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Suzuki H, Tanifuji T, Kimura S, Fukunaga T. Epidemiology of alcohol-related accidental death in Tokyo Metropolitan area (2015). MEDICINE, SCIENCE, AND THE LAW 2020; 60:4-10. [PMID: 31500507 DOI: 10.1177/0025802419843457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Alcohol consumption may be a risk factor for accidental deaths; however, characteristics of alcohol-related deaths are unclear. We investigated characteristics of alcohol-related accidental deaths to facilitate target strategies. Methods In this article, 1060 cases of accidental deaths examined by the Tokyo Medical Examiner’s Office (2015) were divided into two groups: deceased individuals who drank alcohol (alcohol; n = 212) and those who did not (control; n = 848). Age, sex, alcohol consumption patterns, and manners/causes of deaths were compared. Places where individuals in the alcohol group met with an accident, and their blood alcohol concentration was assessed. Results Lower mean age (60.5 vs. 73.7 years) and a higher male ratio (75.9% vs. 58.5%) were observed in the alcohol group. Daily alcohol consumption was more common in the alcohol group (70.8% vs. 13.4%). Falling was the leading cause of death in the alcohol group, but without a significant difference (alcohol: 31.6%, control: 30.4%). Incidence rates of drowning (22.2% vs. 7.9%) and poisoning (11.3% vs. 2.0%) were significantly higher in the alcohol group. The mean blood alcohol concentration was 1.6 mg/mL. Of the total alcohol-related accidents, 60.8% occurred at home. Falling down the stairs was the primary type of falling, and majority of drownings occurred in a bathtub. Conclusion Male habitual drinkers (middle-aged to older adults) should be targeted to prevent alcohol-related accidental deaths. More than 50% of deaths occurred at home and care should be taken when performing daily activities, including using stairs and while bathing.
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Affiliation(s)
- Hideto Suzuki
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan
| | - Takanobu Tanifuji
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan
| | - Satoko Kimura
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan
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Almeida-González M, Luzardo OP, Boada LD, Zaragoza E, Meilán MJ, Zumbado M, Henríquez-Hernández LA. Ethanol levels in legally autopsied subjects (2016-2017): Update of data and epidemiological implications in relation to violent deaths in Canary Islands (Spain). J Forensic Leg Med 2019; 68:101868. [PMID: 31585334 DOI: 10.1016/j.jflm.2019.101868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/24/2019] [Accepted: 09/08/2019] [Indexed: 11/25/2022]
Abstract
The aim of this study was to analyze the prevalence of ethanol in individuals (277) subjected to a mandatory medico-legal autopsy in the Institute of Legal Medicine of Las Palmas (Canary Islands, Spain) during 2016-2017, comparing the results with data published in 2015. Blood and/or vitreous humor samples were analyzed by gas chromatography. 31.8% of the individuals were positive to ethanol. We observed a decrease in the prevalence of ethanol among males (p = 0.002). While the prevalence of ethanol was reduced, the concentration among those positive subjects has increased. 11.9% of the series died in a traffic accident and the percentage of positive to ethanol decreased in relation to 2015 (64.3, 25.0, and 35.3%). The number of suicides remains constant, although the age of the suiciders has been significantly reduced (p = 0.022). The results of this study indicate that ethanol is still heavily involved in non-natural deaths.
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Affiliation(s)
- M Almeida-González
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016, Las Palmas de Gran Canaria, Spain.
| | - O P Luzardo
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016, Las Palmas de Gran Canaria, Spain.
| | - L D Boada
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016, Las Palmas de Gran Canaria, Spain.
| | - E Zaragoza
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain.
| | - M J Meilán
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain.
| | - M Zumbado
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016, Las Palmas de Gran Canaria, Spain.
| | - L A Henríquez-Hernández
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016, Las Palmas de Gran Canaria, Spain.
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3
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Outcome after pre-hospital cardiac arrest in accordance with underlying cause. Resuscitation 2019; 138:36-41. [PMID: 30831217 DOI: 10.1016/j.resuscitation.2019.02.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 01/01/2023]
Abstract
AIM In terms of treatment options, the underlying cause of out-of-hospital cardiac arrest (OHCA) has an impact on survival. This study aimed to examine the frequencies of different causes of OHCA and their outcomes using data from a national resuscitation registry. METHODS All pre-hospital cardiopulmonary resuscitations (CPR) documented in the German Resuscitation Registry between 2007 and 2017 were retrospectively investigated with regard to cause of cardiac arrest, return of spontaneous circulation (ROSC), and hospital discharge rate with good neurological outcome. To avoid selection bias, only rescue services with a return rate in the form 'further clinical treatment' of >30% were included, this resulted in a total return rate of 84% of the included data. RESULTS In total, 33,772 patients were included. The most common causes of OHCA were cardiac events (62.2%), hypoxia (11.1%) and trauma (3.2%), in 17.2% no or unknown cause were documented. Overall, 44.8% of patients achieved ROSC, 13.1% of patients were discharged alive from hospital and 68.3% of these were in good neurological condition (9.0% of all patients). ROSC rates differed between 8.9% (sudden infant death syndrome) and 64.4% (intracranial bleeding), while discharge rates with good neurological outcome ranged between 0.9% (sepsis) and 14.0% (intoxication). CONCLUSION The most common causes of OHCA are cardiac events and hypoxia. Depending on the underlying cause, outcome after pre-hospital CPR varies widely with a survival rate with good neurological outcome ranging from 0.9 to 14%.
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Almeida-González M, Henríquez-Hernández LA, P Luzardo O, Zumbado M, Zaragoza E, Meilán MJ, Camacho M, D Boada L. Ethanol levels in legally autopsied subjects: Analytical approach and epidemiological relevance in a prospective study in the touristic region of the Canary Islands (Spain). J Forensic Leg Med 2017; 52:40-45. [PMID: 28858689 DOI: 10.1016/j.jflm.2017.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/17/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to analyze the presence of alcohol in individuals (137) that were subjected to a mandatory medico-legal autopsy in the Institute of Legal Medicine of Las Palmas (Canary Islands, Spain) during 2015. Blood and vitreous humor samples (232) were analyzed by gas chromatography. 46.0% of the individuals were positive for alcohol, being half of them tourists. Blood alcohol concentrations (BAC) was higher in men over 60 years (p = 0.041). 10.2% of the series died in a traffic accident, and victims had the highest proportion of positives to alcohol (64.3%) and the highest BAC (2.56 g/L, p = 0.048). The BAC:VHAC (alcohol in vitreous humor) ratio was higher among victims of traffic crashes (p = 0.036), suggesting a short elapsed interval between the alcohol intake and the fatal accident. The results of this study indicate that ethanol is still heavily involved in non-natural deaths.
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Affiliation(s)
- Maira Almeida-González
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Luis A Henríquez-Hernández
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Octavio P Luzardo
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Manuel Zumbado
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Enrique Zaragoza
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain.
| | - María J Meilán
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain.
| | - María Camacho
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - Luis D Boada
- Laboratory of Toxicology, Institute of Legal Medicine, Government of the Canary Islands, Spain; Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain.
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Pajunen T, Vuori E, Vincenzi FF, Lillsunde P, Smith G, Lunetta P. Unintentional drowning: Role of medicinal drugs and alcohol. BMC Public Health 2017; 17:388. [PMID: 28521790 PMCID: PMC5437510 DOI: 10.1186/s12889-017-4306-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/25/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Alcohol is a well-known risk factor in unintentional drownings. Whereas psychotropic drugs, like alcohol, may cause psychomotor impairment and affect cognition, no detailed studies have focused on their association with drowning. Finland provides extensive post-mortem toxicological data for studies on drowning because of its high medico-legal autopsy rates. METHODS Drowning cases, 2000 through 2009, for which post-mortem toxicological analysis was performed, came from the database of the Toxicological Laboratory, Department of Forensic Medicine, University of Helsinki, using the ICD-10 nature-of-injury code T75.1. The data were narrowed to unintentional drowning, using the ICD-10 external-injury codes V90, V92, and W65-74. Each drowning case had its blood alcohol concentration (BAC) and concentrations of other drugs recorded. Evaluation of the contribution of psychotropic drugs to drowning was based on their blood concentration by means of a 6-grade scale. RESULTS Among victims ≥15 years old, unintentional drownings numbered 1697, of which, 303 (17.9%) were boating-related and 1394 (82.1%) non-boating-related. Among these, 65.0% of boating-related and 61.8% of non-boating-related victims were alcohol-positive (=BAC ≥ 50 mg/dL). The male-to-female ratio in alcohol-positive drownings was 7.3. At least one psychotropic drug appeared in 453 (26.7%) drowning cases, with some victims' bodies showing up to 7 different drugs. Overall 70 different psychotropic drugs were detectable, with 134 (7.9%) cases both alcohol-negative and psychotropic-drug-positive, of these, 59 (3.5%) were graded 4 to 6, indicating a possible to very probable contribution to drowning. Our findings suggest that psychotropic drugs may play a significant role in drowning, in up to 14.5% of cases, independently or in association with alcohol. CONCLUSIONS Psychotropic drugs alone or in association with alcohol may be an overlooked risk factor in drowning, due to their effects on psychomotor function and cognition. Future studies should also address other mechanisms-for instance drug-induced long-QT syndrome-by which drugs may contribute to drowning.
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Affiliation(s)
- Tuulia Pajunen
- Department of Biomedicine, Pathology and Forensic Medicine, University of Turku, Turku, Finland.
| | - Erkki Vuori
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Frank F Vincenzi
- Department of Pharmacology, University of Washington, Seattle, Washington, USA
| | - Pirjo Lillsunde
- National Institute for Health and Welfare, Helsinki, Finland
| | - Gordon Smith
- Department of Epidemiology and Public Health, University of Maryland, Maryland, USA
| | - Philippe Lunetta
- Department of Biomedicine, Pathology and Forensic Medicine, University of Turku, Turku, Finland
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Tyler MD, Richards DB, Reske-Nielsen C, Saghafi O, Morse EA, Carey R, Jacquet GA. The epidemiology of drowning in low- and middle-income countries: a systematic review. BMC Public Health 2017; 17:413. [PMID: 28482868 PMCID: PMC5423024 DOI: 10.1186/s12889-017-4239-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 370,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 91% of unintentional drowning deaths. Methods The authors performed a systematic review of literature indexed in EMBASE, PubMed, Web of Science, Cochrane Library, and Traumatology journals formerly indexed in PubMed in January 2014 and again in September 2016. Abstracts were limited to human studies in English, conducted in low- and middle-income countries, and containing quantitative data on drowning epidemiology. Results A total of 62 articles met inclusion criteria. The majority of articles originate from Asia (56%) and Africa (26%). Risk factors for drowning included young age (<17–20 years old), male gender (75% vs. 25% female), rural environment (84% vs. 16% urban), occurring in the daytime (95% vs. 5% night time), lack of adult supervision (76% vs. 18% supervised), and limited swimming ability (86% vs. 10% with swimming ability). There was almost equal risk of drowning in a small body of water versus a large body of water (42% ponds, ditches, streams, wells; 46% lakes, rivers, sea, ocean). Conclusion Drowning is a significant cause of injury-related deaths, especially in LMICs. Young males who are unsupervised in rural areas and have limited formal swimming instruction are at greatest risk of drowning in small bodies of water around their homes. Preventative strategies include covering wells and cisterns, fencing off ditches and small ponds, establishing community daycares, providing formal swimming lessons, and increasing awareness of the risks of drowning. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4239-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Robert Carey
- Boston University School of Medicine, Boston, USA
| | - Gabrielle A Jacquet
- Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 537] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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The role of hereditary KCNQ1 mutations in water-related death. Int J Legal Med 2015; 130:361-3. [DOI: 10.1007/s00414-015-1259-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/31/2015] [Indexed: 01/13/2023]
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