

Augenstein, Jeffrey; Digges, Kennerly

2003-01-01

The Ryder Trauma Center is a Level I trauma center that treats only the most severely injured occupants of vehicle crashes as well as other severe cases of trauma. The center investigates these crashes through funding provided by the Alliance of Automobile Manufacturers and the U.S. Department of Transportation-sponsored Crash Injury Research and Engineering Network (CIREN) program. MAIS 3+ nonfatal and fatal injuries comprise approximately 2 percent of the total NASS/CDS cases. Among the Ryder trauma center cases, 50 percent are MAIS 3+ and 25 percent are fatal. If the MAIS 3+ fatal and nonfatal injuries were considered as "failures" and the remaining 98 percent with MAIS 2 or less as successes, this could be equated to the 75 percent failure rate (MAIS 3+ and fatal) in the trauma center cases for analysis purposes. The total database of frontal cases with no rollover consists of 147 drivers with first-generation airbags and 58 cases with second-generation airbags.

Prominent barriers and motivators to installing ROPS: an analysis of survey responses from Pennsylvania and Vermont.

PubMed

Jenkins, P L; Sorensen, J A; Yoder, A; Myers, M; Murphy, D; Cook, G; Wright, F; Bayes, B; May, J J

2012-04-01

Tractor overturns contribute significantly to the number of work-related deaths that occur every year on U.S. farms. Although the agriculture, forestry, and fishing industries have the highest fatality rates of any industries, researchers predict that the elimination of tractor overturn fatalities could result in a noticeable reduction in the farm fatality rate. Rollover protection structures (ROPS) are 99% effective in preventing overturn fatalities. However, roughly 50% of U.S. tractors do not have a ROPS. In order to identify prominent barriers and motivators to installing ROPS, a phone survey was conducted with a random sample of farmers (n = 327) in Vermont and Pennsylvania, two states interested in developing ROPS installation programs. Results indicated that cost and perceived need were the most frequently highly rated barriers to ROPS installation in both states, while working near hills or ditches and concerns regarding liability were the most frequently highly rated motivators for installing ROPS. Additionally, older farmers identified limited use of a tractor as a highly rated barrier.

Investigation of hot air balloon fatalities.

PubMed

McConnell, T S; Smialek, J E; Capron, R G

1985-04-01

The rising popularity of the sport of hot air ballooning has been accompanied by several recent incidents, both in this country and other parts of the world, where mechanical defects and the improper operation of balloons have resulted in several fatalities. A study was conducted to identify the location and frequency of hot air ballooning accidents. Furthermore, the study attempted to identify those accidents that were the result of improper handling on the part of the balloon operators and those that were related to specific defects in the construction of the balloon. This paper presents a background of the sport of hot air ballooning, together with an analysis of the construction of a typical hot air balloon, pointing out the specific areas where defects may occur that could result in a potential fatal balloon crash. Specific attention is given to the two recent balloon crashes that occurred in Albuquerque, N.M., hot air balloon capital of the world, and that resulted in multiple fatalities.

Analysis of the Cochrane Review: Fibrates for secondary prevention of cardiovascular disease and stroke.

PubMed

Pires da Rosa, Gilberto; Libânio, Diogo; Filipe Azevedo, Luís

2017-01-01

The influence of fibrates on cardiovascular risk has been the focus of several clinical trials. This Cochrane Collaboration Systematic Review evaluated the efficacy of fibrates for secondary prevention of cardiovascular events and stroke, analyzing 13 randomized controlled trials, in a total of 16 112 participants with a history of cardiovascular disease. Fibrates showed a protective effect for the composite outcome of non-fatal stroke, non-fatal myocardial infarction (MI) and vascular death, mainly due to reduction in the risk of non-fatal or fatal MI. Nonetheless, these results largely relied on studies including clofibrate, a drug withdrawn from the market in 2002. No statistically significant differences regarding adverse events were found between fibrates and placebo. Although insufficient to support the routine prescription of fibrates in this setting, this evidence should be taken into account when deciding on lipid-modifying therapy in dyslipidemic patients with a history of cardiovascular disease. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

The construction FACE database - Codifying the NIOSH FACE reports.

PubMed

Dong, Xiuwen Sue; Largay, Julie A; Wang, Xuanwen; Cain, Chris Trahan; Romano, Nancy

2017-09-01

The National Institute for Occupational Safety and Health (NIOSH) has published reports detailing the results of investigations on selected work-related fatalities through the Fatality Assessment and Control Evaluation (FACE) program since 1982. Information from construction-related FACE reports was coded into the Construction FACE Database (CFD). Use of the CFD was illustrated by analyzing major CFD variables. A total of 768 construction fatalities were included in the CFD. Information on decedents, safety training, use of PPE, and FACE recommendations were coded. Analysis shows that one in five decedents in the CFD died within the first two months on the job; 75% and 43% of reports recommended having safety training or installing protection equipment, respectively. Comprehensive research using FACE reports may improve understanding of work-related fatalities and provide much-needed information on injury prevention. The CFD allows researchers to analyze the FACE reports quantitatively and efficiently. Copyright © 2017 Elsevier Ltd and National Safety Council. All rights reserved.

Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015.

PubMed

Mehmandar, Mohammadreza; Soori, Hamid; Mehrabi, Yadolah

2016-01-01

Predicting the trend in traffic accidents deaths and its analysis can be a useful tool for planning and policy-making, conducting interventions appropriate with death trend, and taking the necessary actions required for controlling and preventing future occurrences. Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015. It was a cross-sectional study. All the information related to fatal traffic accidents available in the database of Iran Legal Medicine Organization from 2004 to the end of 2013 were used to determine the change points (multi-variable time series analysis). Using autoregressive integrated moving average (ARIMA) model, traffic accidents death rates were predicted for 2014 and 2015, and a comparison was made between this rate and the predicted value in order to determine the efficiency of the model. From the results, the actual death rate in 2014 was almost similar to that recorded for this year, while in 2015 there was a decrease compared with the previous year (2014) for all the months. A maximum value of 41% was also predicted for the months of January and February, 2015. From the prediction and analysis of the death trends, proper application and continuous use of the intervention conducted in the previous years for road safety improvement, motor vehicle safety improvement, particularly training and culture-fostering interventions, as well as approval and execution of deterrent regulations for changing the organizational behaviors, can significantly decrease the loss caused by traffic accidents.

Preventive Effect on Post-Operative Pneumonia of Oral Health Care among Patients Who Undergo Esophageal Resection: A Multi-Center Retrospective Study.

PubMed

Soutome, Sakiko; Yanamoto, Souichi; Funahara, Madoka; Hasegawa, Takumi; Komori, Takahide; Oho, Takahiko; Umeda, Masahiro

2016-08-01

Post-operative pneumonia is a frequent and possibly fatal complication of esophagectomy and is likely caused by aspiration of oropharyngeal fluid that contains pathogenic micro-organisms. We conducted a multi-center retrospective study to investigate the preventive effect of oral health care on post-operative pneumonia among patients with esophageal cancer who underwent esophagectomy. A total of 280 patients underwent esophagectomy at three university hospitals. These patients were divided retrospectively into those who received pre-operative oral care from dentists and dental hygienists (oral care group; n = 173) and those who did not receive such care (control group; n = 107). We evaluated the correlations between the occurrence of post-operative pneumonia and 18 predictive variables (patient factors, tumor factors, treatment factors, and pre-operative oral care) using the χ(2) test and logistic regression analysis. The differences of mean hospital days and mortality rate in both groups were analyzed by the Student t-test. Age, post-operative dysphagia, and absence of pre-operative oral care were correlated significantly with post-operative pneumonia in the univariable analysis. Multivariable analysis revealed that diabetes mellitus, post-operative dysphagia, and the absence of pre-operative oral care were independent risk factors for post-operative pneumonia. The mean hospital stay and mortality rate did not differ between the oral care and control groups. Pre-operative oral care may be an effective and easy method to prevent post-operative pneumonia in patients who are undergoing esophagectomy.

Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border.

PubMed

Fernández, María E; Savas, Lara S; Wilson, Katherine M; Byrd, Theresa L; Atkinson, John; Torres-Vigil, Isabel; Vernon, Sally W

2015-02-01

To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older). In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS. CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS. © 2014 Society for Public Health Education.

Association between non-fatal opioid overdose and encounters with healthcare and criminal justice systems: Identifying opportunities for intervention.

PubMed

Wagner, Karla D; Liu, Lin; Davidson, Peter J; Cuevas-Mota, Jazmine; Armenta, Richard F; Garfein, Richard S

2015-08-01

Accidental overdose, driven largely by opioids, is a leading cause of death among people who inject drugs (PWIDs). We conducted secondary analysis of data from a cohort of PWIDs to identify venues where high-risk PWID could be targeted by overdose education/naloxone distribution (OEND) programs. 573 PWIDs completed a quantitative survey between June, 2012 and January, 2014, which was analyzed using multivariable logistic regression. The dependent variable was a dichotomous indicator of experiencing a heroin/opioid-related overdose in the past six months. Independent variables included: demographics, drug use behavior, and encounters with two venues - the health care and criminal justice systems - that could serve as potential venues for OEND programs. Almost half (41.5%) reported ever experiencing a heroin/opioid overdose, and 45 (7.9%) reported experiencing at least one heroin/opioid overdose in the past six months. In the final multivariable model, receiving care in a hospital in the past six months (Adjusted Odds Ratio [AdjOR] 4.08, 95% Confidence Interval [C.I.] 2.07, 8.04, p<0.001) and being arrested for drug possession in the past six months (AdjOR 5.17, 95% C.I. 2.37, 11.24, p<0.001) were associated with experiencing an opioid overdose in the past six months. Identifying venues outside of those that traditionally target services to PWIDs (i.e., syringe exchange programs) will be critical to implementing OEND interventions at a scale sufficient to address the growing epidemic of heroin/opioid related deaths. Clinical settings, such as hospitals, and drug-related encounters with law enforcement officers are promising venues for the expansion of OEND programs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Incidence and predictors of mental health disorder diagnoses among people who inject drugs in a Canadian setting.

PubMed

Reddon, Hudson; Pettes, Tyler; Wood, Evan; Nosova, Ekaterina; Milloy, Michael-John; Kerr, Thomas; Hayashi, Kanna

2018-04-01

Limited attention has been given to the predictors of mental health diagnoses among people who inject drugs (PWID) in community settings. Therefore, we sought to longitudinally examine the prevalence, incidence and predictors of mental disorder diagnosis among a community-recruited cohort of PWID. Data were derived from two prospective cohort studies of PWID (VIDUS and ACCESS) in Vancouver, Canada between December 2005 and May 2015. We used multivariable extended Cox regression to identify factors independently associated with self-reported mental disorder diagnosis during follow-up among those without a history of such diagnoses at baseline. Among the 923 participants who did not report a mental disorder at baseline, 206 (22.3%) reported a first diagnosis of a mental disorder during follow-up for an incidence density of 4.29 [95% confidence interval (CI) 3.72-4.91] per 100 person-years. In the multivariable analysis, female sex [adjusted hazards ratio (AHR) = 1.74, 95% CI 1.29-2.33], experiencing non-fatal overdose (AHR = 2.33, 95% CI 1.38-3.94), accessing any drug or alcohol treatment (AHR = 1.68, 95% CI 1.24-2.27), accessing any community health or social services (AHR = 1.53, 95% CI 1.02-2.28) and experiencing violence (AHR = 1.60, 95% CI 1.12-2.29) were independently associated with a mental disorder diagnosis at follow-up. We observed a high prevalence and incidence of mental disorders among our community-recruited sample of PWID. The validity and implication of these diagnoses for key substance use and public health outcomes are an urgent priority. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Incident Subjective Cognitive Decline Does Not Predict Mortality in the Elderly--Results from the Longitudinal German Study on Ageing, Cognition, and Dementia (AgeCoDe).

PubMed

Roehr, Susanne; Luck, Tobias; Heser, Kathrin; Fuchs, Angela; Ernst, Annette; Wiese, Birgitt; Werle, Jochen; Bickel, Horst; Brettschneider, Christian; Koppara, Alexander; Pentzek, Michael; Lange, Carolin; Prokein, Jana; Weyerer, Siegfried; Mösch, Edelgard; König, Hans-Helmut; Maier, Wolfgang; Scherer, Martin; Jessen, Frank; Riedel-Heller, Steffi G

2016-01-01

Subjective cognitive decline (SCD) might represent the first symptomatic representation of Alzheimer's disease (AD), which is associated with increased mortality. Only few studies, however, have analyzed the association of SCD and mortality, and if so, based on prevalent cases. Thus, we investigated incident SCD in memory and mortality. Data were derived from the German AgeCoDe study, a prospective longitudinal study on the epidemiology of mild cognitive impairment (MCI) and dementia in primary care patients over 75 years covering an observation period of 7.5 years. We used univariate and multivariate Cox regression analyses to examine the relationship of SCD and mortality. Further, we estimated survival times by the Kaplan Meier method and case-fatality rates with regard to SCD. Among 971 individuals without objective cognitive impairment, 233 (24.0%) incidentally expressed SCD at follow-up I. Incident SCD was not significantly associated with increased mortality in the univariate (HR = 1.0, 95% confidence interval = 0.8-1.3, p = .90) as well as in the multivariate analysis (HR = 0.9, 95% confidence interval = 0.7-1.2, p = .40). The same applied for SCD in relation to concerns. Mean survival time with SCD was 8.0 years (SD = 0.1) after onset. Incident SCD in memory in individuals with unimpaired cognitive performance does not predict mortality. The main reason might be that SCD does not ultimately lead into future cognitive decline in any case. However, as prevalence studies suggest, subjectively perceived decline in non-memory cognitive domains might be associated with increased mortality. Future studies may address mortality in such other cognitive domains of SCD in incident cases.

The causes and control of loader- and truck-related fatalities in surface mining operations.

PubMed

Kecojevic, Vladislav; Radomsky, Mark

2004-12-01

At surface mining operations throughout the world, loaders and trucks are a primary means of material loading and haulage. As the size, use and technological complexity of these units have increased, so has the concern regarding loader and truck safety. The severity and number of accidents involving loaders and trucks is higher when compared to all other mining accident types. In this paper, an analysis of loader and truck-related fatalities over the last 8 years is performed, the fatality categories and causes of accidents are established and control strategies are discussed and evaluated in an effort to increase hazard awareness by emphasizing safe loading, hauling and maintenance practices, as well as the value of traditional and innovative miner training programmes.

Multivariate Models for Normal and Binary Responses in Intervention Studies

ERIC Educational Resources Information Center

Pituch, Keenan A.; Whittaker, Tiffany A.; Chang, Wanchen

2016-01-01

Use of multivariate analysis (e.g., multivariate analysis of variance) is common when normally distributed outcomes are collected in intervention research. However, when mixed responses--a set of normal and binary outcomes--are collected, standard multivariate analyses are no longer suitable. While mixed responses are often obtained in…

Hydro-geomorphologic disasters in Portugal: mortality trends in the past 150 years

NASA Astrophysics Data System (ADS)

Pereira, Susana; Zêzere, José L.; Quaresma, Ivânia; Santos, Pedro P.; Santos, Mónica

2015-04-01

For the first time in Portugal, an extensive analysis of the mortality caused by hydro-geomorphological hazards was made, for a long period (1865-2010) using the DISASTER database (Zêzere et al., 2014). This database was built under the assumption that social consequences (including fatalities) of floods and landslides are relevant enough to be reported by newspapers, which were the source for data collection. This database counts 1902 hydro-geomorphologic cases that caused 1248 fatalities, 14 191 evacuated persons and 41 844 homeless persons. Floods correspond to the majority of cases (85.2%) that caused 1012 fatalities. Landslides correspond to 14.8 % of the total hydro-geomorphologic cases and caused 236 fatalities. The exploitation of the DISASTER database allowed: (i) to analyze the frequency and the temporal evolution of fatal floods and landslides; (ii) to analyze the spatio-temporal distribution of fatalities; (iii) to identify the most deadly flood and landslide types; and (iv) to evaluate the individual and societal risk. The obtained results demonstrate the absence of any exponential growth with time of hydro-geomorphologic cases and associated fatalities in Portugal. The highest flood and landslide cases as well as the associated mortality were registered in the period 1935-1969. After this period, flood and landslide mortality decreased, although landslide fatalities remained higher than the registered in the period 1865-1934. These features do not account the exceptional flash flood event occurred in the Lisbon region in November 1967. This outlier event was responsible for 522 fatalities, which corresponds to more than half of the total mortality generated by floods in Portugal in the complete time series (1865 - 2010). Moreover, the 1967 flash flood event was the deadliest natural disaster registered in Portugal after the Lisbon earthquake occurred in 1755, not accounting heat waves. Flood fatalities occurred widespread in the country, with an important cluster in the Lisbon Region and in the Tagus valley, Oporto and Coimbra cities, where simultaneously, natural conditions are favorable to floods and a high number of people are exposed to flood hazard (e.g. residential buildings and economic activities installed in floodplains). The occurrence of landslide fatalities is mostly constrained in the north of the Tagus valley, where geologic and geomorphologic conditions are more landslide-prone than in the southern part of the country. Flash floods caused the majority of fatalities associated with floods, while falls and flows were responsible for the highest frequency of fatalities associated with landslides. The temporal evolution of flood fatalities reflects the implementation of territorial management policies and the improving of early warning systems for floods and the evacuation of people living in floodplain areas prior major flood events, in Portugal in the latest four decades. In the case of landslides, despite the improving in the quality of buildings construction, fatalities generated by landslides are still frequent because buildings are often located in hazardous slopes. In addition, so far no early warning system for landslide was implemented in Portugal. This research was supported by the Portuguese Foundation for Science and Technology (FCT). The first author is a Post-Doc fellow funded by FCT (SFRH/BPD/69002/2010).

Factors predicting mortality in severe acute pancreatitis.

PubMed

Compañy, L; Sáez, J; Martínez, J; Aparicio, J R; Laveda, R; Griñó, P; Pérez-Mateo, M

2003-01-01

Acute pancreatitis (AP) is a common disorder in which ensuing serious complications may lead to a fatal outcome in patients. To describe a large series of patients with severe AP (SAP) who were admitted to our hospital and to identify factors predicting mortality. In a retrospective study, all patients with SAP diagnosed between February 1996 and October 2000 according to the Atlanta criteria were studied. Out of a total of 363 AP patients, 67 developed SAP. The mean age of the patients was 69; the commonest etiology was biliary; 55.2% developed necrosis; the commonest systemic complication was respiratory failure (44.7%), followed by acute renal failure (35.8%) and shock (20.9%). A total of 31.3% of the patients died. Factors significantly related to mortality were age, upper digestive tract bleeding, acute renal failure, respiratory failure and shock by univariate analysis. However, pseudocysts seemed to have a protective effect. By multivariate analysis, independent prognostic factors were age, acute renal failure and respiratory failure. Patients with SAP mainly died due to systemic complications, especially acute renal failure and respiratory failure. Necrosis (in the absence or presence of infection) was not correlated with increased mortality. A pseudocyst was found to be a protective factor, probably because the definition itself led to the selection of patients who had survived multiorgan failure. Copyright 2003 S. Karger AG, Basel and IAP

A Comprehensive Analysis of Small-Passerine Fatalities from Collision with Turbines at Wind Energy Facilities

PubMed Central

Erickson, Wallace P.; Wolfe, Melissa M.; Bay, Kimberly J.; Johnson, Douglas H.; Gehring, Joelle L.

2014-01-01

Small passerines, sometimes referred to as perching birds or songbirds, are the most abundant bird group in the United States (US) and Canada, and the most common among bird fatalities caused by collision with turbines at wind energy facilities. We used data compiled from 116 studies conducted in the US and Canada to estimate the annual rate of small-bird fatalities. It was necessary for us to calculate estimates of small-bird fatality rates from reported all-bird rates for 30% of studies. The remaining 70% of studies provided data on small-bird fatalities. We then adjusted estimates to account for detection bias and loss of carcasses from scavenging. These studies represented about 15% of current operating capacity (megawatts [MW]) for all wind energy facilities in the US and Canada and provided information on 4,975 bird fatalities, of which we estimated 62.5% were small passerines comprising 156 species. For all wind energy facilities currently in operation, we estimated that about 134,000 to 230,000 small-passerine fatalities from collision with wind turbines occur annually, or 2.10 to 3.35 small birds/MW of installed capacity. When adjusted for species composition, this indicates that about 368,000 fatalities for all bird species are caused annually by collisions with wind turbines. Other human-related sources of bird deaths, (e.g., communication towers, buildings [including windows]), and domestic cats) have been estimated to kill millions to billions of birds each year. Compared to continent-wide population estimates, the cumulative mortality rate per year by species was highest for black-throated blue warbler and tree swallow; 0.043% of the entire population of each species was estimated to annually suffer mortality from collisions with turbines. For the eighteen species with the next highest values, this estimate ranged from 0.008% to 0.038%, much lower than rates attributed to collisions with communication towers (1.2% to 9.0% for top twenty species). PMID:25222738

A comprehensive analysis of small-passerine fatalities from collisions with turbines at wind energy facilities

USGS Publications Warehouse

Erickson, Wallace P.; Wolfe, Melissa M.; Bay, Kimberly J.; Johnson, Douglas H.; Gehring, Joelle L.

2014-01-01

Small passerines, sometimes referred to as perching birds or songbirds, are the most abundant bird group in the United States (US) and Canada, and the most common among bird fatalities caused by collision with turbines at wind energy facilities. We used data compiled from 39 studies conducted in the US and Canada to estimate the annual rate of small-bird fatalities. It was necessary for us to calculate estimates of small-bird fatality rates from reported all-bird rates for 30% of studies. The remaining 70% of studies provided data on small-bird fatalities. We then adjusted estimates to account for detection bias and loss of carcasses from scavenging. These studies represented about 15% of current operating capacity (megawatts [MW]) for all wind energy facilities in the US and Canada and provided information on 4,975 bird fatalities, of which we estimated 62.5% were small passerines comprising 156 species. For all wind energy facilities currently in operation, we estimated that about 134,000 to 230,000 small-passerine fatalities from collision with wind turbines occur annually, or 2.10 to 3.35 small birds/MW of installed capacity. When adjusted for species composition, this indicates that about 368,000 fatalities for all bird species are caused annually by collisions with wind turbines. Other human-related sources of bird deaths, (e.g., communication towers, buildings [including windows]), and domestic cats) have been estimated to kill millions to billions of birds each year. Compared to continent-wide population estimates, the cumulative mortality rate per year by species was highest for black-throated blue warbler and tree swallow; 0.043% of the entire population of each species was estimated to annually suffer mortality from collisions with turbines. For the eighteen species with the next highest values, this estimate ranged from 0.008% to 0.038%, much lower than rates attributed to collisions with communication towers (1.2% to 9.0% for top twenty species).

Front air bag nondeployments in frontal crashes fatal to drivers or right-front passengers.

PubMed

Braver, Elisa R; McCartt, Anne T; Sherwood, Christopher P; Zuby, David S; Blanar, Laura; Scerbo, Marge

2010-04-01

Public concern has arisen about the reliability of front air bags because Fatality Analysis Reporting System (FARS) data indicate many nondeployed air bags in fatal frontal crashes. However, the accuracy of air bag deployment, the variable in question, is uncertain. This study aimed to provide more certain estimates of nondeployment incidence in fatal frontal crashes. Fatally injured passenger vehicle drivers and right-front passengers in frontal crashes were identified in two U.S. databases for calendar years 1998-2006 and model years 1994-2006: FARS, a census of police-reported fatal crashes on public roads, and National Automotive Sampling System/Crashworthiness Data System (NASS/CDS), a probability sample of tow-away crashes. NASS/CDS contains subsets of fatal crashes in FARS and collects detailed data using crash investigators. Front air bag deployment coding for front-seat occupant fatalities was compared in FARS and NASS/CDS, and case reviews were conducted. Among FARS frontal deaths with available deployment status (N = 43,169), front air bags were coded as not deployed for 18 percent of front occupants. In comparison, NASS/CDS (N = 628) reported 9 percent (weighted estimate) nondeployment among front occupants killed. Among crashes common to both databases, NASS/CDS reported deployments for 45 percent of front occupant deaths for which FARS had coded nondeployments. Detailed case reviews of NASS/CDS crashes indicated highly accurate coding for deployment status. Based on this case review, 8 percent (weighted estimate) of front occupant deaths in frontal crashes appeared to involve air bag nondeployments; 1-2 percent of front occupant deaths represented potential system failures where deployments would have been expected. Air bag deployments appeared unwarranted in most nondeployments based on crash characteristics. FARS data overstate the magnitude of the problem of air bag deployment failures; steps should be taken to improve coding. There are inherent uncertainties in judgments about whether or not air bags would be expected to deploy in some crashes. Continued monitoring of air bag performance is warranted.

The effect of the learner license Graduated Driver Licensing components on teen drivers' crashes.

PubMed

Ehsani, Johnathon Pouya; Bingham, C Raymond; Shope, Jean T

2013-10-01

Most studies evaluating the effectiveness of Graduated Driver Licensing (GDL) have focused on the overall system. Studies examining individual components have rarely accounted for the confounding of multiple, simultaneously implemented components. The purpose of this paper is to quantify the effects of a required learner license duration and required hours of supervised driving on teen driver fatal crashes. States that introduced a single GDL component independent of any other during the period 1990-2009 were identified. Monthly and quarterly fatal crash rates per 100,000 population of 16- and 17-year-old drivers were analyzed using single-state time series analysis, adjusting for adult crash rates and gasoline prices. Using the parameter estimates from each state's time series model, the pooled effect of each GDL component on 16- and 17-year-old drivers' fatal crashes was estimated using a random effects meta-analytic model to combine findings across states. In three states, a six-month minimum learner license duration was associated with a significant decline in combined 16- and 17-year-old drivers' fatal crash rates. The pooled effect of the minimum learner license duration across all states in the sample was associated with a significant change in combined 16- and 17-year-old driver fatal crash rates of -.07 (95% Confidence Interval [CI] -.11, -.03). Following the introduction of 30 h of required supervised driving in one state, novice drivers' fatal crash rates increased 35%. The pooled effect across all states in the study sample of having a supervised driving hour requirement was not significantly different from zero (.04, 95% CI -.15, .22). These findings suggest that a learner license duration of at least six-months may be necessary to achieve a significant decline in teen drivers' fatal crash rates. Evidence of the effect of required hours of supervised driving on teen drivers' fatal crash rates was mixed. Copyright © 2013 Elsevier Ltd. All rights reserved.

A comprehensive analysis of small-passerine fatalities from collision with turbines at wind energy facilities.

PubMed

Erickson, Wallace P; Wolfe, Melissa M; Bay, Kimberly J; Johnson, Douglas H; Gehring, Joelle L

2014-01-01

Small passerines, sometimes referred to as perching birds or songbirds, are the most abundant bird group in the United States (US) and Canada, and the most common among bird fatalities caused by collision with turbines at wind energy facilities. We used data compiled from 116 studies conducted in the US and Canada to estimate the annual rate of small-bird fatalities. It was necessary for us to calculate estimates of small-bird fatality rates from reported all-bird rates for 30% of studies. The remaining 70% of studies provided data on small-bird fatalities. We then adjusted estimates to account for detection bias and loss of carcasses from scavenging. These studies represented about 15% of current operating capacity (megawatts [MW]) for all wind energy facilities in the US and Canada and provided information on 4,975 bird fatalities, of which we estimated 62.5% were small passerines comprising 156 species. For all wind energy facilities currently in operation, we estimated that about 134,000 to 230,000 small-passerine fatalities from collision with wind turbines occur annually, or 2.10 to 3.35 small birds/MW of installed capacity. When adjusted for species composition, this indicates that about 368,000 fatalities for all bird species are caused annually by collisions with wind turbines. Other human-related sources of bird deaths, (e.g., communication towers, buildings [including windows]), and domestic cats) have been estimated to kill millions to billions of birds each year. Compared to continent-wide population estimates, the cumulative mortality rate per year by species was highest for black-throated blue warbler and tree swallow; 0.043% of the entire population of each species was estimated to annually suffer mortality from collisions with turbines. For the eighteen species with the next highest values, this estimate ranged from 0.008% to 0.038%, much lower than rates attributed to collisions with communication towers (1.2% to 9.0% for top twenty species).

Clinical profile and predictors of fatal Rocky Mountain spotted fever in children from Sonora, Mexico.

PubMed

Alvarez-Hernandez, Gerardo; Murillo-Benitez, Coral; Candia-Plata, Maria del Carmen; Moro, Manuel

2015-02-01

Rocky Mountain spotted fever (RMSF) is an increasingly important cause of preventable mortality in children in Sonora, Mexico. Although early treatment with tetracycline has shown to prevent fatal outcome, the disease remains a life-threatening condition, particularly for children. This study describes the clinical factors associated with pediatric mortality due to RMSF in Sonora, in order to guide healthcare practices. This is a retrospective analysis of 104 children consecutively hospitalized at the major pediatric hospital of Sonora, diagnosed with RMSF between January 2004 and December 2013. Descriptive statistics and multiple logistic regression were used to identify risk factors for fatal outcome. The case fatality ratio in this cohort was 20.2%. Children were hospitalized after a median of 6 days from onset of symptoms including fever (100%), rash involving palms and soles (88.5%) and headache (79.8%); 90.4% of fatal cases had low platelet counts (<50,000/μL) and 33.3% showed serum creatinine concentrations above the normal value. Acute kidney injury increased mortality, odds ratio (OR(adj)) = 4.84, 95% confidence interval (CI): 1.2-16.2, as well as delay in treatment (≥ 5th day from onset) with doxycycline, OR(adj) = 2.62, 95% CI: 1.24-5.52 and hemorrhage, OR(adj) = 6.11, 95% CI: 1.89-19.69. RMSF is a public health problem in Sonora. Clinically, fatal cases differ from non-fatal cases in renal function and hemorrhagic manifestations, although these findings may occur too late for a timely intervention. First-line providers must be educated to harbor a timely suspicion of RMSF, and should provide empiric treatment with doxycycline when febrile patients first present for care.

Relationships of Fear of Breast Cancer and Fatalism with Screening Behavior in Women Referred to Health Centers of Tabriz in Iran.

PubMed

Ghahramanian, Akram; Rahmani, Azad; Aghazadeh, Ahmad Mirza; Mehr, Lida Emami

2016-01-01

Fear and fatalism have been proposed as factors affecting breast cancer screening, but the evidence is not strong. This study aimed to determine relationships of fear and fatalism with breast cancer screening behavior among Tabriz women in Iran. In a cross- sectional study, 370 women referred to 12 health centers in Tabriz were selected with two-stage cluster sampling and data regarding breast cancer screening, fatalism and fear of breast cancer were collected respectively with a checklist for screening performance, Champions Fear and Pow Fatalism Questionnaires. Data were analyzed by logistic regression with SPSS software version 16. Only 43% and 23% of participants had undergone breast self- examination and clinical breast examination. Among women older than 40 years, 38.2% had mammography history and only 2.7% of them had done it annually. Although fatalism and fear had a stimulating effects on breast cancer screening performance th relationships were not signi cant (P>0.05). There was a negative significant correlation between fear and fatalism (r= -0.24, p=0.000). On logistic regression analysis, age (OR=1.037, p<0.01) and income status (OR= 0.411, p<0.05) significantly explained BSE and age (OR=1.051, p<0.01) and body mass index (OR= 0.879, p<0.01) explained CBE. Also BMI (OR= 0.074, p<0.05) and income status (OR=0.155, p<0.01) was significantly effective for mammography following. Breast cancer screening behavior is inappropriate and affected by family livelihood status and lifestyle leads to weight gain, so that for promoting of screening behavior, economic support to families, lifestyle modification and public education are suggested.

Prescription of Zolpidem and the Risk of Fatal Motor Vehicle Collisions: A Population-Based, Case-Crossover Study from South Korea.

PubMed

Yang, Bo Ram; Kim, Ye-Jee; Kim, Mi-Sook; Jung, Sun-Young; Choi, Nam-Kyong; Hwang, Byungkwan; Park, Byung-Joo; Lee, Joongyub

2018-05-23

Zolpidem is one of the most frequently used hypnotics worldwide, but associations with serious adverse effects such as motor vehicle collisions have been reported. The objective of this study was to evaluate the association of fatal motor vehicle collisions with a prescription for zolpidem, considering the context of the motor vehicle collisions. We conducted a case-crossover study, where each case served as its own control, by linking data about fatal motor vehicle collisions from the Korean Road Traffic Authority between 2010 and 2014 with national health insurance data. The case period was defined as 1 day before the fatal motor vehicle collisions, and was matched to four control periods at 90-day intervals. Conditional logistic regression was performed to calculate the odds ratio for fatal motor vehicle collisions associated with zolpidem exposure, and odds ratios were adjusted for time-varying exposure to confounding medications. A stratified analysis was performed by age group (younger than 65 years or not), the Charlson Comorbidity Index, and whether patients were new zolpidem users. Among the 714 subjects, the adjusted odds ratio for a fatal motor vehicle collision associated with a prescription for zolpidem the previous day was 1.48 (95% confidence interval 1.06-2.07). After stratification, a significantly increased risk was observed in subjects with a high Charlson Comorbidity Index (odds ratio 1.81; 95% confidence interval 1.16-2.84), the younger age group (odds ratio: 1.62; 95% confidence interval 1.03-2.56), and new zolpidem users (odds ratio 2.37; 95% confidence interval 1.40-4.00). A prescription for zolpidem on the previous day was significantly related to an increased risk of fatal motor vehicle collisions in this population-based case-crossover study.

Fall-related accidents among hikers in the Austrian Alps: a 9-year retrospective study

PubMed Central

Faulhaber, Martin; Pocecco, Elena; Ruedl, Gerhard; Walter, Dagmar; Sterr, Regina; Ebner, Hans; Schobersberger, Wolfgang; Burtscher, Martin

2017-01-01

Objective To analyse the circumstances of fatal and non-fatal mountain hiking accidents caused by falls. Methods The study was designed as a retrospective analysis. Mountain hiking accidents caused by falls were documented during a 9-year period (2006–2014). After screening of all data for potential exclusion criteria the final sample size of 5368 accidents and 5665 victims was included into the analyses. Main outcome measures were details about accidents, victims, type of trail and surface. Results The annual number of accidents showed a continuous increase from 467 in 2006 to 700 in 2014. In total, 5.8% of all victims died during the 9-year period. 75.3% of the hikers fell during descent and 80.9% of the victims had their accident on a marked hiking trail or small path. The sex ratio for non-fatal accidents was 55% female and 45% male; for fatal accidents the female-to-male ratio was 28%:72%. Mean age of all victims was 52.5±17.5 years and victims of fatalities were about 5 years older compared with victims of non-fatal accidents (57.5±16.5 vs 52.2±17.5 years, P<0.01). Conclusion Descent is the most risky part for accidents caused by falls during mountain hiking. Male hikers are at greater risk for fatalities independent of age and this is associated with accidents occurring in pathless terrain. The death rate from falls was 6%. We recommend a critical self-assessment of the individual capabilities and mountain hiking skills and adequate planning of the hiking tours for mountain hikers. PMID:29259815

Trends in Automobile Travel, Motor Vehicle Fatalities, and Physical Activity: 2003-2015.

PubMed

McDonald, Noreen C

2017-05-01

Annual per-capita automobile travel declined by 600 miles from 2003 to 2014 with decreases greatest among young adults. This article tests whether the decline has been accompanied by public health co-benefits of increased physical activity and decreased motor vehicle fatalities. Minutes of auto travel and physical activity derived from active travel, sports, and exercise were obtained from the American Time Use Survey. Fatalities were measured using the Fatality Analysis Reporting System. Longitudinal change was assessed for adults aged 20-59 years by age group and sex. Significance of changes was assessed by absolute differences and unadjusted and adjusted linear trends. Analyses were conducted in 2016. Daily auto travel decreased by 9.2 minutes from 2003 to 2014 for all ages (p<0.001) with the largest decrease among men aged 20-29 years (Δ= -21.7, p<0.001). No significant changes were observed in total minutes of physical activity. Motor vehicle occupant fatalities per 100,000 population showed significant declines for all ages (Δ=-5.8, p<0.001) with the largest for young men (Δ= -15.3, p<0.001). Fatalities per million minutes of auto travel showed only modest declines across age groups and, for men aged 20-29 years, varied from 10.9 (95% CI=10.0, 11.7) in 2003 to 9.7 (95% CI=8.7, 10.8) in 2014. Reduced motor vehicle fatalities are a public health co-benefit of decreased driving, especially for male millennials. Despite suggestions to the contrary, individuals did not switch from cars to active modes nor spend more time in sports and exercise. Maintenance of the safety benefits requires additional attention to road safety efforts, particularly as auto travel increases. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Occupational injuries in Italy: risk factors and long term trend (1951-98)

PubMed Central

Fabiano, B; Curro, F; Pastorino, R

2001-01-01

OBJECTIVES—Trends in the rates of total injuries and fatal accidents in the different sectors of Italian industries were explored during the period 1951-98. Causes and dynamics of injury were also studied for setting priorities for improving safety standards.
METHODS—Data on occupational injuries from the National Organisation for Labour Injury Insurance were combined with data from the State Statistics Institute to highlight the interaction between the injury frequency index trend and the production cycle—that is, the evolution of industrial production throughout the years. Multiple regression with log transformed rates was adopted to model the trends of occupational fatalities for each industrial group.
RESULTS—The ratios between the linked indices of injury frequency and industrial production showed a good correlation over the whole period. A general decline in injuries was found across all sectors, with values ranging from 79.86% in the energy group to 23.32% in the textile group. In analysing fatalities, the trend seemed to be more clearly decreasing than the trend of total injuries, including temporary and permanent disabilities; the fatalities showed an exponential decrease according to multiple regression, with an annual decline equal to 4.42%.
CONCLUSIONS—The overall probability of industrial fatal accidents in Italy tended to decrease exponentially by year. The most effective actions in preventing injuries were directed towards fatal accidents. By analysing the rates of fatal accident in the different sectors, appropriate targets and priorities for increased strategies to prevent injuries can be suggested. The analysis of the dynamics and the material causes of injuries showed that still more consideration should be given to human and organisational factors.


Keywords: labour injuries; severity; regression model PMID:11303083

Increasing Trend of Fatal Falls in Older Adults in the United States, 1992 to 2005: Coding Practice or Reporting Quality?

PubMed

Kharrazi, Rebekah J; Nash, Denis; Mielenz, Thelma J

2015-09-01

To investigate whether changes in death certificate coding and reporting practices explain part or all of the recent increase in the rate of fatal falls in adults aged 65 and older in the United States. Trends in coding and reporting practices of fatal falls were evaluated under mortality coding schemes for International Classification of Diseases (ICD), Ninth Revision (1992-1998) and Tenth Revision (1999-2005). United States, 1992 to 2005. Individuals aged 65 and older with falls listed as the underlying cause of death (UCD) on their death certificates. The primary outcome was annual fatal falls rates per 100,000 U.S. residents aged 65 and older. Coding practice was assessed through analysis of trends in rates of specific UCD fall ICD e-codes over time. Reporting quality was assessed by examining changes in the location on the death certificate where fall e-codes were reported, in particular, the percentage of fall e-codes recorded in the proper location on the death certificate. Fatal falls rates increased over both time periods: 1992 to 1998 and 1999 to 2005. A single falls e-code was responsible for the increasing trend of fatal falls overall from 1992 to 1998 (E888, other and unspecified fall) and from 1999 to 2005 (W18, other falls on the same level), whereas trends for other falls e-codes remained stable. Reporting quality improved steadily throughout the study period. Better reporting quality, not coding practices, contributed to the increasing rate of fatal falls in older adults in the United States from 1992 to 2005. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Graduated driver licensing programs and fatal crashes of 16-year-old drivers: a national evaluation.

PubMed

Chen, Li-Hui; Baker, Susan P; Li, Guohua

2006-07-01

Implementation of graduated driver licensing programs is associated with reductions in crash rates of young drivers, but graduated driver licensing programs vary in their components. The impact of programs with different components is unknown. The purpose of this work was to determine which graduated driver licensing programs are associated with the greatest reductions in fatal motor vehicle crashes involving 16-year-old drivers. We conducted a retrospective study of all 16-year-old drivers involved in fatal crashes in the United States from 1994 through 2004 using data from the Fatality Analysis Reporting System and the US Census Bureau. We measured incidence rate ratios of fatal motor vehicle crashes involving 16-year-old drivers according to graduated driver licensing programs, adjusted for state and year. Compared with state quarters with no graduated driver licensing program components, reductions of 16% to 21% in fatal crash involvement rates of 16-year-old drivers occurred with programs that included > or = 3-month mandatory waiting period, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction. Reductions of 18% to 21% occurred in state quarters with programs that included > or = 5 of the 7 components examined. Drivers aged 20 to 24 or 25 to 29 years did not experience significant reductions. Comprehensive graduated driver licensing programs are associated with reductions of approximately 20% in 16-year-old drivers' fatal crash involvement rates. The greatest benefit seems to be associated with programs that include age requirements and > or = 3 months of waiting before the intermediate stage, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction.

Fatalism, optimism, spirituality, depressive symptoms and stroke outcome: A population-based analysis

PubMed Central

Morgenstern, Lewis B.; Sánchez, Brisa N.; Skolarus, Lesli E.; Garcia, Nelda; Risser, Jan M.H.; Wing, Jeffrey J.; Smith, Melinda A.; Zahuranec, Darin B.; Lisabeth, Lynda D.

2011-01-01

Background and Purpose We sought to describe the association of spirituality, optimism, fatalism and depressive symptoms with initial stroke severity, stroke recurrence and post-stroke mortality. Methods Stroke cases June 2004–December 2008 were ascertained in Nueces County, Texas. Patients without aphasia were queried on their recall of depressive symptoms, fatalism, optimism, and non-organizational spirituality before stroke using validated scales. The association between scales and stroke outcomes was studied using multiple linear regression with log-transformed NIHSS and Cox proportional hazards regression for recurrence and mortality. Results 669 patients participated, 48.7% were women. In fully adjusted models, an increase in fatalism from the first to third quartile was associated with all-cause mortality (HR=1.41, 95%CI: 1.06, 1.88), marginally associated with risk of recurrence (HR=1.35, 95%CI: 0.97, 1.88), but not stroke severity. Similarly, an increase in depressive symptoms was associated with increased mortality (HR=1.32, 95%CI: 1.02, 1.72), marginally associated with stroke recurrence (HR=1.22, CI: 0.93, 1.62), and with a 9.0% increase in stroke severity (95%CI: 0.01, 18.0). Depressive symptoms altered the fatalism-mortality association such that the association of fatalism and mortality was more pronounced for patients reporting no depressive symptoms. Neither spirituality nor optimism conferred a significant effect on stroke severity, recurrence or mortality. Conclusions Among patients who have already had a stroke, self-described pre-stroke depressive symptoms and fatalism, but not optimism or spirituality, are associated with increased risk of stroke recurrence and mortality. Unconventional risk factors may explain some of the variability in stroke outcomes observed in populations, and may be novel targets for intervention. PMID:21940963

Postmortem computed tomography as an adjunct to autopsy for analyzing fatal motor vehicle crash injuries: results of a pilot study.

PubMed

Sochor, Mark R; Trowbridge, Matthew J; Boscak, Alexis; Maino, John C; Maio, Ronald F

2008-09-01

Detailed fatal injury data after fatal motor vehicle crashes (MVC) are necessary to improve occupant safety and promote injury prevention. Autopsy remains the principle source of detailed fatal injury data. However, procedure rates are declining because of a range of technical, ethical, and religious concerns. Postmortem computed tomography (PMCT) is a potential alternative or adjunct to autopsy which is increasingly used by forensic researchers. However, there are only limited data regarding the utility of PMCT for analysis of fatal MVC injuries. We performed whole body PMCT and autopsy on six subjects fatally injured in MVC in a single county in Michigan. All injuries detected by either method were coded using the Abbreviated Injury Scale (AIS). Severe injuries, defined as AIS 3 or higher (AIS 3+), were tallied for each forensic procedure to allow a comparison of relative diagnostic performance. A total of 46 AIS 3+ injuries were identified by autopsy and PMCT for these cases. The addition of PMCT to autopsy increased overall detection of AIS 3+ injuries (all types) by 28%. PMCT detected 27% more AIS 3+ skeletal injuries than autopsy but 25% less soft tissue injuries. Use of PMCT improves the detection of AIS 3+ injuries after fatal MVC compared with isolated use of autopsy and also produces a highly detailed permanent objective record. PMCT appears to improve detection of skeletal injury compared with autopsy but is less sensitive than autopsy for the detection of AIS 3+ soft tissue injuries. Neither autopsy nor PMCT identified all AIS 3+ injuries revealed by the combination of the two methodologies. This suggests that PMCT should be used as an adjunct to autopsy rather than a replacement whenever feasible.

PubMed

Giliberti, Claudia; Salerno, Silvana

2016-12-13

Commuting accidents represent the leading cause of work-related fatalities among women in Italy. For working women, the journey from home to work is the most dangerous part of the day. Analysis of data on fatal commuting accidents in order to identify risk factors among women. INAIL Statistical Data (2009-2013) related to fatal commuting were analyzed by gender, age, immigration, activities, geographical area, working time, month and day of the week. Italian and immigrant women die mainly from commuting accidents (207 cases out of 371; 56%), a significant number of immigrant women also die in commuting accidents involving no vehicles (4%); Italian and immigrant men die mainly from causes related to the work environment (48%), especially immigrants (54%), and not from commuting accidents (921 out of 3997; 23%). Prevalent age at commuting fatality is 35-49 years, and among immigrant women 18-34. Deaths among women occur mostly in Northeast Italy, and among women working in health and social services; among immigrant women accommodation and catering services are also relevant. The highest number of fatal accidents among men occurs in Northwest Italy, among men working in wholesale trade. All fatalities take place mainly going to work, between 5-10 a.m., among women from October to December, among men from July to September, among Italian women are significantly higher on Saturday, among immigrant women on Sunday. Deaths among men are significantly higher in the eighth hour of work, between 3- 8 p.m. and on Monday among Italian workers, on Wednesday among immigrant men. Commuting fatalities among women, according to INAIL Statistical Data, show specific risk conditions by age, immigration, work activity, geographical area, working time, month and day of the week that require targeted preventive policies.

Different features of Vδ2 T and NK cells in fatal and non-fatal human Ebola infections

PubMed Central

Cimini, Eleonora; Viola, Domenico; Cabeza-Cabrerizo, Mar; Romanelli, Antonella; Tumino, Nicola; Sacchi, Alessandra; Bordoni, Veronica; Casetti, Rita; Turchi, Federica; Martini, Federico; Bore, Joseph A.; Koundouno, Fara Raymond; Duraffour, Sophie; Michel, Janine; Holm, Tobias; Zekeng, Elsa Gayle; Cowley, Lauren; Garcia Dorival, Isabel; Doerrbecker, Juliane; Hetzelt, Nicole; Baum, Jonathan H. J.; Portmann, Jasmine; Wölfel, Roman; Gabriel, Martin; Miranda, Osvaldo; Díaz, Graciliano; Díaz, José E.; Fleites, Yoel A.; Piñeiro, Carlos A.; Castro, Carlos M.; Koivogui, Lamine; Magassouba, N’Faly; Diallo, Boubacar; Ruibal, Paula; Oestereich, Lisa; Wozniak, David M.; Lüdtke, Anja; Becker-Ziaja, Beate; Capobianchi, Maria R.; Ippolito, Giuseppe; Carroll, Miles W.; Günther, Stephan; Di Caro, Antonino; Muñoz-Fontela, César

2017-01-01

Background Human Ebola infection is characterized by a paralysis of the immune system. A signature of αβ T cells in fatal Ebola infection has been recently proposed, while the involvement of innate immune cells in the protection/pathogenesis of Ebola infection is unknown. Aim of this study was to analyze γδ T and NK cells in patients from the Ebola outbreak of 2014–2015 occurred in West Africa, and to assess their association with the clinical outcome. Methodology/Principal findings Nineteen Ebola-infected patients were enrolled at the time of admission to the Ebola Treatment Centre in Guinea. Patients were divided in two groups on the basis of the clinical outcome. The analysis was performed by using multiparametric flow cytometry established by the European Mobile Laboratory in the field. A low frequency of Vδ2 T-cells was observed during Ebola infection, independently from the clinical outcome. Moreover, Vδ2 T-cells from Ebola patients massively expressed CD95 apoptotic marker, suggesting the involvement of apoptotic mechanisms in Vδ2 T-cell loss. Interestingly, Vδ2 T-cells from survivors expressed an effector phenotype and presented a lower expression of the CTLA-4 exhaustion marker than fatalities, suggesting a role of effector Vδ2 T-cells in the protection. Furthermore, patients with fatal Ebola infection were characterized by a lower NK cell frequency than patients with non fatal infection. In particular, both CD56bright and CD56dim NK frequency were very low both in fatal and non fatal infections, while a higher frequency of CD56neg NK cells was associated to non-fatal infections. Finally, NK activation and expression of NKp46 and CD158a were independent from clinical outcome. Conclusions/Significances Altogether, the data suggest that both effector Vδ2 T-cells and NK cells may play a role in the complex network of protective response to EBOV infection. Further studies are required to characterize the protective effector functions of Vδ2 and NK cells. PMID:28558022

Patterns of drug use in fatal crashes.

PubMed

Romano, Eduardo; Pollini, Robin A

2013-08-01

To characterize drug prevalence among fatally injured drivers, identify significant associations (i.e. day of week, time of day, age, gender), and compare findings with those for alcohol. Descriptive and logistic mixed-model regression analyses of Fatality Analysis Reporting System data. US states with drug test results for >80% of fatally injured drivers, 1998-2010. Drivers killed in single-vehicle crashes on public roads who died at the scene of the crash (n = 16 942). Drug test results, blood alcohol concentration (BAC), gender, age and day and time of crash. Overall, 45.1% of fatally injured drivers tested positive for alcohol (39.9% BAC ≥ 0.08) and 25.9% for drugs. The most common drugs present were stimulants (7.2%) and cannabinols (7.1%), followed by 'other' drugs (4.1%), multiple drugs (4.1%), narcotics (2.1%) and depressants (1.5%). Drug-involved crashes occurred with relative uniformity throughout the day while alcohol-involved crashes were more common at night (P < 0.01). The odds of testing positive for drugs varied depending upon drug class, driver characteristics, time of day and the presence of alcohol. Fatal single-vehicle crashes involving drugs are less common than those involving alcohol and the characteristics of drug-involved crashes differ, depending upon drug class and whether alcohol is present. Concerns about drug-impaired driving should not detract from the current law enforcement focus on alcohol-impaired driving. © 2013 Society for the Study of Addiction.

Plasma big endothelin-1 levels at admission and future cardiovascular outcomes: A cohort study in patients with stable coronary artery disease.

PubMed

Zhou, Bing-Yang; Guo, Yuan-Lin; Wu, Na-Qiong; Zhu, Cheng-Gang; Gao, Ying; Qing, Ping; Li, Xiao-Lin; Wang, Yao; Dong, Qian; Liu, Geng; Xu, Rui Xia; Cui, Chuan-Jue; Sun, Jing; Li, Jian-Jun

2017-03-01

Big endothelin-1 (ET-1) has been proposed as a novel prognostic indicator of acute coronary syndrome, while its predicting role of cardiovascular outcomes in patients with stable coronary artery disease (CAD) is unclear. A total of 3154 consecutive patients with stable CAD were enrolled and followed up for 24months. The outcomes included all-cause death, non-fatal myocardial infarction, stroke and unplanned revascularization (percutaneous coronary intervention and coronary artery bypass grafting). Baseline big ET-1 was measured using sandwich enzyme immunoassay method. Cox proportional hazard regression analysis and Kaplan-Meier analysis were used to evaluate the prognostic value of big ET-1 on cardiovascular outcomes. One hundred and eighty-nine (5.99%) events occurred during follow-up. Patients were divided into two groups: events group (n=189) and non-events group (n=2965). The results indicated that the events group had higher levels of big ET-1 compared to non-events group. Multivariable Cox proportional hazard regression analysis showed that big ET-1 was positively and statistically correlated with clinical outcomes (Hazard Ratio: 1.656, 95% confidence interval: 1.099-2.496, p=0.016). Additionally, the Kaplan-Meier analysis revealed that patients with higher big ET-1 presented lower event-free survival (p=0.016). The present study firstly suggests that big ET-1 is an independent risk marker of cardiovascular outcomes in patients with stable CAD. And more studies are needed to confirm our findings. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Global incidence and case fatality rate of pulmonary embolism following major surgery: a protocol for a systematic review and meta-analysis of cohort studies.

PubMed

Temgoua, Mazou N; Tochie, Joel Noutakdie; Noubiap, Jean Jacques; Agbor, Valirie Ndip; Danwang, Celestin; Endomba, Francky Teddy A; Nkemngu, Njinkeng J

2017-12-04

Pulmonary embolism (PE) is a life-threatening condition common after major surgery. Although the high incidence (0.3-30%) and mortality rate (16.9-31%) of PE in patients undergoing major surgical procedures is apparent from findings of contemporary observational studies, there is a lack of a summary and meta-analysis data on the epidemiology of postoperative PE in this same regard. Hence, we propose to conduct the first systematic review to summarise existing data on the global incidence, determinants and case fatality rate of PE following major surgery. Electronic databases including MEDLINE, EMBASE, SCOPUS, WHO global health library (including LILACS), Web of Science and Google scholar from inception to April 30, 2017, will be searched for cohort studies reporting on the incidence, determinants and case fatality rate of PE occurring after major surgery. Data from grey literature will also be assessed. Two investigators will independently perform study selection and data extraction. Included studies will be evaluated for risk of bias. Appropriate meta-analytic methods will be used to pool incidence and case fatality rate estimates from studies with identical features, globally and by subgroups of major surgical procedures. Random-effects and risk ratio with 95% confidence interval will be used to summarise determinants and predictors of mortality of PE in patients undergoing major surgery. This systematic review and meta-analysis will provide the most up-to-date epidemiology of PE in patients undergoing major surgery to inform health authorities and identify further research topics based on the remaining knowledge gaps. PROSPERO CRD42017065126.

GIS based analysis of Intercity Fatal Road Traffic Accidents in Iran

PubMed Central

Alizadeh, A; Zare, M; Darparesh, M; Mohseni, S; Soleimani-Ahmadi, M

2015-01-01

Road traffic accidents including intercity car traffic accidents (ICTAs) are among the most important causes of morbidity and mortality due to the growing number of vehicles, risky behaviors, and changes in lifestyle of the general population. A sound knowledge of the geographical distribution of car traffic accidents can be considered as an approach towards the accident causation and it can be used as an administrative tool in allocating the sources for traffic accidents prevention. This study was conducted to investigate the geographical distribution and the time trend of fatal intercity car traffic accidents in Iran. To conduct this descriptive study, all Iranian intercity road traffic mortality data were obtained from the Police reports in the Statistical Yearbook of the Governor’s Budget and Planning. The obtained data were for 17 complete Iranian calendar years from March 1997 to March 2012. The incidence rate (IR) of fatal ICTAs for each year was calculated as the total number of fatal ICTAs in every 100000 population in specified time intervals. Figures and maps indicating the trends and geographical distribution of fatal ICTAs were prepared while using Microsoft Excel and ArcGis9.2 software. The number of fatal car accidents showed a general increasing trend from 3000 in 1996 to 13500 in 2012. The incidence of fatal intercity car accidents has changed from six in 100000 population in 1996 to 18 in 100000 population in 2012. GIS based data showed that the incidence rate of ICTAs in different provinces of Iran was very divergent. The highest incidence of fatal ICTAs was in Semnan province (IR= 35.2), followed by North Khorasan (IR=22.7), and South Khorasan (IR=22). The least incidence of fatal ICTAs was in Tehran province (IR=2.4) followed by Khozestan (IR=6.5), and Eastern Azarbayejan (IR=6.6). The compensation cost of fatal ICTAs also showed an increasing trend during the studied period. Since an increasing amount of money was being paid yearly for the car accidents, which were in their nature preventable, the key players in road safety including governments, car manufacturers, and road developers were recommended to use GIS based accident data for a more efficient planning and budgeting towards the intercity car accidents reduction. PMID:28255402

GIS based analysis of Intercity Fatal Road Traffic Accidents in Iran.

PubMed

Alizadeh, A; Zare, M; Darparesh, M; Mohseni, S; Soleimani-Ahmadi, M

2015-01-01

Road traffic accidents including intercity car traffic accidents (ICTAs) are among the most important causes of morbidity and mortality due to the growing number of vehicles, risky behaviors, and changes in lifestyle of the general population. A sound knowledge of the geographical distribution of car traffic accidents can be considered as an approach towards the accident causation and it can be used as an administrative tool in allocating the sources for traffic accidents prevention. This study was conducted to investigate the geographical distribution and the time trend of fatal intercity car traffic accidents in Iran. To conduct this descriptive study, all Iranian intercity road traffic mortality data were obtained from the Police reports in the Statistical Yearbook of the Governor's Budget and Planning. The obtained data were for 17 complete Iranian calendar years from March 1997 to March 2012. The incidence rate (IR) of fatal ICTAs for each year was calculated as the total number of fatal ICTAs in every 100000 population in specified time intervals. Figures and maps indicating the trends and geographical distribution of fatal ICTAs were prepared while using Microsoft Excel and ArcGis9.2 software. The number of fatal car accidents showed a general increasing trend from 3000 in 1996 to 13500 in 2012. The incidence of fatal intercity car accidents has changed from six in 100000 population in 1996 to 18 in 100000 population in 2012. GIS based data showed that the incidence rate of ICTAs in different provinces of Iran was very divergent. The highest incidence of fatal ICTAs was in Semnan province (IR= 35.2), followed by North Khorasan (IR=22.7), and South Khorasan (IR=22). The least incidence of fatal ICTAs was in Tehran province (IR=2.4) followed by Khozestan (IR=6.5), and Eastern Azarbayejan (IR=6.6). The compensation cost of fatal ICTAs also showed an increasing trend during the studied period. Since an increasing amount of money was being paid yearly for the car accidents, which were in their nature preventable, the key players in road safety including governments, car manufacturers, and road developers were recommended to use GIS based accident data for a more efficient planning and budgeting towards the intercity car accidents reduction.

Deconstructing multivariate decoding for the study of brain function.

PubMed

Hebart, Martin N; Baker, Chris I

2017-08-04

Multivariate decoding methods were developed originally as tools to enable accurate predictions in real-world applications. The realization that these methods can also be employed to study brain function has led to their widespread adoption in the neurosciences. However, prior to the rise of multivariate decoding, the study of brain function was firmly embedded in a statistical philosophy grounded on univariate methods of data analysis. In this way, multivariate decoding for brain interpretation grew out of two established frameworks: multivariate decoding for predictions in real-world applications, and classical univariate analysis based on the study and interpretation of brain activation. We argue that this led to two confusions, one reflecting a mixture of multivariate decoding for prediction or interpretation, and the other a mixture of the conceptual and statistical philosophies underlying multivariate decoding and classical univariate analysis. Here we attempt to systematically disambiguate multivariate decoding for the study of brain function from the frameworks it grew out of. After elaborating these confusions and their consequences, we describe six, often unappreciated, differences between classical univariate analysis and multivariate decoding. We then focus on how the common interpretation of what is signal and noise changes in multivariate decoding. Finally, we use four examples to illustrate where these confusions may impact the interpretation of neuroimaging data. We conclude with a discussion of potential strategies to help resolve these confusions in interpreting multivariate decoding results, including the potential departure from multivariate decoding methods for the study of brain function. Copyright © 2017. Published by Elsevier Inc.

Noise as an explanatory factor in work-related fatality reports

PubMed Central

Deshaies, Pierre; Martin, Richard; Belzile, Danny; Fortier, Pauline; Laroche, Chantal; Leroux, Tony; Nélisse, Hugues; Girard, Serge-André; Arcand, Robert; Poulin, Maurice; Picard, Michel

2015-01-01

Noise exposure in the workplace is a common reality in Québec, Canada as it is elsewhere. However, the extent to which noise acts as a causal or contributive factor in industrial work-related accidents has not been studied thoroughly despite its plausibility. This article aims to describe the importance or potential importance, during investigations looking into the specific causes of each work-related fatal accident, of noise as an explanatory factor. The written information contained in the accident reports pertaining to contextual and technical elements were used. The study used multiple case qualitative content analysis. This descriptive study was based on the content analysis of the 788 reports from the Commission de la santé et de la sécurité du travail du Québec [Workers’ Compensation Board (WCB)] investigating the fatal work-related accidents between 1990 and 2005. The study was descriptive (number and percentages). Noise was explicitly stated as one of the explanatory factors for the fatal outcome in 2.2% (17/788) of the fatal accidents, particularly when the work involved vehicular movement or the need to communicate between workers. Noise was not typically considered a unique cause in the accident, notably because the investigators considered that the accident would have probably occurred due to other risk factors (for example, disregard of safety rules, shortcomings in work methods, and inadequate training). Noise is an important risk factor when communication is involved in work. Since noise is ubiquitous and may also interfere with vigilance and other risk factors for accidents, it may be a much more important contributing factor to accidents than is currently recognized. PMID:26356371

Noise as an explanatory factor in work-related fatality reports.

PubMed

Deshaies, Pierre; Martin, Richard; Belzile, Danny; Fortier, Pauline; Laroche, Chantal; Leroux, Tony; Nélisse, Hugues; Girard, Serge-André; Arcand, Robert; Poulin, Maurice; Picard, Michel

2015-01-01

Noise exposure in the workplace is a common reality in Québec, Canada as it is elsewhere. However, the extent to which noise acts as a causal or contributive factor in industrial work-related accidents has not been studied thoroughly despite its plausibility. This article aims to describe the importance or potential importance, during investigations looking into the specific causes of each work-related fatal accident, of noise as an explanatory factor. The written information contained in the accident reports pertaining to contextual and technical elements were used. The study used multiple case qualitative content analysis. This descriptive study was based on the content analysis of the 788 reports from the Commission de la santé et de la sécurité du travail du Québec [Workers' Compensation Board (WCB)] investigating the fatal work-related accidents between 1990 and 2005. The study was descriptive (number and percentages). Noise was explicitly stated as one of the explanatory factors for the fatal outcome in 2.2% (17/788) of the fatal accidents, particularly when the work involved vehicular movement or the need to communicate between workers. Noise was not typically considered a unique cause in the accident, notably because the investigators considered that the accident would have probably occurred due to other risk factors (for example, disregard of safety rules, shortcomings in work methods, and inadequate training). Noise is an important risk factor when communication is involved in work. Since noise is ubiquitous and may also interfere with vigilance and other risk factors for accidents, it may be a much more important contributing factor to accidents than is currently recognized.

Differences in combinations and concentrations of drugs of abuse in fatal intoxication and driving under the influence cases.

PubMed

Edvardsen, Hilde Erøy; Tverborgvik, Torill; Frost, Joachim; Rogde, Sidsel; Morild, Inge; Waal, Helge; Clausen, Thomas; Slørdal, Lars; Vindenes, Vigdis

2017-12-01

In toxicology, international classification systems focus on single intoxicants as the cause of death. It is, however, well known that very few drug related deaths are caused by a single substance and that information concerning the drug concentrations as well as the combinations of drugs are essential in order to ascertain the cause of death. The aim of the study was to assess whether those prone to fatal intoxications differ significantly from chronic drug users - in terms of demographics and drug exposure patterns. Fatal psychoactive drug intoxications in Norway during 2012, where a forensic autopsy including toxicological analysis were performed, were included. Analytical findings in blood were compared with concentrations in blood from apprehended drivers under the influence of drugs and ethanol (DUID) during the same time period. The opioid and benzodiazepine concentrations were assessed as morphine and diazepam equivalents, respectively, in order to compare concentrations across the different groups. A total of 194 autopsy cases and 4811 DUID cases were included. Opioids were detected in around 90% of the drug intoxication cases, but in only 16% of the DUID cases. The number of substances detected in fatal intoxications was 4.9 compared to 2.6 in the DUID cases. The total opioid concentrations were significantly higher in the fatal intoxication cases compared to DUID cases (229ng/mL versus 56.9ng/mL morphine equivalents, respectively). Benzodiazepines were detected in 90% of the fatal cases. Only one fatal opioid mono-intoxication was found; a case with a very high methadone concentration (1238ng/mL). Mono-intoxication with heroin was not seen in any of the fatal intoxications in Norway, and single drug intoxications were rare (1.5%). Fatal intoxications were caused by a combination of drugs with significantly more substances as well as higher total drug concentrations among the fatal cases compared to the DUID cases. The combination of opioids and benzodiazepines seemed to represent an increased risk of death. The total load of drugs influence the degree of intoxication and the total concentration level must be considered, including the total number of substances. Our findings imply that international statistics regarding an opioid being the main intoxicant should have a shift in focus towards combinations of drugs (especially opioids and benzodiazepines) as a major risk factor for fatal drug overdoses. Copyright © 2017 Elsevier B.V. All rights reserved.

Multivariate meta-analysis: Potential and promise

PubMed Central

Jackson, Dan; Riley, Richard; White, Ian R

2011-01-01

The multivariate random effects model is a generalization of the standard univariate model. Multivariate meta-analysis is becoming more commonly used and the techniques and related computer software, although continually under development, are now in place. In order to raise awareness of the multivariate methods, and discuss their advantages and disadvantages, we organized a one day ‘Multivariate meta-analysis’ event at the Royal Statistical Society. In addition to disseminating the most recent developments, we also received an abundance of comments, concerns, insights, critiques and encouragement. This article provides a balanced account of the day's discourse. By giving others the opportunity to respond to our assessment, we hope to ensure that the various view points and opinions are aired before multivariate meta-analysis simply becomes another widely used de facto method without any proper consideration of it by the medical statistics community. We describe the areas of application that multivariate meta-analysis has found, the methods available, the difficulties typically encountered and the arguments for and against the multivariate methods, using four representative but contrasting examples. We conclude that the multivariate methods can be useful, and in particular can provide estimates with better statistical properties, but also that these benefits come at the price of making more assumptions which do not result in better inference in every case. Although there is evidence that multivariate meta-analysis has considerable potential, it must be even more carefully applied than its univariate counterpart in practice. Copyright © 2011 John Wiley & Sons, Ltd. PMID:21268052

The political ecology of disaster: an analysis of factors influencing U.S. tornado fatalities and injuries, 1998-2000.

PubMed

Donner, William R

2007-08-01

This study examines casualties from tornadoes in the United States between the years 1998 and 2000. A political model of human ecology (POET) was used to explore how the environment, technology, and social inequality influence rates of fatalities and injuries in two models. Data were drawn from four sources: John Hart's Severe Plot v2.0, National Weather Service (NWS) Warning Verification data, Storm Prediction Center (SPC) watch data, and tract-level census data. Negative binomial regression was used to analyze the causes of tornado fatalities and injuries. Independent variables (following POET) are classified in the following manner: population, organization, environment, and technology. Rural population, population density, and household size correspond to population; racial minorities and deprivation represent social organization; tornado area represents environment; and tornado watches and warnings, as well as mobile homes, correspond to technology. Findings suggest a strong relationship between the size of a tornado path and both fatalities and injuries, whereas other measures related to technology, population, and organization produce significant yet mixed results. Census tracts having larger populations of rural residents was, of the nonenvironmental factors, the most conclusive regarding its effects across the two models. The outcomes of analysis, although not entirely supportive of the model presented in this study, suggest to some degree that demographic and social factors play a role in vulnerability to tornadoes.

Fatal falls involving stairs: an anthropological analysis of skeletal trauma.

PubMed

Rowbotham, Samantha K; Blau, Soren; Hislop-Jambrich, Jacqueline; Francis, Victoria

2018-06-01

The skeletal blunt force trauma resulting from fatal falls involving stairs is complex. There are countless ways an individual may fall when stairs are involved, and thus a variety of ways the skeleton may fracture. Therefore anecdotally, it may be said that there is no specific skeletal trauma characteristic of this fall type. In order to scientifically investigate this anecdotal understanding, this study provides a detailed investigation of the skeletal fracture patterns and morphologies resulting from fatal falls involving stairs. Skeletal trauma was analyzed using the full-body postmortem computed tomography scans of 57 individuals who died from a fall involving stairs. Trauma was examined in the context of the variables that potentially influence how an individual falls (i.e. sex, age, body mass index, number of stairs involved, psychoactive drugs, pre-existing conditions, landing surface and manner of the fall) using logistic regression. Skeletal trauma primarily occurred in the axial skeleton. An analysis of fracture patterns showed the cranial base was less likely to fracture in younger individuals and the cervical vertebrae were more likely to fracture in falls that involved more than half a flight of stairs. A total of 56 fracture morphologies were identified. Of these, diastatic fractures were less likely to occur in older individuals. Findings indicate that there are skeletal fracture patterns and morphologies characteristic of a fatal fall involving stairs.

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities

PubMed Central

Karb, Rebecca A.; Subramanian, S. V.; Fleegler, Eric W.

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999–2012. Complete annual compressed mortality and population data for 1999–2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty. PMID:27144919

Opisthorchis viverrini infections and associated risk factors in a lowland area of Binh Dinh Province, Central Vietnam.

PubMed

Dao, Thanh Thi Ha; Bui, Tuan Van; Abatih, Emmanuel Nji; Gabriël, Sarah; Nguyen, Thanh Thi Giang; Huynh, Quang Hong; Nguyen, Chuong Van; Dorny, Pierre

2016-05-01

Opisthorchiasis caused by Opisthorchis viverrini is a major public health problem in the Mekong Basin in South East Asia. It is associated with cholangiocarcinoma, a fatal cancer of the bile duct, which is very common in some areas of Thailand and Lao PDR. Although there is evidence of opisthorchiasis in the central and Southern provinces of Vietnam, data are scarce and Vietnam is often not considered an opisthorchiasis endemic area in the international literature. We conducted a cross-sectional survey in June 2015 in a lowland rural area of Binh Dinh Province in Central Vietnam to investigate the apparent prevalence of O. viverrini infection in the population and the associated risk factors. A total of 254 stool samples were collected and examined by the Kato Katz method. Consenting people shedding Opisthorchis-like eggs with their stools were treated with praziquantel and MgSO4 and adult worms were collected from stools for morphological and molecular identifications. Risk factors were studied with a structured questionnaire and the association with infection was evaluated by univariate and multivariate Firth's logistic regression analysis. The apparent prevalence in the investigated population determined by stool examination was 11.4% (CI: 8-16%). Infection with O. viverrini was confirmed in all 11 individuals consenting to receive praziquantel treatment and subsequent worm recovery from stools. The mean number of worms recovered after treatment/purgation was 14.5 (range 2-44). Male gender and the consumption of dishes prepared from raw small wild-caught freshwater fish (Carassius auratus) were found to be significant risk factors associated with opisthorchiasis in the area. These findings confirm the presence of O. viverrini infection in Central Vietnam related to the consumption of raw fish dishes. Awareness campaigns and control programs should be implemented in the region to combat this potentially fatal fluke infection. Copyright © 2016 Elsevier B.V. All rights reserved.

A score including ADAM17 substrates correlates to recurring cardiovascular event in subjects with atherosclerosis.

PubMed

Rizza, Stefano; Copetti, Massimiliano; Cardellini, Marina; Menghini, Rossella; Pecchioli, Chiara; Luzi, Alessio; Di Cola, Giovanni; Porzio, Ottavia; Ippoliti, Arnaldo; Romeo, Franco; Pellegrini, Fabio; Federici, Massimo

2015-04-01

Atherosclerosis disease is a leading cause for mortality and morbidity. The narrowing/rupture of a vulnerable atherosclerotic plaque is accountable for acute cardiovascular events. However, despite of an intensive research, a reliable clinical method which may disclose a vulnerable patient is still unavailable. We tested the association of ADAM17 (A Disintegrin and Metallo Protease Domain 17) circulating substrates (sICAM-1, sVCAM-1, sIL6R and sTNFR1) with a second major cardiovascular events [MACEs] (cardiovascular death, peripheral artery surgeries, non-fatal myocardial infarction and non-fatal stroke) in 298 patients belonging to the Vascular Diabetes (AVD) study. To evaluate ADAM17 activity we create ADAM17 score through a RECPAM model. Finally we tested the discrimination ability and the reclassification of clinical models. At follow-up (mean 47 months, range 1-118 months), 55 MACEs occurred (14 nonfatal MI, 14 nonfatal strokes, 17 peripheral artery procedures and 10 cardiovascular deaths) (incidence = 7.8% person-years). An increased risk for incident events was observed among the high ADAM17 score individuals both in univariable (HR 19.20, 95% CI 15.82-63.36, p < 0.001) and multivariable analysis (HR 3.42, 95% CI 1.55-7.54, p < 0.001). Finally we found that ADAM17 score significantly increases the prediction accuracy of the Framingham Recurring-Coronary-Heart-Disease-Score, with a significant improvement in discrimination (integrated discrimination improvement = 9%, p = 0.012) and correctly reclassifying 10% of events and 41% of non-events resulting in a cNRI = 0.51 (p = 0.005). We demonstrated a positive role of ADAM17 activity to predicting CV events. We think that an approach that targets strategies beyond classic cardiovascular risk factors control is necessary in individuals with an established vascular atherosclerosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Pneumococcal vaccination programs and the burden of invasive pneumococcal disease in Ontario, Canada, 1995-2011.

PubMed

Rudnick, Wallis; Liu, Zhong; Shigayeva, Altynay; Low, Donald E; Green, Karen; Plevneshi, Agron; Devlin, Roslyn; Downey, James; Katz, Kevin; Kitai, Ian; Krajden, Sigmund; Ostrowska, Krystyna; Richardson, David; Richardson, Susan; Sarabia, Alicia; Silverman, Michael; Simor, Andrew E; Tyrrell, Gregory; McGeer, Allison

2013-12-02

In 1995, a publicly funded pneumococcal vaccination program for 23-valent polysaccharide vaccine (PPV23) was introduced in Ontario. Conjugate vaccines were authorized in 2001 (PCV7), 2009 (PCV10) and 2010 (PCV13). From 1995-2011, active, population-based surveillance for invasive pneumococcal disease (IPD) was conducted in Metropolitan Toronto and Peel Region, Canada. 6404 IPD cases were included. After PPV23 program implementation in 1995, IPD due to PPV23 strains decreased 49% in older adults prior to PCV7 introduction. Estimated PPV23 efficacy in vaccine eligible adults was 42.2% (95% CI; 28.6-53.2%). IPD incidence due to PCV7 serotypes in children <5 years decreased significantly after PCV7 authorization and before introduction of a publicly funded PCV7 program. Seven years after PCV7 program implementation, the incidence of IPD due to PCV7 serotypes decreased to zero in children and by 88% in adults, however, overall IPD incidence remained unchanged in adults. In 2011, the incidence of IPD was 4.5 per 100,000 in adults aged 15-64 and 19.9 per 100,000 in adults aged over 65 years, with 45 serotypes causing disease. Between 1995 and 2011, the case fatality rate of IPD in adults decreased 2% per year (95% CI, -0.9% to -3.2%). In multivariable analysis, predictors of mortality included older age, chronic conditions, nursing home residence, current smoking, bacteraemia, and illness due to serotypes 3,11A, 19A, and 19F. While vaccination programs resulted in substantial public health benefits, herd immunity benefits of PCV7 were seen at low pediatric vaccination rates, and the case fatality rate of IPD has decreased, IPD will continue to be a cause of considerable morbidity and mortality in adults. Copyright © 2013. Published by Elsevier Ltd.

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities.

PubMed

Karb, Rebecca A; Subramanian, S V; Fleegler, Eric W

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999-2012. Complete annual compressed mortality and population data for 1999-2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty.

Cardiovascular safety of empagliflozin in patients with type 2 diabetes: a meta-analysis of data from randomized placebo-controlled trials.

PubMed

Salsali, A; Kim, G; Woerle, H J; Broedl, U C; Hantel, S

2016-10-01

To assess the effect of empagliflozin on cardiovascular (CV) risk in patients with type 2 diabetes (T2DM) through a meta-analysis of data from eight placebo-controlled trials. Data were analysed from eight randomized placebo-controlled trials undertaken to investigate the efficacy and safety of empagliflozin 10 and 25 mg once daily in patients with T2DM, comprising patients at low/medium and high CV risk. Suspected CV events were prospectively adjudicated. The empagliflozin 10 and 25 mg groups were pooled for the primary analysis. The primary endpoint was a composite of CV death, non-fatal myocardial infarction (MI), non-fatal stroke and hospitalization for unstable angina [4-point major adverse CV events (MACE)]. The secondary endpoint was a composite of CV death, non-fatal MI and non-fatal stroke (3-point MACE). Risk estimates were calculated using Cox regression analysis. A total of 3835 patients received placebo and 7457 received empagliflozin. Total exposure was 7448.3 years for placebo and 15482.1 years for empagliflozin. Four-point MACE occurred in 365 (9.5%) patients receiving placebo and 635 (8.5%) patients receiving empagliflozin [hazard ratio for empagliflozin vs. placebo 0.86 (95% CI 0.76, 0.98)]. Three-point MACE occurred in 307 (8.0%) patients receiving placebo and 522 (7.0%) patients receiving empagliflozin [hazard ratio for empagliflozin vs. placebo 0.84 (95% CI 0.73, 0.96)]. In a meta-analysis of data from eight randomized trials involving 11 292 patients with T2DM at low/medium or high CV risk, empagliflozin was associated with a reduced risk of 4-point MACE and 3-point MACE compared with placebo. © 2016 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

A comment on "Novel scavenger removal trials increase wind turbine-caused avian fatality estimates"

USGS Publications Warehouse

Huso, Manuela M.P.; Erickson, Wallace P.

2013-01-01

In a recent paper, Smallwood et al. (2010) conducted a study to compare their “novel” approach to conducting carcass removal trials with what they term the “conventional” approach and to evaluate the effects of the different methods on estimated avian fatality at a wind power facility in California. A quick glance at Table 3 that succinctly summarizes their results and provides estimated fatality rates and 80% confidence intervals calculated using the 2 methods reveals a surprising result. The confidence intervals of all of their estimates and most of the conventional estimates extend below 0. These results imply that wind turbines may have the capacity to create live birds. But a more likely interpretation is that a serious error occurred in the calculation of either the average fatality rate or its standard error or both. Further evaluation of their methods reveals that the scientific basis for concluding that “many estimates of scavenger removal rates prior to [their] study were likely biased low due to scavenger swamping” and “previously reported estimates of avian fatality rates … should be adjusted upwards” was not evident in their analysis and results. Their comparison to conventional approaches was not applicable, their statistical models were questionable, and the conclusions they drew were unsupported.

Multivariate Longitudinal Analysis with Bivariate Correlation Test

PubMed Central

Adjakossa, Eric Houngla; Sadissou, Ibrahim; Hounkonnou, Mahouton Norbert; Nuel, Gregory

2016-01-01

In the context of multivariate multilevel data analysis, this paper focuses on the multivariate linear mixed-effects model, including all the correlations between the random effects when the dimensional residual terms are assumed uncorrelated. Using the EM algorithm, we suggest more general expressions of the model’s parameters estimators. These estimators can be used in the framework of the multivariate longitudinal data analysis as well as in the more general context of the analysis of multivariate multilevel data. By using a likelihood ratio test, we test the significance of the correlations between the random effects of two dependent variables of the model, in order to investigate whether or not it is useful to model these dependent variables jointly. Simulation studies are done to assess both the parameter recovery performance of the EM estimators and the power of the test. Using two empirical data sets which are of longitudinal multivariate type and multivariate multilevel type, respectively, the usefulness of the test is illustrated. PMID:27537692

Multivariate Longitudinal Analysis with Bivariate Correlation Test.

PubMed

Adjakossa, Eric Houngla; Sadissou, Ibrahim; Hounkonnou, Mahouton Norbert; Nuel, Gregory

2016-01-01

In the context of multivariate multilevel data analysis, this paper focuses on the multivariate linear mixed-effects model, including all the correlations between the random effects when the dimensional residual terms are assumed uncorrelated. Using the EM algorithm, we suggest more general expressions of the model's parameters estimators. These estimators can be used in the framework of the multivariate longitudinal data analysis as well as in the more general context of the analysis of multivariate multilevel data. By using a likelihood ratio test, we test the significance of the correlations between the random effects of two dependent variables of the model, in order to investigate whether or not it is useful to model these dependent variables jointly. Simulation studies are done to assess both the parameter recovery performance of the EM estimators and the power of the test. Using two empirical data sets which are of longitudinal multivariate type and multivariate multilevel type, respectively, the usefulness of the test is illustrated.

Risk factors of fatal occupational accidents in Iran.

PubMed

Asady, Hadi; Yaseri, Mehdi; Hosseini, Mostafa; Zarif-Yeganeh, Morvarid; Yousefifard, Mahmoud; Haghshenas, Mahin; Hajizadeh-Moghadam, Parisa

2018-01-01

Occupational accidents are of most important consequences of globalization in developing countries. Therefore, investigating the causes of occupational accidents for improving the job situation and making operational policy is necessary. So the aim of this study was to investigate factors affecting the fatal occupational accidents and also calculate the years of life lost for dead workers. This cross-sectional study was conducted on data related to the 6052 injured workers that was registered in the 2013 registry system of the Ministry of Health and Medical Education of Iran. Variables including sex, education, age, job tenure, injury cause, referred location of injured workers, occupation, shift work, season, accident day, damaged part of the body were chosen as independent variables. The Chi-squared and Fisher exact tests were used for univariate analysis and then exact multiple logistic regression was carried out to identify independent risk factors of fatal occupational accidents. Finally, for dead workers, years of life lost, according to the injury causes was calculated. Among the 6052 accidents reported, 33 deaths were recorded. Chi-square and Fisher exact tests showed that factors including: current job tenure ( p  = 0.01), damaged parts of the body ( p  < 0.001) and injury cause ( p  < 0.001) are associated with the fatal accidents. Also exact multiple logistic regression analysis showed a significant association between electric shocks as a cause of injury (OR = 7.04; 95% CI: 1.01-43.74; p  = 0.02) and current job tenure more than 1 year (OR = 0.21; 95% CI: 0.05-0.70; p  = 0.005) with the fatal accidents. The total amount of years of life lost based on causes of injuries was estimated 1289.12 years. In Iran, fatal accident odds in workers with job tenure more than 1 year was less in comparing to the workers with job tenure less and equal to 1 year. Also odd of death for electrical shock was more than other causes of injuries. So it seems that employing of workers who have more than one-year work experience in a specific job and using of appropriate safeguards will be useful for the reducing of fatal occupational accidents.

Analysis of crashes involving 15-passenger vans

DOT National Transportation Integrated Search

2004-05-01

This study explores the relationship between vehicle occupancy and several other variables in the National Highway Traffic Safety Administration's (NHTSA's) Fatality Analysis Reporting System (FARS) database and a 15-passenger van's risk of rollover....

Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study.

PubMed

Lebwohl, Benjamin; Cao, Yin; Zong, Geng; Hu, Frank B; Green, Peter H R; Neugut, Alfred I; Rimm, Eric B; Sampson, Laura; Dougherty, Lauren W; Giovannucci, Edward; Willett, Walter C; Sun, Qi; Chan, Andrew T

2017-05-02

Objective  To examine the association of long term intake of gluten with the development of incident coronary heart disease. Design  Prospective cohort study. Setting and participants  64 714 women in the Nurses' Health Study and 45 303 men in the Health Professionals Follow-up Study without a history of coronary heart disease who completed a 131 item semiquantitative food frequency questionnaire in 1986 that was updated every four years through 2010. Exposure  Consumption of gluten, estimated from food frequency questionnaires. Main outcome measure  Development of coronary heart disease (fatal or non-fatal myocardial infarction). Results  During 26 years of follow-up encompassing 2 273 931 person years, 2431 women and 4098 men developed coronary heart disease. Compared with participants in the lowest fifth of gluten intake, who had a coronary heart disease incidence rate of 352 per 100 000 person years, those in the highest fifth had a rate of 277 events per 100 000 person years, leading to an unadjusted rate difference of 75 (95% confidence interval 51 to 98) fewer cases of coronary heart disease per 100 000 person years. After adjustment for known risk factors, participants in the highest fifth of estimated gluten intake had a multivariable hazard ratio for coronary heart disease of 0.95 (95% confidence interval 0.88 to 1.02; P for trend=0.29). After additional adjustment for intake of whole grains (leaving the remaining variance of gluten corresponding to refined grains), the multivariate hazard ratio was 1.00 (0.92 to 1.09; P for trend=0.77). In contrast, after additional adjustment for intake of refined grains (leaving the variance of gluten intake correlating with whole grain intake), estimated gluten consumption was associated with a lower risk of coronary heart disease (multivariate hazard ratio 0.85, 0.77 to 0.93; P for trend=0.002). Conclusion  Long term dietary intake of gluten was not associated with risk of coronary heart disease. However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Multivariate Regression Analysis and Slaughter Livestock,

DTIC Science & Technology

AGRICULTURE, *ECONOMICS), (*MEAT, PRODUCTION), MULTIVARIATE ANALYSIS, REGRESSION ANALYSIS , ANIMALS, WEIGHT, COSTS, PREDICTIONS, STABILITY, MATHEMATICAL MODELS, STORAGE, BEEF, PORK, FOOD, STATISTICAL DATA, ACCURACY

Impact of the effect of economic crisis and the targeted motorcycle safety programme on motorcycle-related accidents, injuries and fatalities in Malaysia.

PubMed

Law, T H; Umar, R S Radin; Zulkaurnain, S; Kulanthayan, S

2005-03-01

In 1997, a Motorcycle Safety Programme (MSP) was introduced to address the motorcycle-related accident problem. The MSP was specifically targeted at motorcyclists. In addition to the MSP, the recent economic recession has significantly contributed to a reduction of traffic-related incidents. This paper examines the effects of the recent economic crisis and the MSP on motorcycle-related accidents, casualties and fatalities in Malaysia. The autocorrelation integrated moving average model with transfer function was used to evaluate the overall effects of the interventions. The variables used in developing the model were gross domestic product and MSPs. The analysis found a 25% reduction in the number of motorcycle-related accidents, a 27% reduction in motorcycle casualties and a 38% reduction in motorcycle fatalities after the implementation of MSP. Findings indicate that the MSP has been one of the effective measures in reducing motorcycle safety problems in Malaysia. Apart from that, the performance of the country's economy was also found to be significant in explaining the number of motorcycle-related accidents, casualties and fatalities in Malaysia.

Mortuary operations following mass fatality natural disasters: a review.

PubMed

Anderson, Madelyn; Leditschke, Jodie; Bassed, Richard; Cordner, Stephen M; Drummer, Olaf H

2017-03-01

This is a critical review to discuss the best practice approaches to mortuary operations in preparation for and the response to natural, mass fatality, disaster events, as identified by a review of published articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) Statement guided the identification of potential articles to use in this critical review. Subsequent searches were also conducted to identify articles relating to heat wave, and flood mortality. All identified peer-reviewed studies published in English which discussed the preparation and response of mortuaries to mass fatality natural disasters occurring in developed countries were included. Using the PRISMA-P method of identifying articles, 18 articles were selected for inclusion in this review. Although there are numerous articles which describe the mortuary response to mass fatality incidents, few articles analyzed the response, or discussed the roles which supported and enabled the organization to undertake the task of identifying disaster victims. It is thus difficult to determine objectively if the actions and activities outlined in the articles represent best-practice.

Teens and Spice: A Review of Adolescent Fatalities Associated with Synthetic Cannabinoid Use.

PubMed

Paul, Anthea B Mahesan; Simms, Lary; Amini, Saeideh; Paul, Abraham Ebenezer

2017-12-01

Synthetic cannabinoids (SCs) are commonly abused by adolescents with reported past year (2013) use in high school students between 3 and 10%. Standard adolescent postmortem toxicology does not include routine SC analysis, and thus, the true burden of fatalities related to SCs is unknown. A retrospective case review of two cases included scene investigation, interviews, autopsy, and toxicology. SCs were confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Review of the eight adolescent SC-associated fatalities in the literature revealed five of eight cases had no other discernible cause of death on autopsy. Compounds detected included PB-22 (1.1 ng/mL), JWH-210 (12 ng/mL), XLR-11 (1.3 ng/mL), JWH-122, AB-CHMINACA (8.2 ng/mL), UR-144 (12.3 ng/mL), and JWH-022 (3 ng/mL). With synthetic drug use on the rise, forensic experts should have a high index of suspicion for the possibility of SC intoxication in adolescent fatalities with no other discernible cause of death. © 2017 American Academy of Forensic Sciences.

[Occupational injury in foreign workers by economic activity and autonomous community (Spain 2005)].

PubMed

López-Jacob, Ma José; Ahonen, Emily; García, Ana M; Gil, Angel; Benavides, Fernando G

2008-01-01

While the immigrant collective in Spain has grown considerably in recent years, little is known about working conditions and their corresponding effects on occupational injury in this group. The objective of this study was to compare the incidences for both fatal and non-fatal injuries in foreign workers to that of Spanish workers in 2005, by autonomous community and economic activity. injury data came from the accident registry of the ministry of labor and social issues, and denominators were taken from available social security affiliation statistics from general and coal mining social security system. Incidence indices for fatal and non-fatal occupational injuries for foreign and spanish workers were calculated. In addition, relative risks and their 95% confidence intervals (95% CI) were calculated by autonomous community and economic activity, using spanish workers as the reference group. Overall, relative risk for occupational injury in foreign workers in 2005 was superior to base risk for both fatal (1.34; 95% CI: 1.11-1.62) and non-fatal injury (1.13; 95% CI: 1.13-1.14), though there were important differences by autonomous community and activity sectors. Compared with Spanish workers, risk for occupational injury was higher for foreign workers in industrial activities, while it was lower in construction, commerce and restaurants and hotels. By autonomous community, Aragón and Catalonia showed the highest risks for foreign workers. A higher risk for occupational injury among foreign workers is confirmed, and may be higher than that observed. The differences in risk among economic activities and autonomous communities require more detailed analysis.

Are 1994 alcohol production and the sales deregulation policy in Japan associated with increased road traffic fatalities among adult and teenage males and females in Japan?

PubMed

Desapriya, Ediriweera; Fujiwara, Takeo; Scime, Giulia; Sasges, Deborah; Pike, Ian; Shimizu, Shinji

2009-10-01

International studies have shown a significant association between alcohol availability and traffic crashes that involve alcohol-impaired drivers. A key limitation to previous alcohol availability and motor vehicle crash (MVC) evaluation research is the assumption of population homogeneity in responding to the policies. The present analysis focuses on the evaluation of the impact of alcohol availability on different segments of the Japanese population by comparing MVC fatality rates from before and after implementation of the alcohol deregulation policy in 1994. Poisson regression with robust standard error was used to model the before-to-after change in incidence rate ratios (IRR) in adult males, adult females, teenage males and teenage females. To control potential confounders, unemployment rate, vehicle miles of travel (VMT), vehicle registration, and number of drivers licensed in Japan were added to the model. The exponents of the fitted coefficients are equivalent to incidence rate ratios. Implementation of the policy deregulating alcohol sales and production did not appear to increase traffic fatalities among adult or teenage males or females in Japan. We found that male adult fatalities demonstrated a statistically significant decline following enactment of the deregulation policy in 1994. Contrary to previous research, the findings of this study demonstrated lower rates of fatalities and higher compliance with alcohol-related driving legislation in Japanese society following implementation of the deregulation policy in 1994. Further well designed, nonaligned studies on alcohol availability and traffic fatalities in other countries are urgently needed.

Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado*

PubMed Central

Salomonsen-Sautel, Stacy; Min, Sung-Joon; Sakai, Joseph T.; Thurstone, Christian; Hopfer, Christian

2014-01-01

Background Legal medical marijuana has been commercially available on a widespread basis in Colorado since mid-2009; however, there is a dearth of information about the impact of marijuana commercialization on impaired driving. This study examined if the proportions of drivers in a fatal motor vehicle crash who were marijuana-positive and alcohol-impaired, respectively, have changed in Colorado before and after mid-2009 and then compared changes in Colorado with 34 non-medical marijuana states (NMMS). Methods Thirty-six 6-month intervals (1994–2011) from the Fatality Analysis Reporting System were used to examine temporal changes in the proportions of drivers in a fatal motor vehicle crash who were alcohol-impaired (≥ 0.08 g/dl) and marijuana-positive, respectively. The pre-commercial marijuana time period in Colorado was defined as 1994–June 2009 while July 2009–2011 represented the post-commercialization period. Results In Colorado, since mid-2009 when medical marijuana became commercially available and prevalent, the trend became positive in the proportion of drivers in a fatal motor vehicle crash who were marijuana-positive (change in trend, 2.16 (0.45), p < 0.0001); in contrast, no significant changes were seen in NMMS. For both Colorado and NMMS, no significant changes were seen in the proportion of drivers in a fatal motor vehicle crash who were alcohol-impaired. Conclusions Prevention efforts and policy changes in Colorado are needed to address this concerning trend in marijuana-positive drivers. In addition, education on the risks of marijuana-positive driving needs to be implemented. PMID:24831752

Modeling the impact of rescinding Michigan's primary and secondary seat belt laws on death and injury from passenger vehicle crashes.

PubMed

Carter, Patrick M; Flannagan, Carol A C; Bingham, C Raymond; Cunningham, Rebecca M; Rupp, Jonathan D

2014-01-01

Seat belts are the most effective method of decreasing fatal and nonfatal motor vehicle crash injury. Advocacy groups have recently been successful in enacting repeals of mandatory motorcycle helmet laws in several states. In some states, this has prompted renewed efforts aimed at repealing mandatory seat belt laws. To evaluate and quantify the potential impact of rescinding seat belt laws on annual crash-related fatalities, nonfatal injuries, and associated economic costs, using Michigan as a model, to inform the national debate. Proportional injury rates were calculated utilizing police-reported statewide passenger vehicle crash data from 1999 and 2002, where belt use rates approximate estimates associated with repeal of primary and secondary seat belt laws. Proportional rates were applied to the most recent year of crash data (2011) to estimate changes in statewide fatalities and nonfatal injuries. National cost estimates were applied to injury data to calculate associated economic costs. Full repeal of the seat belt law is estimated to result in an additional 163 fatalities, 13,722 nonfatal injuries, and an associated societal cost of $1.6 billion annually. Repeal of the primary seat belt law only is estimated to result in an additional 95 fatalities, 9156 nonfatal injuries, and an associated societal cost of $1.0 billion annually. This analysis suggests that repealing the either the primary or full seat belt law would have a substantial and negative impact on public health, increasing motor vehicle crash related fatality, nonfatal injury, and associated economic costs.

The dynamic nature of risk perceptions after a fatal transit accident.

PubMed

Wernstedt, Kris; Murray-Tuite, Pamela

2015-03-01

In 2009, two trains of Washington, DC's Metrorail system collided, resulting in nine deaths and 50 serious injuries. Based on a multiwave survey of Metrorail users in the months after the crash, this article reports how the accident appears to have (1) changed over time the tradeoffs among safety, speed, frequency of service, cost, and reliability that the transit users stated they were willing to make in the postaccident period and (2) altered transit users' concerns about safety as a function of time and distance from the accident site. We employ conditional logit models to examine tradeoffs among stated preferences for system performance measures after the accident, as well as the influence that respondent characteristics of transit use, location, income, age, and gender have on these preference tradeoffs. As expected, respondents appear averse to longer headways between trains, longer travel durations, higher travel costs, a higher number of late trains, and a higher number of fatalities. The models also show evidence of higher aversion to fatalities from transit system operation among females compared to males. In addition, respondents less experienced with Metrorail travel and those with lower household incomes show higher aversion to fatalities, and this aversion increases as a subject's psychological distance from the accident site decreases. Contrary to expectations shaped by previous studies, aversion to fatalities appears to have increased between the early months after the accident and the end of the survey period, and the expected relationship between age and aversion to fatalities is not statistically significant. © 2014 Society for Risk Analysis.

What are the differences in injury patterns of young and elderly traffic accident fatalities considering death on scene and death in hospital?

PubMed

Heinrich, Daniela; Holzmann, Christopher; Wagner, Anja; Fischer, Anja; Pfeifer, Roman; Graw, Matthias; Schick, Sylvia

2017-07-01

Older traffic participants have higher risks of injury than the population up to 65 years in case of comparable road traffic accidents and further, higher mortality rates at comparable injury severities. Rib fractures as risk factors are currently discussed. However, death on scene is associated with hardly survivable injuries and might not be a matter of neither rib fractures nor age. As 60% of traffic accident fatalities are estimated to die on scene, they are not captured in hospital-based trauma registries and injury patterns remain unknown. Our database comprises 309 road traffic fatalities, autopsied at the Institute of Legal Medicine Munich in 2004 and 2005. Injuries are coded according to Abbreviated Injury Scale, AIS© 2005 update 2008 [1]. Data used for this analysis are age, sex, site of death, site of accident, traffic participation mode, measures of injury severity, and rib fractures. The injury patterns of elderly, aged 65+ years, are compared to the younger ones divided by their site of death. Elderly with death on scene more often show serious thorax injuries and pelvic fractures than the younger. Some hints point towards older fatalities showing less frequently serious abdominal injuries. In hospital, elderly fatalities show lower Injury Severity Scores (ISSs) compared to the younger. The number of rib fractures is significantly higher for the elderly but is not the reason for death. Results show that young and old fatalities have different injury patterns and reveal first hints towards the need to analyze death on scene more in-depth.

Risk assessment of the fatality due to explosion in land mass transport infrastructure by fast transient dynamic analysis.

PubMed

Giannopoulos, G; Larcher, M; Casadei, F; Solomos, G

2010-01-15

Terrorist attacks in New York have shocked the world community showing clearly the vulnerability of air transport in such events. However, the terrorist attacks in Madrid and London showed that land mass transport infrastructure is equally vulnerable in case of similar attacks. The fact that there has not been substantial investment in the domain of risk analysis and evaluation of the possible effects due to such events in land mass transportation infrastructure leaves large room for new developments that could eventually fill this gap. In the present work using the finite element code EUROPLEXUS there has been a large effort to perform a complete study of the land mass infrastructure in case of explosion events. This study includes a train station, a metro station and a metro carriage providing thus valuable simulation data for a variety of different situations. For the analysis of these structures it has been necessary to apply a laser scanning method for the acquisition of geometrical data, to improve the simulation capabilities of EUROPLEXUS by adding failure capabilities for specific finite elements, to implement new material models (e.g. glass), and to add new modules that achieve data post-processing for the calculation of fatal and non-fatal injuries risk. The aforementioned improvements are explained in the present work with emphasis in the newly developed risk analysis features of EUROPLEXUS.

How severe and prevalent are Ebola and Marburg viruses? A systematic review and meta-analysis of the case fatality rates and seroprevalence.

PubMed

Nyakarahuka, Luke; Kankya, Clovice; Krontveit, Randi; Mayer, Benjamin; Mwiine, Frank N; Lutwama, Julius; Skjerve, Eystein

2016-11-25

Ebola and Marburg virus diseases are said to occur at a low prevalence, but are very severe diseases with high lethalities. The fatality rates reported in different outbreaks ranged from 24-100%. In addition, sero-surveys conducted have shown different seropositivity for both Ebola and Marburg viruses. We aimed to use a meta-analysis approach to estimate the case fatality and seroprevalence rates of these filoviruses, providing vital information for epidemic response and preparedness in countries affected by these diseases. Published literature was retrieved through a search of databases. Articles were included if they reported number of deaths, cases, and seropositivity. We further cross-referenced with ministries of health, WHO and CDC databases. The effect size was proportion represented by case fatality rate (CFR) and seroprevalence. Analysis was done using the metaprop command in STATA. The weighted average CFR of Ebola virus disease was estimated to be 65.0% [95% CI (54.0-76.0%), I 2  = 97.98%] whereas that of Marburg virus disease was 53.8% (26.5-80.0%, I 2  = 88.6%). The overall seroprevalence of Ebola virus was 8.0% (5.0%-11.0%, I 2  = 98.7%), whereas that for Marburg virus was 1.2% (0.5-2.0%, I 2  = 94.8%). The most severe species of ebolavirus was Zaire ebolavirus while Bundibugyo Ebolavirus was the least severe. The pooled CFR and seroprevalence for Ebola and Marburg viruses were found to be lower than usually reported, with species differences despite high heterogeneity between studies. Countries with an improved health surveillance and epidemic response have lower CFR, thereby indicating need for improving early detection and epidemic response in filovirus outbreaks.

Analysis of recreational closed-circuit rebreather deaths 1998-2010.

PubMed

Fock, Andrew W

2013-06-01

Since the introduction of recreational closed-circuit rebreathers (CCRs) in 1998, there have been many recorded deaths. Rebreather deaths have been quoted to be as high as 1 in 100 users. Rebreather fatalities between 1998 and 2010 were extracted from the Deeplife rebreather mortality database, and inaccuracies were corrected where known. Rebreather absolute numbers were derived from industry discussions and training agency statistics. Relative numbers and brands were extracted from the Rebreather World website database and a Dutch rebreather survey. Mortality was compared with data from other databases. A fault-tree analysis of rebreathers was compared to that of open-circuit scuba of various configurations. Finally, a risk analysis was applied to the mortality database. The 181 recorded recreational rebreather deaths occurred at about 10 times the rate of deaths amongst open-circuit recreational scuba divers. No particular brand or type of rebreather was over-represented. Closed-circuit rebreathers have a 25-fold increased risk of component failure compared to a manifolded twin-cylinder open-circuit system. This risk can be offset by carrying a redundant 'bailout' system. Two-thirds of fatal dives were associated with a high-risk dive or high-risk behaviour. There are multiple points in the human-machine interface (HMI) during the use of rebreathers that can result in errors that may lead to a fatality. While rebreathers have an intrinsically higher risk of mechanical failure as a result of their complexity, this can be offset by good design incorporating redundancy and by carrying adequate 'bailout' or alternative gas sources for decompression in the event of a failure. Designs that minimize the chances of HMI errors and training that highlights this area may help to minimize fatalities.

Multivariate calibration in Laser-Induced Breakdown Spectroscopy quantitative analysis: The dangers of a 'black box' approach and how to avoid them

NASA Astrophysics Data System (ADS)

Safi, A.; Campanella, B.; Grifoni, E.; Legnaioli, S.; Lorenzetti, G.; Pagnotta, S.; Poggialini, F.; Ripoll-Seguer, L.; Hidalgo, M.; Palleschi, V.

2018-06-01

The introduction of multivariate calibration curve approach in Laser-Induced Breakdown Spectroscopy (LIBS) quantitative analysis has led to a general improvement of the LIBS analytical performances, since a multivariate approach allows to exploit the redundancy of elemental information that are typically present in a LIBS spectrum. Software packages implementing multivariate methods are available in the most diffused commercial and open source analytical programs; in most of the cases, the multivariate algorithms are robust against noise and operate in unsupervised mode. The reverse of the coin of the availability and ease of use of such packages is the (perceived) difficulty in assessing the reliability of the results obtained which often leads to the consideration of the multivariate algorithms as 'black boxes' whose inner mechanism is supposed to remain hidden to the user. In this paper, we will discuss the dangers of a 'black box' approach in LIBS multivariate analysis, and will discuss how to overcome them using the chemical-physical knowledge that is at the base of any LIBS quantitative analysis.

Linear regression analysis and its application to multivariate chromatographic calibration for the quantitative analysis of two-component mixtures.

PubMed

Dinç, Erdal; Ozdemir, Abdil

2005-01-01

Multivariate chromatographic calibration technique was developed for the quantitative analysis of binary mixtures enalapril maleate (EA) and hydrochlorothiazide (HCT) in tablets in the presence of losartan potassium (LST). The mathematical algorithm of multivariate chromatographic calibration technique is based on the use of the linear regression equations constructed using relationship between concentration and peak area at the five-wavelength set. The algorithm of this mathematical calibration model having a simple mathematical content was briefly described. This approach is a powerful mathematical tool for an optimum chromatographic multivariate calibration and elimination of fluctuations coming from instrumental and experimental conditions. This multivariate chromatographic calibration contains reduction of multivariate linear regression functions to univariate data set. The validation of model was carried out by analyzing various synthetic binary mixtures and using the standard addition technique. Developed calibration technique was applied to the analysis of the real pharmaceutical tablets containing EA and HCT. The obtained results were compared with those obtained by classical HPLC method. It was observed that the proposed multivariate chromatographic calibration gives better results than classical HPLC.