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Chau CSM, Ee SCE, Huang X, Siow WS, Tan MBH, Sim SKR, Chang TY, Kwok KM, Ng K, Yeo LF, Lim A, Sim LE, Conroy S, Rosario BH. Frailty-aware surgical care: Validation of Hospital Frailty Risk Score (HFRS) in older surgical patients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:90-100. [PMID: 38920233 DOI: 10.47102/annals-acadmedsg.2023221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Frailty has an important impact on the health outcomes of older patients, and frailty screening is recommended as part of perioperative evaluation. The Hospital Frailty Risk Score (HFRS) is a validated tool that highlights frailty risk using 109 International Classification of Diseases, 10th revision (ICD-10) codes. In this study, we aim to compare HFRS to the Charlson Comorbidity Index (CCI) and validate HFRS as a predictor of adverse outcomes in Asian patients admitted to surgical services. Method A retrospective study of electronic health records (EHR) was undertaken in patients aged 65 years and above who were discharged from surgical services between 1 April 2022 to 31 July 2022. Patients were stratified into low (HFRS <5), interme-diate (HFRS 5-15) and high (HFRS >15) risk of frailty. Results Those at high risk of frailty were older and more likely to be men. They were also likely to have more comorbidities and a higher CCI than those at low risk of frailty. High HFRS scores were associated with an increased risk of adverse outcomes, such as mortality, hospital length of stay (LOS) and 30-day readmission. When used in combination with CCI, there was better prediction of mortality at 90 and 270 days, and 30-day readmission. Conclusion To our knowledge, this is the first validation of HFRS in Singapore in surgical patients and confirms that high-risk HFRS predicts long LOS (≥7days), increased unplanned hospital readmissions (both 30-day and 270-day) and increased mortality (inpatient, 10-day, 30-day, 90-day, 270-day) compared with those at low risk of frailty.
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Affiliation(s)
| | | | - Xiaoting Huang
- Department of Geriatric Medicine, Changi General Hospital, Singapore
| | - Wei Shyan Siow
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
| | - Michelle Bee Hua Tan
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
| | | | | | - Kah Meng Kwok
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Kangqi Ng
- Department of Internal Medicine, Changi General Hospital, Singapore
| | - Li Fang Yeo
- Department of Internal Medicine, Changi General Hospital, Singapore
| | - Aileen Lim
- Health Systems Intelligence, Changi General Hospital, Singapore
| | | | - Simon Conroy
- University College London, London, United Kingdom
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2
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Sarkar R, Dipnall JF, Bassed R, Ozanne-Smith Ao J. Family violence homicide rates: a state-wide comparison of three data sources in Victoria, Australia. HEALTH INF MANAG J 2023; 52:135-143. [PMID: 34875905 DOI: 10.1177/18333583211060464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family violence homicide (FVH) is a major public health and social problem in Australia. FVH trend rates are key outcomes that determine the effectiveness of current management practices and policy directions. Data source-related methodological problems affect FVH research and policy and the reliable measurement of homicide trends. OBJECTIVE This study aimed to determine data reliability and temporal trends of Victorian FVH rates and sex and relationship patterns. METHOD FVH rates per 100,000 persons in Victoria were compared between the National Coronial Information System (NCIS), Coroners Court of Victoria (CCoV) Homicide Register, and the National Homicide Monitoring Program (NHMP). Trends for 2001-2017 were analysed using Joinpoint regression. Crude rates were determined by sex and relationship categories using annual frequencies and Australian Bureau of Statistics population estimates. RESULTS NCIS closed FVH cases totalled 360, and an apparent downward trend in the FVH rate was identified. However, CCoV and NHMP rates trended upwards. While NCIS and CCoV were case-based, NHMP was incident-based, contributing to rate variations. The NCIS-derived trend was particularly impacted by unavailable case data, potential coding errors and entry backlog. Neither CCoV nor NHMP provided victim-age in their public domain data to enable age-adjusted rate comparison. CONCLUSION Current datasets have limitations for FVH trend determination; most notably lag times for NCIS data. IMPLICATIONS This study identified an indicative upward trend in FVH rates in Victoria, suggesting insufficiency of current management and policy settings for its prevention and control.
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Affiliation(s)
- Reena Sarkar
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Joanna F Dipnall
- Pre-hospital, Emergency and Trauma Research, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Medicine, Deakin University, VIC, Australia
| | - Richard Bassed
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Joan Ozanne-Smith Ao
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
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3
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Kennedy B, Ibrahim J, Koppel S, Bugeja L. The epidemiology of homicide among older adults: retrospective analysis using data from the Victorian Homicide Register. Int J Legal Med 2023; 137:1583-1593. [PMID: 37246176 PMCID: PMC10421821 DOI: 10.1007/s00414-023-03022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
Older adult homicide is unique and under-researched, requiring immediate attention due to the rapidly ageing population. The current study aims to contribute to the description of homicide at the individual, interpersonal, incident and community levels. This research comprised a whole of state jurisdiction population-based retrospective analysis of homicide deaths of older adults aged 65 years and older reported to the Coroner between 2001 and 2015. Descriptive statistical analyses were conducted to compare older adult homicides by sex and the deceased-offender relationship. There were 59 homicide incidents involving 23 female and 36 male deceased (median age=72 years) and 16 female and 41 male offenders (median age=41 years). Individual factors included the following: Deceased frequently had a recorded physical illness (66%), and over one-third were born overseas (37%) or had recent contact with general practitioners and human services (36%). Offenders frequently had a history of illicit drug or alcohol use (63%), diagnosed mental illness (63%) and historical exposure to violence (61%). Interpersonal factors included the following: The deceased-offender relationship tended to be intimate or familial (63%). Incidents factors included the following: incident predominantly occurred in the victim's home (73%), involving the use of a sharp object (36%), bodily force (31%) or blunt force (20%). The older adult homicide is characterised by poor health in the victim, mental illness, substance abuse or a history of conflict in the either the victim or the offender, familial deceased-offender relationship and the home as the incident location. The results identify future prevention opportunities in clinical and human services settings.
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Affiliation(s)
- Briohny Kennedy
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, 3006, Australia.
| | - Joseph Ibrahim
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, 3006, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, Clayton, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, 3006, Australia
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4
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, Gerche AL. Causes, circumstances, and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry. Europace 2022; 24:1933-1941. [PMID: 36037012 DOI: 10.1093/europace/euac141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The causes, circumstances, and preventability of young sudden cardiac arrest remain uncertain. METHODS AND RESULTS A prospective state-wide multi-source registry identified all out-of-hospital cardiac arrests (OHCAs) in 1-50 year olds in Victoria, Australia, from 2019 to 2021. Cases were adjudicated using hospital and forensic records, clinic assessments and interviews of survivors and family members. For confirmed cardiac causes of OHCA, circumstances and cardiac history were collected. National time-use data was used to contextualize circumstances. 1319 OHCAs were included. 725 (55.0%) cases had a cardiac aetiology of OHCA, with coronary disease (n = 314, 23.8%) the most common pathology. Drug toxicity (n = 226, 17.1%) was the most common non-cardiac cause of OHCA and the second-most common cause overall. OHCAs were most likely to occur in sleep (n = 233, 41.2%). However, when compared to the typical Australian day, OHCAs occurred disproportionately more commonly during exercise (9% of patients vs. 1.3% of typical day, P = 0.018) and less commonly while sedentary (39.6 vs. 54.6%, P = 0.047). 38.2% of patients had known standard modifiable cardiovascular risk factors. 77% of patients with a cardiac cause of OHCA had not reported cardiac symptoms nor been evaluated by a cardiologist prior to their OHCA. CONCLUSION Approximately half of OHCAs in the young have a cardiac cause, with coronary disease and drug toxicity dominant aetiologies. OHCAs disproportionately occur during exercise. Of patients with cardiac cause of OHCA, almost two-thirds have no standard modifiable cardiovascular risk factors, and more than three-quarters had no prior warning symptoms or interaction with a cardiologist.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | | | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Vanessa Connell
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Missenden Rd, Sydney, NSW 2050, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
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5
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Batson A, Newnam S, Koppel S. Examining Coroners' Recommendations for Health and Safety Management of Ageing Heavy Vehicle Drivers: A STAMP Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16112. [PMID: 36498186 PMCID: PMC9740677 DOI: 10.3390/ijerph192316112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Recommendations were analysed from coronial cases involving ageing heavy vehicle drivers (≥55 years) and mapped onto a Systems Theoretic Accident Model and Processes (STAMP) control structure to identify the controllers and control actions influential in the heavy vehicle industry with regard to health and safety. A National Coronial Information System (NCIS) database search revealed 38 coroners' recommendations arising from 14 unique cases of ageing driver involvement. There were no ageing themes identified in the analysis of coroners' findings and recommendations. An examination of the STAMP control structure identified that the highest concentration of recommendations was in the level of regulation, the second most senior level of control, although safety constraints were advised for all five levels of the system. In regard to identifying themes of control flaws in the recommendations, the study found that "unidentified hazards" were the most common type of safety failure in the analysis of cases of ageing drivers, concentrated at the regulatory level, which indicates that additional risk identification methods by upper levels of control are needed. Therefore, a recommendation arising from the current study is that additional controls in safety intervention are necessitated in the upper and middle levels of the road freight transportation system; in particular, formalising health and safety education for organisational managers, with a focus on identifying ageing issues, would fill a gap in the system for managing ageing heavy vehicle drivers. In conclusion, this study has found that improving the health and safety of ageing heavy vehicle drivers necessitates additional safety constraints with a focus on formalised safety education for organisational managers, in addition to a means to detect emerging and unforeseen hazards in the road freight transportation industry.
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Affiliation(s)
- Angela Batson
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, Melbourne, VIC 3800, Australia
| | - Sharon Newnam
- School of Psychology and Counselling, Queensland University of Technology, Brisbane City, QLD 4000, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, Melbourne, VIC 3800, Australia
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6
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Prahladh S, van Wyk J. Introductory evidence on data management and practice systems of forensic autopsies in sudden and unnatural deaths: a scoping review. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022; 12:38. [PMID: 36158168 PMCID: PMC9484346 DOI: 10.1186/s41935-022-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/14/2022] [Indexed: 11/15/2022] Open
Abstract
Background The investigation into sudden unexpected and unnatural deaths supports criminal justice, aids in litigation, and provides important information for public health including surveillance, epidemiology, and prevention programs. The use of mortality data to convey trends can inform policy development and resource allocations. Hence, data practices/management systems in Forensic Medicine are critical. This study scoped literature and described the body of knowledge on data management and practice systems in Forensic Medicine. Methods Five steps of the methodological framework of Arksey and O’Malley guided this scoping review. A combination of keywords, Boolean terms, and Medical Subject Headings was used to search PubMed, EBSCOhost (CINAHL with full text and Health Sources), Cochrane Library, Scopus, Web of Science, Science Direct, WorldCat, and Google Scholar from the 18th to 24th of June 2020 and updated in November 2021 for peer review papers. This study included articles involving unnatural deaths, focused on data practice or data management systems, relating to Forensic Medicine, all study designs, and published in English. Screening and selection and data extraction were conducted by two reviews. Thematic analysis was conducted, and the results were reported using both quantitatively and qualitatively. Results Of the 23,059 articles, 16 met this study’s inclusion criteria. The included articles were published between 2008 and 2019. Eight of the 16 articles were published between 2017 and 2019. Most of the included studies were conducted in the USA (5) and Australia/New Zealand (4). Only two publications were from lower- and middle-income countries (Nigeria, Mexico), and the remaining 14 were from high-income countries (Italy, Denmark, USA, Australia, and New Zealand, Japan, Switzerland, Canada). The data management systems found in this study were as follows: Virtopsy, Canadian Coroner and Medical Examiner Database, Infant Injury Database, Fatal injury surveillance system, Medical Examiners and Coroners Alert System, National Violent Deaths Reporting System, AM/PM Database, Tokyo CDISC/ODM, and National Coronial Information System. Conclusions This study’s results revealed limited articles relating to data management and practice systems in Forensic Medicine, particularly in LMICs through literature indicating there is a prevalence of unnatural deaths in LMICs. This study, therefore, recommends research on data management and practice systems relating to forensic medicine in LMICs to inform policy decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s41935-022-00293-3.
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7
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Willoughby M, Young JT, Hail-Jares K, Spittal MJ, Borschmann R, Patton G, Sawyer SM, Janca E, Teplin L, Heffernan E, Kinner SA. Circumstances and toxicology of violence-related deaths among young people who have had contact with the youth justice system: a data linkage study. BMC Public Health 2021; 21:2207. [PMID: 34861851 PMCID: PMC8642952 DOI: 10.1186/s12889-021-12244-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Young people who have had contact with the youth justice system have an increased risk of dying from violence. Examining the context of violence-related deaths is essential in informing prevention strategies. We examined the circumstances and toxicology of violence-related deaths among young people who have had contact with the youth justice system in Queensland, Australia. Methods This data linkage study linked youth justice records from Queensland, Australia (30 June 1993-1 July 2014) on 48,670 young people to national death and coroner records (1 July 2000-1 January 2017). Circumstances and toxicology of deaths were coded from coroner’s records. We calculated the incidence of violence-related deaths that were reported to a coroner. Fisher’s exact tests were used to examine crude differences in the circumstances and toxicology of violence-related death, according to sex and Indigenous status. Results There were 982 deaths reported to a coroner in the cohort. Of which, 36 (4%) were from violence-related causes (incidence: 6 per 100,000 person-years, 95% confidence interval: 4-8). People who died from violence were most frequently male (n = 28/36; 78%), and almost half were Indigenous (n = 16/36; 44%). The majority of violence-related deaths involved a weapon (n = 24/36; 67%), most commonly a knife (n = 17/36; 47%). Compared to men where the violent incident was most frequently preceded by an altercation (n = 12/28; 43%), for women it was frequently preceded by a relationship breakdown or argument (n < 5; p = 0.004). Substances most commonly present in toxicology reports were cannabis (n = 16/23; 70%) and alcohol (n = 15/23; 65%). Conclusions Therapeutic alcohol and other drug programs, both in the community and detention, are likely important for reducing violence-related deaths among young people who have had contact with the youth justice system. The majority of violence-related deaths among women were in the context of intimate partner violence, indicating the urgent need for interventions that prevent intimate partner violence in this population. Diversion programs and increased investment in health and social services may reduce the overrepresentation of Indigenous people in the youth justice system and in violence-related deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12244-z.
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Affiliation(s)
- Melissa Willoughby
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia. .,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Jesse T Young
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Katie Hail-Jares
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Queensland, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia
| | - Rohan Borschmann
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - George Patton
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,The Nossal Institute for Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Sawyer
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,The Nossal Institute for Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Emilia Janca
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia
| | - Linda Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, Parkville, Victoria, 3053, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Mater Research Institute-UQ, University of Queensland, Brisbane, Queensland, Australia.,Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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8
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Nie L, Davie G, Lilley R. Factors related to absence of toxicological investigation following fatal injury: a retrospective quantitative review of Coronial records in New Zealand. Forensic Sci Med Pathol 2021; 17:643-648. [PMID: 34677794 DOI: 10.1007/s12024-021-00422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The accuracy of cause of death certification is strongly influenced by the quality of post mortem investigations (autopsies). In New Zealand, this can include toxicological investigation at the discretion of the Coroner. Little is known both within New Zealand and internationally about potential selection biases related to Coronial cases not undergoing toxicology investigation. METHODS A retrospective review of eligible injury-related deaths referred to a Coroner in New Zealand in 2014 was undertaken. Using data collected from the Australasian National Coronial Information System and New Zealand's Mortality Collection, descriptive analyses were undertaken to understand patterns related to toxicology report requests and patterns within toxicology reports. RESULTS In New Zealand in 2014, 25% of 744 Coronial cases for fatal injury in those under 85 years of age did not have corresponding toxicological reports. Reports were more likely to be absent in females (adjusted Odds Ratio (aOR) 1.7, 95%CI 1.0, 2.7), and in decedents aged under 15 and over 65 years (aOR 11.0 and 4.1 respectively). More than half (56%, 95% CI 45%, 67%) of the deaths due to falls did not receive toxicological investigation. CONCLUSION Better understanding of selection biases in Coronial processes helps inform policymakers, researchers, and practitioners of the limitations of available toxicological evidence.
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Affiliation(s)
- Luke Nie
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
| | - Rebbecca Lilley
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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9
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Campbell G, Darke S, Degenhardt L, Townsend H, Carter G, Draper B, Farrell M, Duflou J, Lappin J. Prevalence and Characteristics Associated with Chronic Noncancer Pain in Suicide Decedents: A National Study. Suicide Life Threat Behav 2020; 50:778-791. [PMID: 32162732 DOI: 10.1111/sltb.12627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims were to estimate the prevalence of CNCP in suicide decedents, and compare sociodemographic and clinical characteristics of people who die by suicide (i) with and without a history of CNCP and (ii) among decedents with CNCP who are younger (<65 years) and older (65 + years). METHOD We examined all closed cases of intentional deaths in Australia in 2014, utilizing the National Coronial Information System. RESULTS We identified 2,590 closed cases of intentional deaths in Australia in 2014 in decedents over 18 years of age. CNCP was identified in 14.6% of cases. Decedents with CNCP were more likely to be older, have more mental health and physical health problems, and fewer relationship problems, and were more likely to die by poisoning from drugs, compared with decedents without CNCP. Comparisons of older and younger decedents with CNCP found that compared to younger (<65 years) decedents with CNCP, older decedents (65 + years) were less likely to have mental health problems. CONCLUSIONS This is the first national study to examine the characteristics of suicide deaths with a focus on people with CNCP. Primary care physicians should be aware of the increased risk for suicide in people living with CNCP, and it may be useful for clinicians to screen for CNCP among those presenting with suicidal behaviors.
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Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.,School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Harriet Townsend
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Edith St Waratah, NSW, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Johan Duflou
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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10
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Campbell G, Darke S, Zahra E, Duflou J, Shand F, Lappin J. Trends and characteristics in barbiturate deaths Australia 2000–2019: a national retrospective study. Clin Toxicol (Phila) 2020; 59:224-230. [DOI: 10.1080/15563650.2020.1789653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. Campbell
- School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - S. Darke
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - E. Zahra
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - J. Duflou
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - F. Shand
- Black Dog Institute, UNSW Sydney, Sydney, Australia
| | - J. Lappin
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychiatry, UNSW Sydney, Sydney, Australia
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11
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Rates, characteristics and manner of cannabis-related deaths in Australia 2000-2018. Drug Alcohol Depend 2020; 212:108028. [PMID: 32370933 DOI: 10.1016/j.drugalcdep.2020.108028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 04/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The most commonly used illicit substance worldwide is cannabis. To date, no national level study of cannabis-related death has been undertaken in Australia. The current study aimed to investigate the rates, characteristics and manner of cannabis-related deaths recorded in Australia (2000-2018). METHODS A retrospective case review of medicolegal files was undertaken through the National Coronial Information System (NCIS) (1/07/2000-31/12/2018). RESULTS A total of 559 cases were identified, with a mean age of 35.8 years, 81.2% were male. The crude mortality rate per 100,000 people ranged between 0.10 (CI = 0.06-0.15) and 0.23 (CI = 0.17-0.30). The manner of deaths were: accidental injury (29.9%), suicide (25.0%), polysubstance toxicity (17.0%), natural disease (16.1 %), natural disease and drug effect/toxicity (7.9%), assault (3.0%) and unascertained (1.1%). No deaths were solely due to cannabis toxicity. Men were over-represented in this group and were three times as likely to die of accidental injury than women who died from cannabis-related deaths. Motor vehicle accidents were the leading cause of accidental injury. Cardiovascular (14.3%) and respiratory conditions (9.7%) were the most common disease types recorded in cause of death. The median Δ-9-tetrahydrocannabinol blood concentration was 0.008 mg/L (range 0.0005-19.00 mg/L). Other drugs were cited in the cause of death alongside cannabis (81.4%), the most common being alcohol (47.2%). CONCLUSIONS Low all-cause crude mortality rates remained relatively stable over the study period. No deaths were due to direct cannabis toxicity, but death due to accidental injury was prominent.
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12
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Orpana H, Giesbrecht N, Hajee A, Kaplan MS. Alcohol and other drugs in suicide in Canada: opportunities to support prevention through enhanced monitoring. Inj Prev 2020; 27:194-200. [PMID: 32220934 PMCID: PMC8005800 DOI: 10.1136/injuryprev-2019-043504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 02/06/2023]
Abstract
The use of alcohol and other drugs has been identified as a significant factor related to suicide through multiple pathways. This paper highlights current understanding of their contributions to suicide in Canada and identifies opportunities for enhancing monitoring and prevention initiatives. Publications from 1998 to 2018 about suicide in Canada and that referred to alcohol or other drugs were identified using PubMed and Google Scholar. A second literature search restricted to articles including results of toxicology testing was conducted by a librarian. We summarised the literature identified on ecological analyses, attributable fractions and deaths, and research including the results of toxicological analyses. Our literature search yielded 5230 publications, and 164 documents were identified for full-text screening. We summarised the findings from 30 articles. Ecological analyses support the association between alcohol sales, annual per capita alcohol consumption and suicide rates. Based on published estimates, approximately a quarter of suicide deaths in Canada are alcohol-attributable, while the estimated attributable fraction for illegal drugs is more variable. Finally, there is a dearth of literature examining the role of acute alcohol and/or drug consumption prior to suicide based on toxicological findings. The proportion of suicide decedents with drugs or alcohol present at the time of death varies widely. While there is evidence on the role of alcohol and drugs in suicide deaths, there is not a large body of research about the acute use of these substances at the time of death among suicide decedents in Canada. Our understanding of the role of alcohol and other drugs in suicide deaths could be enhanced through systematic documentation, which in turn could provide much needed guidance for clinical practice, prevention strategies and policy initiatives.
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Affiliation(s)
- Heather Orpana
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aliya Hajee
- Downtown West Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
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13
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Eastwood K, Bugeja L, Zail J, Cartwright A, Hopkins A, Ibrahim JE. Deaths of young people living in residential aged care: a national population-based descriptive epidemiological analysis of cases notified to Australian coroners. Disabil Rehabil 2019; 43:2213-2218. [PMID: 31774709 DOI: 10.1080/09638288.2019.1696417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM This study provides a descriptive epidemiological analysis stratified by age of deaths reported to Australian Coroners of residential aged care facility residents aged under 65 years. METHOD A national population-based retrospective analysis was conducted of deaths of Australian residential aged care facility residents reported to Australian Coroners between 2000 and 2013. Descriptive statistics compared adult residents categorised using age by factors relating to the individual, incident and death investigation. RESULTS Of the 21,736 deaths of residential aged care facilities residents aged over 20 years reported to Australian Coroners, 782 (3.6%) were of residents aged 20-64 years. Natural cause deaths occurred at similar rates irrespective of age. Intentional external cause deaths were higher in residents aged 20-64 years (5.3% vs. 16.0%; OR 3.43, 95% CI 2.0-5.9; p < 0.001), with suicide rates three times that of the over 65 years group (13.2% vs. 4.1%; OR 0.28, 95% CI 0.16-0.51; p < 0.001). External cause deaths from choking and falls were most common in the younger and older groups respectively. CONCLUSIONS More is required to prevent external cause deaths in young residential care facility residents.IMPLICATIONS FOR REHABILITATIONOne in seven (14.1%) deaths of people aged 20-64 years in residential aged care facilities are premature and potentially avoidable. The more common external causes of death include suicide, choking and falls.The prevalence and causes of preventable deaths in this study provide a basis for prompting and developing more specific prevention policies and practices to reduce harm for young people in residential aged care. Specifically, addressing loneliness would improve social inclusion, mental health and suicide risk. Better management of progressive neurological conditions with multidisciplinary team and re-ablement programs would reduce risk of choking and falls.Improving outcomes for young people in residential aged care requires a co-ordinated, multisector approach comprising relevant government departments, aged care providers, researchers and clinicians.Effective planning requires more information about the cause and nature of deaths, and due to the small event counts, this would ideally involve an international collaboration.
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Affiliation(s)
- Kathryn Eastwood
- Victorian Institute of Forensic Medicine, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Monash Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Joshua Zail
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Anna Cartwright
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Alexandra Hopkins
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Melbourne, Australia
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14
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Peden AE, Franklin RC, Clemens T. Exploring the burden of fatal drowning and data characteristics in three high income countries: Australia, Canada and New Zealand. BMC Public Health 2019; 19:794. [PMID: 31226973 PMCID: PMC6588923 DOI: 10.1186/s12889-019-7152-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/11/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Drowning is a leading and preventable cause of death that has suffered an attention deficit. Improving drowning data in countries would assist the understanding of the full extent and circumstances of drowning, to target interventions and evaluate their effectiveness. The World Health Organization identifies data collection as a key strategy underpinning effective interventions. This study compares unintentional fatal drowning data collection, management and comparison using the databases of Australia, Canada and New Zealand. METHODS Cases of fatal unintentional drowning between 1-January-2005 and 31-December-2014 were extracted. Cases were combined into a single dataset and univariate and chi square analysis (p < 0.01) were undertaken. Location and activity variables were mapped and combined. Variables consistently collected across the three countries were compared to the ILCOR Drowning Data Guideline. The authors also recommend variables for a minimum core dataset. RESULTS Of 55 total variables, 19 were consistent and 13 could be compared across the three databases. When mapped against the ILCOR Drowning Data Guideline, six variables were consistently collected by all countries, with five compared within this study. The authors recommend a minimum core dataset of 11 variables including age, sex, location, activity, date of incident, and alcohol and drug involvement). There were 8176 drowning deaths (Australia 34.1%, Canada 55.9%, New Zealand 9.9%). All countries achieved reductions in crude drowning rates (Australia - 10.2%, Canada - 20.4%, New Zealand - 24.7%). Location and activity prior to drowning differed significantly across the three countries. Beaches (X2 = 1151.0;p < 0.001) and ocean/harbour locations (X2 = 300.5;p < 0.001) were common in Australia and New Zealand, while lakes/ponds (X2 = 826.5;p < 0.001) and bathtubs (X2 = 27.7;p < 0.001) were common drowning locations in Canada. Boating prior to drowning was common in Canada (X2 = 66.3;p < 0.001). CONCLUSIONS The comparison of data across the three countries was complex. Work was required to merge categories within the 20% of variables collected that were comparable, thus reducing the fidelity of data available. Data sources, collection and coding varied by country, with the widest diversity seen in location and activity variables. This study highlights the need for universally agreed and consistently applied categories and definitions to allow for global comparisons and proposes a core minimum dataset.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, PO Box 558, Broadway, New South Wales, Australia. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Richard C Franklin
- Royal Life Saving Society - Australia, PO Box 558, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Tessa Clemens
- Drowning Prevention Research Centre Canada, Toronto, Canada
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15
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Murphy B, Kennedy B, Martin C, Bugeja L, Willoughby M, Ibrahim JE. Health and Care Related Risk Factors for Suicide Among Nursing Home Residents: A Data Linkage Study. Suicide Life Threat Behav 2019; 49:695-706. [PMID: 29665103 DOI: 10.1111/sltb.12465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/19/2018] [Indexed: 12/01/2022]
Abstract
This study aimed to examine associations between health status and care needs of nursing home residents and risk of death from suicide compared to other causes through a retrospective data linkage cohort study examining nursing home resident deaths in Australia between 2000 and 2013. Data linkage was performed between aged care assessment tools-Resident Classification System and Aged Care Funding Instrument-and the National Coronial Information System. A competing risks survival analysis was performed to determine the association between care assessment variables (activities of daily living (ADL), behavior, and complex health care) and the risk of death from suicide and any other cause. Of the 146 nursing home residents who died from suicide, 130 (89%) were matched to their assessment data, with comparable information available for 95 residents (65%). Residents who required high levels of care with ADL, physical health care, and cognitive and behavioral issues had a higher risk of dying from all other causes, yet lower risk of dying from suicide. The study findings demonstrate the feasibility and value of linking these two data sets; highlight a need for improved data collection processes; and support a person-centered care approach for prevention of suicide among nursing home residents.
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Affiliation(s)
- Briony Murphy
- Health, Law, & Ageing Research Unit (HLARU), Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Briohny Kennedy
- Health, Law, & Ageing Research Unit (HLARU), Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Catherine Martin
- Department of Epidemiology and Preventive Medicine, Monash University, Southbank, Vic., Australia
| | - Lyndal Bugeja
- Health, Law, & Ageing Research Unit (HLARU), Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Melissa Willoughby
- Health, Law, & Ageing Research Unit (HLARU), Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Joseph E Ibrahim
- Health, Law, & Ageing Research Unit (HLARU), Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
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16
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Jokanovic N, Ferrah N, Lovell JJ, Weller C, Bugeja L, Bell JS, Ibrahim JE. A review of coronial investigations into medication-related deaths in residential aged care. Res Social Adm Pharm 2019; 15:410-416. [DOI: 10.1016/j.sapharm.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 01/04/2023]
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17
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Holmes AL, Bugeja L, Young C, Ibrahim JE. Deaths due to thermal injury from cigarette smoking in a 13-year national cohort of nursing home residents. Int J Older People Nurs 2019; 14:e12233. [PMID: 30925015 DOI: 10.1111/opn.12233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the nature and frequency of deaths due to thermal injuries from cigarette smoking reported to Australian coroners and to examine the decisions which surround these deaths. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Residents dwelling in accredited nursing homes whose deaths were reported to coroners between 1 July 2000 and 30 June 2013 and attributed to thermal injuries from cigarette smoking. MEASURES A descriptive analysis was undertaken to report socio-demographic characteristics of the deceased, medical history, mobility, level of observation, safety equipment provided/used, nursing home location, decision to smoke, timing of incident, time from incident to death, incident findings, mechanism of death, formal reports attached and coroners' recommendations. RESULTS Ten deaths of nursing home residents due to thermal injury from cigarette smoking were reported in Australia over a 13-year period. The median age of residents was 78 years (IQR = 15.25); nine residents were female and one was male. Seven residents had impaired mobility with three residents being wheelchair bound and one resident bed bound. None of the residents were supervised by staff while they smoked, and none of the residents utilised any safety equipment to minimise harm. Burns/thermal injury was the mechanism of harm in most cases. CONCLUSIONS This national study confirms that thermal injuries caused by cigarette smoking in nursing homes result in fatalities, particularly in the absence of supervision. It also demonstrates the complex tension arising from balancing autonomy with safety. IMPLICATIONS FOR PRACTICE Nurses and aged care practitioners should endeavour to give effect to each resident's wishes while mitigating the risk of harm. The supervision requirements for cigarette smoking residents should be tailored to the needs of individual residents and staff should try to ensure that residents who require supervision receive it.
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Affiliation(s)
- Alice L Holmes
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Southbank, Victoria, Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Southbank, Victoria, Australia
| | - Carmel Young
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Southbank, Victoria, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Southbank, Victoria, Australia
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18
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Cenderadewi M, Franklin RC, Peden AE, Devine S. Pattern of intentional drowning mortality: a total population retrospective cohort study in Australia, 2006-2014. BMC Public Health 2019; 19:207. [PMID: 30782167 PMCID: PMC6381671 DOI: 10.1186/s12889-019-6476-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/24/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While a downward trend in unintentional drowning deaths in Australia has been observed, little is known about intentional drowning mortality. Limited information on intentional drowning death impedes the planning, implementation, and evaluation of prevention strategies. This study aims to describe rates of intentional fatal drowning in Australia and compare these to other categories of drowning. METHODS Data were sourced from the Australian Bureau of Statistics (ABS) over a 9-year period (2006-2014). Rates and trends of intentional drowning were compared with unintentional, water-transport related and undetermined intent drowning. Rates of intentional drowning deaths across gender, age groups, states/territories, remoteness of residence and First Peoples of Australia were calculated. Relative risk (RR) (95% confidence interval [CI]) was calculated, and chi-square tests of independence were performed (p < 0.05). RESULTS The crude mortality rate for intentional drowning deaths in Australia over the study period was 0.23/100000, lower than unintentional drowning (0.89/100000). Males were 1.6 (CI: 1.4-2.0) times more likely than females to intentionally drown, however females made up a significantly larger proportion of intentional drowning deaths (38.2%) compared to unintentional deaths (22.4%) (χ2 = 47.3; df = 1; p < 0.05). A significant linear association between age group and intentional drowning was observed (χ2 = 131.3; p < 0.05), with individuals aged 75 years and over 32.6 times more likely to intentionally drown. Non-Indigenous peoples were 4.1 times more likely to intentionally drown in comparison to First Peoples of Australia. Residents of Inner Regional, Outer Regional, and Major Cities were 4.2 times (CI: 0.6-30.0), 4.1 times (CI: 0.6-29.9), and 4.0 times (CI: 0.6-28.6) more likely to intentionally drown, respectively, compared with residents of Very Remote areas. CONCLUSIONS This study adds to the limited evidence currently available about intentional drowning rates and trends in Australia. Being male, of older age groups, non-Indigenous, residing in Inner and Outer Regional areas, and Major Cities were risk factors for intentional drowning deaths. Improving data collection systems and furthering understanding of the risk factors of intentional drowning, as well as the development, implementation, and evaluation of prevention programmes, are required to reduce the risk of intentional drowning death in Australia.
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Affiliation(s)
- Muthia Cenderadewi
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811 Australia
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811 Australia
- Royal Life Saving Society – Australia, Sydney, NSW 2007 Australia
| | - Amy E. Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811 Australia
- Royal Life Saving Society – Australia, Sydney, NSW 2007 Australia
| | - Sue Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811 Australia
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19
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Murphy BJ, Bugeja LC, Pilgrim JL, Ibrahim JE. Suicide among nursing home residents in Australia: A national population-based retrospective analysis of medico-legal death investigation information. Int J Geriatr Psychiatry 2018; 33:786-796. [PMID: 29505665 DOI: 10.1002/gps.4862] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Suicide among nursing home residents is a growing public health concern, currently lacking in empirical research. This study aims to describe the frequency and nature of suicide among nursing home residents in Australia. METHODS This research comprised a national population-based retrospective analysis of suicide deaths among nursing home residents in Australia reported to the Coroner between July 2000 and December 2013. Cases were identified using the National Coronial Information System, and data collected from paper-based coroners' records on individual, incident, and organizational factors, as well as details of the medico-legal death investigation. Data analysis comprised univariate and bivariate descriptive statistical techniques; ecological analysis of incidence rates using population denominators; and comparison of age and sex of suicide cases to deaths from other causes using logistic regression. RESULTS The study identified 141 suicides among nursing home residents, occurring at a rate of 0.02 deaths per 100 000 resident bed days. The ratio of deaths from suicide to deaths from any other cause was higher in males than females (OR = 3.56, 95%CI = 2.48-5.12, P = <0.001). Over half of the residents who died from suicide had a diagnosis of depression (n = 93, 66.0%) and had resided in the nursing home for less than 12 months (n = 71, 50.3%). Common major life stressors identified in suicide cases included the following: health deterioration (n = 112, 79.4%); isolation and loneliness (n = 60, 42.6%); and maladjustment to nursing home life (n = 42, 29.8%). CONCLUSIONS This research provides a foundational understanding of suicide among nursing home residents in Australia and contributes important new information to the international knowledge base.
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Affiliation(s)
- Briony J Murphy
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Lyndal C Bugeja
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
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20
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Willoughby M, Kipsaina C, Ferrah N, Bugeja L, Winbolt M, Ibrahim JE. A greater risk of premature death in residential respite care: a national cohort study. Age Ageing 2018; 47:226-233. [PMID: 29253078 DOI: 10.1093/ageing/afx177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background the demand for residential respite care for older persons is high yet little is known about the occurrence of harm, including death in this care setting. Objective to compare the prevalence and nature of deaths among residential respite to permanent nursing home residents. Design retrospective cohort study. Setting australian accredited nursing homes between 1 July 2000 and 30 June 2013. Subjects respite and permanent residents of Australian accredited nursing homes, whose deaths were investigated by Australian coroners. Methods prevalence of deaths of nursing home residents were calculated using routinely generated coronial data stored in the National Coronial Information System. Odds ratios (OR) were calculated to examine residency (respite or permanent) by cause of death. Results of the 21,672 residents who died during the study period, 172 (0.8%) were in respite care. The majority of deaths were due to natural causes. A lower proportion occurred in respite (n = 119, 69.2%) than permanent (n = 18,264, 84.9%) residents. Falls-related deaths in respite as a proportion (n = 41, 23.8%) was almost double that in permanent care (n = 2,638, 12.3%). Deaths from other injury-related causes (such as suicide and choking) were significantly more likely in respite residents (OR = 2.0; 95% confidence interval: 1.1-3.6; P = 0.026). Conclusions this is the first national cohort study examining mortality among respite residents. It established that premature, injury-related deaths do occur during respite care. This is the first step towards better understanding and reducing the risk of harm in respite care.
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Affiliation(s)
- Melissa Willoughby
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Chebi Kipsaina
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Margaret Winbolt
- La Trobe University, Faculty of Health Sciences, Melbourne, Victoria, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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21
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Koppel S, Bugeja L, Smith D, Lamb A, Dwyer J, Fitzharris M, Newstead S, D'Elia A, Charlton J. Using medico-legal data to investigate fatal older road user crash circumstances and risk factors. TRAFFIC INJURY PREVENTION 2018; 19:133-140. [PMID: 28758801 DOI: 10.1080/15389588.2017.1360492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHOD The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013-2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0-10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%). CONCLUSIONS RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.
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Affiliation(s)
- Sjaan Koppel
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Lyndal Bugeja
- b Coroners Court of Victoria , Melbourne , Australia
- c Department of Forensic Medicine , Monash University , Melbourne , Victoria , Australia
| | - Daisy Smith
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Ashne Lamb
- b Coroners Court of Victoria , Melbourne , Australia
| | - Jeremy Dwyer
- b Coroners Court of Victoria , Melbourne , Australia
| | - Michael Fitzharris
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Stuart Newstead
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Angelo D'Elia
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
| | - Judith Charlton
- a Monash University Accident Research Centre, Monash University , Clayton , Victoria , Australia
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22
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Saar E, Bugeja L, Ranson DL. National Coronial Information System: Epidemiology and the Coroner in Australia. Acad Forensic Pathol 2017; 7:582-590. [PMID: 31240008 DOI: 10.23907/2017.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/30/2017] [Indexed: 11/12/2022]
Abstract
The National Coronial Information System (NCIS) is the world's first national Internet-based database of coronial information. It was established in Australia following the recognition by coroners that their mandate for public health and safety could be improved if they could identify previous similar deaths. The NCIS is funded from state, territory, and commonwealth government agencies and overseen by the NCIS Board of Management. A team of ten staff manage the day-to-day operation of the system. The NCIS enables the rapid identification of up-to-date information on deaths investigated by the coroners' jurisdictions in Australia (from July 2000) and New Zealand (from July 2007). It is accessible to death investigators (coroners; forensic, medical, and scientific staff; and police) to assist with death investigation and approved third parties (e.g., researchers). The NCIS contains demographic information about the deceased, contextual information about the circumstances in which the death occurred, the cause and manner of death, and four full text reports generated during the investigation. The NCIS contains information on over 328 000 completed coroners' death investigations across Australia and New Zealand. Approximately 350 death investigators are registered to access the data for their ongoing death investigations, and 235 third party users are registered to utilize the data set in their research. In addition to the utility of the NCIS, this paper describes the rationale and governance structure of the NCIS, the information technology infrastructure, data set, quality assurance framework, and contribution to death and injury prevention.
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Affiliation(s)
- Eva Saar
- National Coronial Information System
| | - Lyndal Bugeja
- Victorian Institute of Forensic Medicine - Department of Forensic Medicine
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Murphy B, Bugeja L, Pilgrim J, Ibrahim JE. Deaths from Resident-to-Resident Aggression in Australian Nursing Homes. J Am Geriatr Soc 2017; 65:2603-2609. [DOI: 10.1111/jgs.15051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Briony Murphy
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Jennifer Pilgrim
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Joseph E. Ibrahim
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
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Roxburgh A, Hall WD, Dobbins T, Gisev N, Burns L, Pearson S, Degenhardt L. Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug Alcohol Depend 2017; 179:291-298. [PMID: 28826104 DOI: 10.1016/j.drugalcdep.2017.07.018] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND There has been international concern over the rise in fatal pharmaceutical opioid overdose rates, driven by increased opioid analgesic prescribing. The current study aimed to examine trends in opioid overdose deaths by: 1) opioid type (heroin and pharmaceutical opioids); and 2) age, gender, and intent of the death assigned by the coroner. METHODS Analysis of data from the National Coronial Information System (NCIS) of opioid overdose deaths occurring between 2001 and 2012. RESULTS Deaths occurred predominantly (98%) among Australians aged 15-74 years. Approximately two-thirds of the decedents (68%) were male. The heroin overdose death rate remains unchanged over the period; these were more likely to occur among males. Pharmaceutical opioid overdose deaths increased during the study period (from 21.9 per million population in 2001-36.2), and in 2012 they occurred at 2.5 times the incident rate of heroin overdose deaths. Increases in pharmaceutical opioid deaths were largely driven by accidental overdoses. They were more likely to occur among males than females, and highest among Australians aged 45-54 years. Rates of fentanyl deaths in particular showed an increase over the study period (from a very small number at the beginning of the period) but in 2012 rates of morphine deaths were higher than those for oxycodone, fentanyl and tramadol. CONCLUSIONS Given the increase in rates of pharmaceutical opioid overdose deaths, it is imperative to implement strategies to reduce pharmaceutical opioid-related mortality, including more restrictive prescribing practices and increasing access to treatment for opioid dependence.
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Affiliation(s)
- Amanda Roxburgh
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Wayne D Hall
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia; University of Queensland Clinical Centre for Research, University of Queensland, Brisbane, QLD, 4072, Australia; University of Queensland Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, 4006, Australia; National Addiction Centre, Kings College London, WC2R 2LS, United Kingdom
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia
| | - Sallie Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia; School of Population and Global Health, University of Melbourne, VIC, 3010, Australia
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Johnston CI, Ryan NM, Page CB, Buckley NA, Brown SG, O'Leary MA, Isbister GK. The Australian Snakebite Project, 2005-2015 (ASP-20). Med J Aust 2017; 207:119-125. [PMID: 28764620 DOI: 10.5694/mja17.00094] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/08/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the epidemiology, treatment and adverse events after snakebite in Australia. DESIGN Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005-2015) and data from the National Coronial Information System. Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation. MAIN OUTCOME MEASURES Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths. RESULTS 1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7-6.3 hours). CONCLUSIONS Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. The median antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.
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Massoudi BL, Chester KG. Public Health, Population Health, and Epidemiology Informatics: Recent Research and Trends in the United States. Yearb Med Inform 2017; 26:241-247. [PMID: 29063572 PMCID: PMC6239230 DOI: 10.15265/iy-2017-035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives: To survey advances in public and population health and epidemiology informatics over the past 18 months. Methods: We conducted a review of English-language research works conducted in the domain of public and population health informatics and published in MEDLINE or Web of Science between January 2015 and June 2016 where information technology or informatics was a primary subject or main component of the study methodology. Selected articles were presented using a thematic analysis based on the 2011 American Medical Informatics Association (AMIA) Public Health Informatics Agenda tracks as a typology. Results: Results are given within the context developed by Dixon et al., (2015) and key themes from the 2011 AMIA Public Health Informatics Agenda. Advances are presented within a socio-technical infrastructure undergirded by a trained, competent public health workforce, systems development to meet the business needs of the practice field, and research that evaluates whether those needs are adequately met. The ability to support and grow the infrastructure depends on financial sustainability. Conclusions: The fields of public health and population health informatics continue to grow, with the most notable developments focused on surveillance, workforce development, and linking to or providing clinical services, which encompassed population health informatics advances. Very few advances addressed the need to improve communication, coordination, and consistency with the field of informatics itself, as identified in the AMIA agenda. This will likely result in the persistence of the silos of public health information systems that currently exist. Future research activities need to aim toward a holistic approach of informatics across the enterprise.
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Affiliation(s)
- B. L. Massoudi
- Public Health Informatics Program, RTI International, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - K. G. Chester
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- C3 Informatics, Milton, GA, USA
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Bellenger E, Ibrahim JE, Bugeja L, Kennedy B. Physical restraint deaths in a 13-year national cohort of nursing home residents. Age Ageing 2017; 46:688-693. [PMID: 28049621 DOI: 10.1093/ageing/afw246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/13/2022] Open
Abstract
Objective this paper aims to investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period. Methods the study comprised a retrospective cohort study of residents dwelling in accredited nursing homes in Australia whose deaths were reported to the Coroners between 1 July 2000 and 30 June 2013 and was attributed to physical restraint. Results five deaths in nursing home residents due to physical restraint were reported in Australia over a 13-year period. The median age of residents was 83 years; all residents had impaired mobility and had restraints applied for falls prevention. Neck compression and entrapment by the restraints was the mechanism of harm in all cases, resulting in restraint asphyxia and mechanical asphyxia, respectively. Conclusions this national study confirms that the use of physical restraint does cause fatalities, although rare. Further research is still needed to identify which alternatives strategies to restraint are most effective, and to examine the reporting system for physical restraint-related deaths.
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Affiliation(s)
- Emma Bellenger
- University of Notre Dame Australia, Darlinghurst Campus, Sydney, New South Wales, Australia
| | - Joseph Elias Ibrahim
- Monash University, Forensic Medicine, Victorian Institute Forensic Medicine, Southbank, Victoria 3006, Australia
| | - Lyndal Bugeja
- Monash University, Department Forensic Medicine, Victorian Institute Forensic Medicine, Southbank, Victoria, Australia
| | - Briohny Kennedy
- Monash University, Forensic Medicine, Victorian Institute Forensic Medicine, Southbank, Victoria 3006, Australia
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Ibrahim JE, Bugeja L, Willoughby M, Bevan M, Kipsaina C, Young C, Pham T, Ranson DL. Premature deaths of nursing home residents: an epidemiological analysis. Med J Aust 2017; 206:442-447. [DOI: 10.5694/mja16.00873] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/27/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | - David L Ranson
- Victorian Institute of Forensic Medicine, Melbourne, VIC
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Pilgrim JL, Jenkins EL, Baber Y, Caldicott D, Drummer OH. Fatal acute poisonings in Australian children (2003-13). Addiction 2017; 112:627-639. [PMID: 27766705 DOI: 10.1111/add.13669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/21/2016] [Accepted: 10/19/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Fatal poisonings in children comprise a small proportion of cases investigated by an Australian coroner; however, they present a major opportunity for death prevention. This study aimed to examine fatal child poisonings in Australia to (1) estimate the rate of acute poisoning deaths in children; (2) describe the key characteristics of the cohort; and (3) describe the outcomes of coronial recommendations made as a death prevention measure. DESIGN Retrospective case series. SETTING The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. PARTICIPANTS Ninety poisoning deaths reported to an Australian coroner between January 2003 and December 2013 involving children (≤ 16 years of age). MEASURES Logistic regression, Pearson's correlation coefficient and descriptive statistics were used to examine the significance of associations. The primary outcome measures were poisoning type and cause of death. Covariates included age and mental illness. FINDINGS There were marginally more males (52.2%) [confidence interval (CI) = 44.4-45.6] in the cohort and most occurred in the 13-16-year age group (58.9%) (CI = 7.5-12.5). Deaths were typically unintentional (61.1%) (CI = 17.9-27.1) and occurred in the home (68.9%) (CI = 6.8-15.7). The most common form of poisoning was due to opioids (24.4%), followed by carbon monoxide (20%) and volatile substances (18.9%) (CI = 18.5-19.6). Males had slightly higher odds of dying from prescription opioids compared with females [odds ratio (OR) = 1.9, CI = 0.7-5.1], but this was not statistically significant. A recommendation was made by a coroner in 12 cases, 10 of which related to poisons (including drugs). Of these, eight recommendations were implemented. CONCLUSIONS In Australia between 2003 and 2013 there were on average eight acute poisoning deaths in children each year, most commonly involving prescription opioids and adolescents. There has been a downward trend in mortality since 2003. These cases generated more than twice as many recommendations for public safety compared with other Australian coroners' cases.
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Affiliation(s)
- Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Australia.,Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia
| | - Elizabeth L Jenkins
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.,Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia
| | - Yeliena Baber
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - David Caldicott
- Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia.,Calvary Health Care, Australian National University, Australian Capital Territory, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Australia.,Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
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Pilgrim JL, Dorward R, Drummer OH. Drug-caused deaths in Australian medical practitioners and health-care professionals. Addiction 2017; 112:486-493. [PMID: 27866392 DOI: 10.1111/add.13619] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/01/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent. DESIGN Retrospective cohort study. SETTING The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. PARTICIPANTS A total of 404 drug-caused deaths reported to an Australian coroner between 2003 and 2013 involving HCPs (including medical practitioners, paramedics, nurses, dentists, psychologists, pharmacists and veterinarians). MEASURES χ2 tests and descriptive statistics were used to examine relationships. The primary outcome measures were drug type and intent. Covariates included occupation type, mental illness and self-harm. FINDINGS Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group [confidence interval (CI) = 42.21-58.79]. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) (CI = 92.15-109.85). Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression (CI = 33.48-44.12). Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians (χ2(7) = 237.391). A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases. CONCLUSIONS Between 2003 and 2013, Australian health-care professionals averaged 37 deaths per year attributed to drug toxicity, with a mortality rate of nearly five deaths per 1000 employed HCPs. Drug-caused deaths among HCPs in Australia commonly involve females in their mid-40s, with a diagnosis of mental illness, personal and professional stress and the intent to self-harm.
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Affiliation(s)
- Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Rhyse Dorward
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia.,Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
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Aitken G, Murphy B, Pilgrim J, Bugeja L, Ranson D, Ibrahim JE. Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends. Forensic Sci Med Pathol 2017; 13:52-57. [PMID: 28091985 DOI: 10.1007/s12024-016-9830-9] [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] [Accepted: 11/26/2016] [Indexed: 11/28/2022]
Abstract
There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS). The variables examined comprised: sex, age group, year-of-death, cause and manner of death. One-third of deaths among nursing home residents in Victoria resulted from external causes (n = 1296, 33.3%) of which just over one-quarter (361, 27.9%) underwent toxicological analysis as part of the medical death investigation. The use of toxicological analysis varied by cause of death with a relatively low proportion conducted in deaths from unintentional falls (n = 286, 24.9%) and choking (n = 36, 40.4%). The use of toxicological analysis decreased as the decedents age increased. Forensic toxicology has the potential to contribute to improving our understanding of premature deaths in nursing home residents however it remains under used and is possibly undervalued.
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Affiliation(s)
- Georgia Aitken
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. .,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Briony Murphy
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. .,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Jennifer Pilgrim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - David Ranson
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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Churruca K, Draper B, Mitchell R. Varying impact of co-morbid conditions on self-harm resulting in mortality in Australia. HEALTH INF MANAG J 2016; 47:28-37. [DOI: 10.1177/1833358316686799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Research has associated some chronic conditions with self-harm and suicide. Quantifying such a relationship in mortality data relies on accurate death records and adequate techniques for identifying these conditions. Objective: This study aimed to quantify the impact of identification methods for co-morbid conditions on suicides in individuals aged 30 years and older in Australia and examined differences by gender. Method: A retrospective examination of mortality records in the National Coronial Information System (NCIS) was conducted. Two different methods for identifying co-morbidities were compared: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coded data, which are provided to the NCIS by the Australian Bureau of Statistics, and free-text searches of Medical Cause of Death fields. Descriptive statistics and χ2 tests were used to compare the methods for identifying co-morbidities and look at differences by gender. Results: Results showed inconsistencies between ICD-10 coded and coronial reports in the identification of suicide and chronic conditions, particularly by type (physical or mental). There were also significant differences in the proportion of co-morbid conditions by gender. Conclusion: While ICD-10 coded mortality data more comprehensively identified co-morbidities, discrepancies in the identification of suicide and co-morbid conditions in both systems require further investigation to determine their nature (linkage errors, human subjectivity) and address them. Furthermore, due to the prescriptive coding procedures, the extent to which medico-legal databases may be used to explore potential and previously unrecognised associations between chronic conditions and self-harm deaths remains limited.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Australia
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