Does the 80 km/h speed limit save lives in France?

INTRODUCTION

Speeding is considered to be a major contributor to road fatalities and injuries worldwide. Inappropriate speeding behavior is associated with a high casualty burden. It could be responsible for at least 30% of road accidents.

METHOD

In 2018, the French authorities decided to introduce a new speed limit. They lowered the speed limit to 80 km/h on the unseparated interurban network. The aim was to reduce the number of fatalities and injuries and to implement some measures in line with international commitments. This paper uses different econometric models applied to time series for different groups of counties.

RESULTS

The results show a significant positive contribution of the new speed limit. The estimated number of lives saved is between 300 and 350. The overall reduction in the number of fatalities is 10%. The results also show a differentiated impact according to the local context and the different dynamics at play.

CONCLUSIONS AND PRACTICAL APPLICATIONS

The results of this paper are in line with the scientific literature on speed limit reductions. They represent a validation of a debated public decision, while at the same time consolidating the body of knowledge on the subject, helping the decision-maker to adopt an appropriate measure to improve road safety performance.

The interest of using vitreous humor for γ-hydroxybutyrate (GHB) quantification in related fatalities: Stability evaluation, case report and literature review

Analysis and interpretation of the findings for γ-hydroxybutyrate (GHB) in related fatalities remains problematic. Indeed, GHB is a naturally occurring compound present in both the mammalian central nervous system and peripheral tissue. Moreover, a postmortem increase in endogenous GHB concentration has been observed, especially in blood. Facing this issue, the use of an alternative matrix such as vitreous humor (VH) can thus be particularly interesting for GHB testing and quantification. VH is considered to be less prone to postmortem redistribution, is easy to collect, and has relatively few interfering compounds for the analytical process. In this context, the authors report the case of a GHB-related fatality involving 22-year-old male. In this case, GHB femoral blood (FB) (790 mg/L) and vitreous (750 mg/L) concentrations appeared similar with a FB to VH (FB/VH) ratio of 1.05. In addition, other similar cases with both GHB blood and vitreous concentrations were reviewed. Five cases were identified. The blood to VH ratios ranging from 0.13 to 2.58. Finally, GHB stability was documented in postmortem blood and VH, in order to address the reliability of VH as an alternative matrix for GHB quantitation at postmortem. GHB appeared relatively stable in postmortem blood specimens (at 50 mg/L) over a period of 28 days when stored at +4 °C or -20 °C. The same results were observed in VH specimens.

Investigating transportation safety in disadvantaged communities by integrating crash and Environmental Justice data

Recent efforts to identify disadvantaged communities (DACs) on a census tract level have evoked possibilities of attaining transportation justice and vision zero goals in these areas. To identify DACs, the United States Department of Transportation (USDOT) has developed six comprehensive indicators: economy, environment, equity, health, resilience, and transportation access. The indicators are used to explore the associations between DACs (in 71,728 census tracts) and five years of fatal crashes, providing a comprehensive understanding of safety risks. Specifically, using data on DACs and linking it with census and crash data, this study aims to understand the complex connections between safety (captured through fatal crashes) and disadvantages that communities confront due to a convergence of multiple challenges and burdens using Zero-Hurdle Negative Binomial models. The results reveal that health, resilience, and transportation-disadvantaged tracts are associated with more fatal crashes. The study also found the presence of a higher percentage of the population with bachelor's degrees and increased use of public transportation are correlated with fewer fatal crashes. Also, a higher fatal crash rate is observed in disadvantaged census tracts where a high proportion of the Hawaiian or other Pacific Islander, and American Indian or Alaska Native populations live. This implies that targeted interventions can be explored further in tracts that show high correlations with fatal crashes. The findings contribute to traffic safety by highlighting the risks in DACs, which can help design and implement traffic safety interventions. The insights gained from this study can inform decision-making and help to guide the development of more equitable traffic safety programs in disadvantaged communities.

Child maltreatment among victims of violent death: an analysis of national violent death reporting system data, 2014-2018

BACKGROUND

Limited information is known about the impact of childhood maltreatment on lifetime risk of violent death. This study aimed to compare manner of death, demographics, age at time of death, and the presence of a mental health or substance use disorder among decedents of violent deaths with a history of child maltreatment to those without.

METHODS

This cross-sectional study compared characteristics of pediatric and adult violent deaths with and without a history of child maltreatment that were captured in the National Violent Death Reporting System from 2014 through 2018.

RESULTS

Decedents who were male, multiracial, and had adulthood substance or mental health disorders were more likely to have a history of maltreatment. All-age decedents with a history of maltreatment were more likely to die by homicide. Adult decedents with a history of maltreatment were more likely to die by suicide. Maltreated decedents died significantly younger than non-maltreated decedents.

CONCLUSIONS

Among victims of violent deaths, an identified history of child maltreatment was associated with increased risk of homicide across the lifespan, adult suicide, and earlier death. A history of child maltreatment was also associated with mental health and substance use disorders, which may reflect one of the pathways through which the child maltreatment-to-death association functions.

Walking against traffic and pedestrian injuries in the United Kingdom: new insights

BACKGROUND

Studies from Finland and Taiwan have shown that walking against traffic was beneficial for reducing pedestrian crashes and fatalities. This study examined whether such beneficial effects are consistent across various circumstances.

METHODS

This study aimed to investigate pedestrian fatalities in walking-against or with-traffic crashes by analysing the UK STATS19 crash data for the period between 1991 and 2020. We firstly employed Chi-square tests to examine risk factors for pedestrian injury severity. These variables were then incorporated into stepwise logistic regression models with multiple variables. We subsequently conducted joint effect analysis to investigate whether the beneficial effects of walking against traffic on injury severity vary across different situations.

RESULTS

Our data contained 44,488 pedestrian crashes, of which 16,889 and 27,599 involved pedestrians walking against and with traffic, respectively. Pedestrians involved in with-traffic crashes were more likely to sustain fatalities (adjusted odds ratio [AOR] = 1.542; confidence interval [CI] = 1.139-1.927) compared with those in walking against-traffic crashes. The detrimental effect of walking with traffic on fatalities appeared to be more pronounced in darkness-unlit conditions (AOR = 1.48; CI = 1.29-1.70), during midnight hours (00:00-06:59 am) (AOR = 1.60; CI = 1.37-1.87), in rural areas (AOR = 2.20; CI = 1.92-2.51), when pedestrians were elderly (≥ 65 years old) (AOR = 2.65, CI = 2.16-3.26), and when heavy goods vehicles were crash partners (AOR = 1.51, CI = 1.28-1.78).

CONCLUSIONS

Walking against traffic was beneficial in reducing pedestrian fatalities compared with walking with traffic. Furthermore, such a beneficial effect was more pronounced in darkness-unlit conditions, at midnights (00:00-06:59 am), in rural areas, when pedestrians were elderly, and when heavy goods vehicles struck pedestrians.

Firearm availability and police shootings of citizens: a city level analysis of fatal and injurious shootings in California and Florida

BACKGROUND

A growing body of research has found a link between firearm availability and police shootings of citizens across place. The problem, however, is that the previous studies on the topic tend to suffer from several limitations: a near exclusive focus on citizen fatalities, units of analysis at the state or county levels, and a variety of proxy measures tapping into community-level firearm access. The current study set out to address these issues by examining the relationship between different forms of firearm availability and both fatal and nonfatal injurious police shootings of citizens at the city level.

METHODS

More specifically, it merged The Trace's "Missing Pieces" measures of guns reported lost and stolen to police as well as licensed firearms dealers across jurisdictions from the Bureau of Alcohol, Tobacco, Firearms, and Explosives as proxies for firearm availability with data on police shootings of citizens in California and Florida from California's URSUS system and the Tampa Bay Times' "Why Cops Shoot" database, respectively. Negative binomial regression analyses were performed on a sample of 253 cities across the two states and a sub-sample of cities with licensed firearms dealers.

RESULTS

Findings uncovered a small positive association between rates of federally licensed guns stores and the number citizens shot by police as well as police shooting incidents while controlling for several community-level measures (e.g., concentrated disadvantage, gun homicide rates). Rates of guns lost or reported stolen were generally not significantly associated with the outcome measures in the multivariate models.

CONCLUSIONS

Firearm availability is a significant correlate of police shootings. Pooled counts of both citizens shot by police and police shooting incidents are heightened in jurisdictions with higher rates of licensed gun dealers, which may be due to the fact that all firearms sold in the USA first make their way to the public through these mechanisms. Such licensed gun dealers must be appropriately monitored and audited to reduce illicit behavior and prevent firearms from making their way into secondary markets. Addressing access to firearms can be meaningful for a host of gun-related morbidity and mortality outcomes, including police shootings of citizens.

Characterizing child maltreatment fatalities among child victims with disabilities in the United States, 2010-2019

BACKGROUND

There has been little research on child maltreatment-related fatalities among children with disabilities. Despite being a minority of children in the United States, children with disabilities experience higher rates of victimization.

OBJECTIVE

To characterize fatalities due to child maltreatment among children with disabilities in the United States.

METHODS

Data from the National Violent Death Reporting System from 2010 to 2019 were analyzed to describe child maltreatment-related deaths among children with disabilities aged birth to 17 years.

RESULTS

There were 106 fatalities meeting the study criteria. The average age of the victims was 5.9 years old and 74.6 % were male. The most frequent suspected perpetrators of maltreatment-related fatalities were biological mothers (35.2 %), and most perpetrators were White (55.7 %). Analyses showed a statistically significant relationship between fatalities caused by neglect and diagnoses of attention deficit hyperactivity disorder, autism spectrum disorder, cerebral palsy, and/or traumatic brain injury. Overall, physical abuse and/or neglect resulting in a fatality among children with disabilities were significantly correlated with the relationship of the perpetrator to the victim.

CONCLUSIONS

Children with disabilities who died as a result of abuse were more likely to have autism spectrum disorder, a developmental disability, or other physical impairment, with physical abuse being the most prevalent type of abuse that resulted in death. To decrease the likelihood of abuse of disabled children, healthcare practitioners and caseworkers should work together to create strategies to help caregivers cope with the financial, mental, and physical stress that comes with raising children with disabilities.

Snorkelling and breath-hold diving fatalities in Australian waters, 2014 to 2018

Introduction

This study investigated snorkelling and breath-hold diving deaths in Australia from 2014-2018 and compared these to those from 2001-2013 to identify ongoing problems and assess the effectiveness of countermeasures.

Methods

Media reports and the National Coronial Information System were searched to identify snorkelling/breath-hold diving deaths for 2014-2018, inclusive. Data were extracted from witness and police reports, medical histories, and autopsies. An Excel® database was created and a chain of events analysis conducted. Comparisons were made with the earlier report.

Results

Ninety-one fatalities (78 males, 13 females, median age 48 years [range 16-80]) were identified with one third likely doing some breath-hold diving. Fifty-two of 77 with known body mass index were overweight or obese. Approximately two thirds were inexperienced snorkellers and 64 were alone. Fifty-one were tourists. Planning shortcomings, such as solo diving and diving in adverse conditions, as well as pre-existing health conditions and inexperience predisposed to many incidents. Primary drowning was the likely disabling condition in 39% of cases with drowning recorded as the cause of death (COD) in two thirds. Cardiac events were the likely disabling conditions in 31% although recorded as the COD in 21% of cases.

Conclusions

Increasing age, obesity and associated cardiac disease have become increasingly prevalent in snorkelling deaths and there is a need for improved health surveillance and risk management. Closer supervision of inexperienced snorkellers is indicated. Apnoeic hypoxia from extended breath-holding and poor supervision remain a problem. The increased risk of harvesting seafood in areas frequented by large marine predators needs to be appreciated and managed appropriately.

Autogeddon or autoheaven: Environmental and social effects of the automotive industry from launch to present

The automotive industry is one of the most significant and increasing sources of pollution worldwide. Previous studies examining its impacts focus on the post-1950 era as data available before this period is scarce. This study carefully reconstructs six datasets from the early 20th century to 2019 for the UK: annual number of motor cars, road lengths, road fatalities, NOx and CO emissions, and fuel consumption. Interpolation was prudently used to fill gaps in the data sets. Results highlight changing health, social and environmental effects throughout the growth of the automotive sector. Ratios of fatalities to cars indicate social ingraining of the car and rapid response to legislation. Significant emissions resulted from the early industry. Successful remediation of emissions occurred in the late 20th century. All variables studied were interrelated, but expansion of road networks particularly contributed to a range of both positive and (unintended) negative consequences. World War 2 appears to have been a landmark for the automotive industry, producing capacity for mass production, personal mobility and research and therefore a struggle between impacts and social policies. We have demonstrated that technological developments and regulatory interventions relating to the motor industry, alongside events that have catalysed societal change, have been crucial in terms of subsequently providing benefits to society whilst also acting to mitigate (but not prevent) the adverse and frequently devastating impacts of motor vehicles on human health and the environment. A periodic, regular, overarching, independent review (~ every 5 years) of the collective positive and negative impacts of the motor vehicle industry and appropriate interventions are essential to maintain and improve social benefits and public and environmental health, as well as supporting delivery of the United Nations' Sustainable Development Goals by 2030 and beyond.

Do Cellphone Bans Save Lives? Evidence From Handheld Laws on Traffic Fatalities

Distracted driving is one of the leading causes of fatal motor vehicle accidents in the United States. Policymakers in several states have responded to this phenomenon by implementing laws that restrict the use of handheld devices while operating a vehicle. In this paper, we utilize various quasi-experimental designs to estimate the impact of state-level handheld mandates on traffic fatalities. We find robust evidence that restricting the use of handheld devices while driving reduces daily traffic fatalities by 0.63 individuals in the short term. The results further indicate that while the magnitude of the impact is smaller in the long term, this policy is still effective at curbing traffic fatalities, saving more than 69 lives per state each year.

Effects of large vehicles on pedestrian and pedalcyclist injury severity

INTRODUCTION

Fatal pedestrian and pedalcyclist crashes have been on the rise in the United States since 2009. This rise in fatalities coincides with the rise of large vehicles on American roadways, continuing a trend that began years earlier.

METHOD

Through rare access to both crash and hospital records, this report investigates the relationship between striking vehicle type and medical outcomes of pedestrian and pedalcyclist cases.

RESULTS

Results suggest that children are eight times more likely to die when struck by a SUV compared to those struck by a passenger car. Passenger cars were the striking vehicle in most fatal pedestrian and pedalcyclist crashes, though they were underrepresented relative to the proportion of all crashes in which they were involved. Though pickup trucks were the striking vehicle in just 5.6% of pedestrian and pedalcyclist crashes, they were involved in 12.6% of fatalities. SUVs were similarly overrepresented in fatalities relative to the proportion of their involvement in all crashes. SUVs struck 14.7% of the pedestrians and pedalcyclists investigated here, but were involved in 25.4% of the fatalities. Head and thorax injury severities are examined by vehicle type and age. Hospital charges of pedestrian and pedalcycle crash victims are also analyzed by striking vehicle type and victim age.

PRACTICAL APPLICATIONS

Findings suggest larger vehicles are involved in pedestrian and pedalcyclist crashes with more severe injuries that result in higher hospital charges. By race, Blacks are also found to be overrepresented as pedestrian and pedalcyclist crash victims.

Fatal Food Anaphylaxis: Distinguishing Fact From Fiction

Although there is a general perception that the prevalence of food allergy is increasing, data supporting this are limited. Food is the least common cause of fatal anaphylaxis, and fortunately, it is a very rare event; however, it is also unpredictable. There is widespread consensus that severe reactions cannot be predicted in a clinically meaningful way. Certain food triggers are more frequently associated with fatal anaphylaxis than others. In observational studies, peanut and tree nuts account for at least 30% to 50% of fatalities, with seafood and cow's milk also associated with fatal reactions. Fatal food-induced anaphylaxis is most likely to occur during adolescence and young adulthood, although the reasons for this are unclear. International guidelines agree that intramuscular (IM) epinephrine is the treatment of choice for managing food-triggered anaphylaxis and has a good safety profile when given by the IM route. However, fatalities still occur despite the timely administration of epinephrine. Food-allergic individuals must navigate a world that requires daily vigilance for allergens and preparedness for allergic reactions. Although the actual risk of fatal reactions is minimal, it is not zero, and severe reactions are unpredictable. Clinicians need to help patients better understand the very low but real risk of fatal reaction and enable them to lead as normal a life as possible through appropriate education, safety netting, and risk reduction.

Hard Boiled: Alcohol Use as a Risk Factor for MDMA-Induced Hyperthermia: a Systematic Review

Although MDMA (ecstasy) is a relatively safe recreational drug and is currently considered for therapeutic use for the treatment of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), recreational MDMA use occasionally elicits hyperthermia and hyponatremia, sometimes with a fatal outcome. Specific risk factors for both adverse effects are profuse sweating while vigorously dancing under unfavorable conditions such as high ambient temperatures and insufficient fluid suppletion which result in dehydration. Concomitant use of MDMA and alcohol is highly prevalent, but adds to the existing risk, because alcohol facilitates the emergence of MDMA-induced adverse events, like hyperthermia, dehydration, and hyponatremia. Because of potential health-related consequences of concomitant use of MDMA and alcohol, it is important to identify the mechanisms of the interactions between alcohol and MDMA. This review summarizes the main drivers of MDMA-induced hyperthermia, dehydration, and hyponatremia and the role of concomitant alcohol use. It is shown that alcohol use has a profound negative impact by its interaction with most of these drivers, including poikilothermia, exposure to high ambient temperatures, heavy exercise (vigorous dancing), vasoconstriction, dehydration, and delayed initiation of sweating and diuresis. It is concluded that recreational and clinical MDMA-users should refrain from concomitant drinking of alcoholic beverages to reduce the risk for adverse health incidents when using MDMA.

Postmortem investigation of fatalities following vaccination with COVID-19 vaccines

Thorough postmortem investigations of fatalities following vaccination with coronavirus disease 2019 (COVID-19) vaccines are of great social significance. From 11.03.2021 to 09.06.2021, postmortem investigations of 18 deceased persons who recently received a vaccination against COVID-19 were performed. Vaxzevria was vaccinated in nine, Comirnaty in five, Spikevax in three, and Janssen in one person. In all cases, full autopsies, histopathological examinations, and virological analyses for the severe acute respiratory syndrome coronavirus 2 were carried out. Depending on the case, additional laboratory tests (anaphylaxis diagnostics, VITT [vaccine-induced immune thrombotic thrombocytopenia] diagnostics, glucose metabolism diagnostics) and neuropathological examinations were conducted. In 13 deceased, the cause of death was attributed to preexisting diseases while postmortem investigations did not indicate a causal relationship to the vaccination. In one case after vaccination with Comirnaty, myocarditis was found to be the cause of death. A causal relationship to vaccination was considered possible, but could not be proven beyond doubt. VITT was found in three deceased persons following vaccination with Vaxzevria and one deceased following vaccination with Janssen. Of those four cases with VITT, only one was diagnosed before death. The synopsis of the anamnestic data, the autopsy results, laboratory diagnostic examinations, and histopathological and neuropathological examinations revealed that VITT was the very likely cause of death in only two of the four cases. In the other two cases, no neuropathological correlate of VITT explaining death was found, while possible causes of death emerged that were not necessarily attributable to VITT. The results of our study demonstrate the necessity of postmortem investigations on all fatalities following vaccination with COVID-19 vaccines. In order to identify a possible causal relationship between vaccination and death, in most cases an autopsy and histopathological examinations have to be combined with additional investigations, such as laboratory tests and neuropathological examinations.

Analysis of the impact of COVID-19 on collisions, fatalities and injuries using time series forecasting: The case of Greece

The current study aims to investigate the impact of the COVID-19 pandemic on road traffic collisions, fatalities, and injuries using time series analyses. To that aim, a database containing road collisions, fatalities, and slight injuries data from Greece were derived from the Hellenic Statistical Authority (HSA) and covered a ten-year timeframe (from January 2010 to August 2020. The chosen time period contained normal operations, as well as the period of the first COVID-19-induced lockdown period in Greece. Three different Seasonal Autoregressive Integrated Moving Average (SARIMA) time series models were implemented in order to compare the observed measurements to forecasted values that were intended to depict assumed conditions; namely, without the appearance of the COVID-19 pandemic. Modelling results revealed that the total number of road collisions, fatalities, and slightly injured were decreased, mainly due to the sharp traffic volume decrease. However, the percentage reduction of the collision variables and traffic volume were found to be disproportionate, which probably indicates that more collisions occurred with regard to the prevailing traffic volume. An additional finding is that fatalities and slightly injured rates were significantly increased during the lockdown period and the subsequent month. Overall, it can be concluded that a worse performance was identified in terms of road safety. Since subsequent waves of COVID-19 cases and other pandemics may reappear in the future, the outcomes of the current study may be exploited for the improvement of road safety from local authorities and policymakers.

Fatal train accidents on Europe's railways: An update to 2019

This paper presents an analysis of fatal train accident rates and trends on Europe's main line railways from 1990-2019. It is a sequel to the paper Fatal train accidents on Europe's railways: 1980-2009 (Evans (2011), which covers the three decades 1980-2009. The present paper discards the data for the 1980s, but adds the data for 2010-2019. The data cover the 28 countries of the European Union as in 2019, together with Norway and Switzerland. The source of the recent data is largely the European Union Agency for Railways. The estimated overall trend in the number of fatal train collisions and derailments per train-kilometre was -5.6 % per year from 1990-2019, with a 95 % confidence interval of -7.1 % to -4.2 %. The estimated accident rate in 2019 was 0.85 fatal collisions or derailments per billion train-kilometres, which represents a fall of 78 % since 1990. This gives an estimated mean number of fatal accidents in Europe in 2019 of 3.89. The data and results for 2010-2019 closely match the extrapolation of the results for 1990-2009, so that in 2009 extrapolation would have given a good forward projection for 2019. By the same argument this paper gives a forward projection of the mean number of accidents in 2029 of 2.12, assuming no change in train-kilometres, or pro-rata changes with changes in train-kilometres. The paper investigates the causes of accidents. A notable finding is that the proportion of accidents caused by signals passed at danger (SPADs) fell from 40 % in 1990-1999 to 21 % in 2010-2019. This is probably due to the increasing deployment of train protection systems. The number of fatalities in individual accidents has a skew distribution: most accidents have a small number of fatalities, but a few have a large number. The overall observed number of fatalities per accident is 4.23, and there is no indication that this mean changes with time. This implies that the mean number of fatalities per year has the same downward trend of 5.6 % per year as the mean number of accidents per year.

Time series data analysis and ARIMA modeling to forecast the short-term trajectory of the acceleration of fatalities in Brazil caused by the corona virus (COVID-19)

OBJECTIVE

This paper incorporates the concept of acceleration to fatalities caused by the coronavirus in Brazil from time series data beginning on 17th March 2020 (the day of the first death) to 3rd February 2021 to explain the trajectory of the fatalities for the next six months using confirmed infections as the explanatory variable.

METHODS

Acceleration of the cases of confirmed infection and fatalities were calculated by using the concept of derivatives. Acceleration of fatality function was then determined from multivariate linear function and calculus chain rule for composite function with confirmed infections as an explanatory variable. Different ARIMA models were fitted for each acceleration of fatality function: the de-seasonalized Auto ARIMA Model, the adjusted lag model, and the auto ARIMA model with seasonality. The ARIMA models were validated. The most realistic models were selected for each function for forecasting. Finally, the short run six-month forecast was conducted on the trajectory of the acceleration of fatalities for all the selected best ARIMA models.

RESULTS

It was found that the best ARIMA model for the acceleration functions were the seasonalized models. All functions suggest a general decrease in fatalities and the pace at which this change occurs will eventually slow down over the next six months.

CONCLUSION

The decreasing fatalities over the next six-month period takes into consideration the direct impact of the confirmed infections. There is an early increase in acceleration for the forecast period, which suggests an increase in daily fatalities. The acceleration eventually reduces over the six-month period which shows that fatalities will eventually decrease. This gives health officials an idea on how the fatalities will be affected in the future as the trajectory of confirmed COVID-19 infections change.

Impact of COVID-19 on motor vehicle injuries and fatalities in older adults in Ontario, Canada

BACKGROUND

Older adults constitute the group most vulnerable to COVID-19 mortality. As a result, in North America and elsewhere, older adults have been strongly advised to shelter in place. Older adults also represent the fastest growing segment of licensed drivers.

OBJECTIVE

We examined the change in injuries and fatalities sustained by younger and older drivers and pedestrians during the first month of the COVID-19 pandemic. We hypothesized that adults ages 80 years and over would have a proportionally larger reduction than the other drivers and pedestrians.

METHODS

Using a cohort design, we compared the proportion of drivers and pedestrians involved in injuries and fatalities attributable to individuals aged 80 years and over, as recorded in the Ministry of Transportation of Ontario (Canada) database, between the 30 days prior to shelter-in-place related to the COVID-19 pandemic and the subsequent 30 days. By way of comparison, we conducted a similar comparison for younger age cohorts (16-24 years, 25-34 years, 35-54 years, 55-64 years, and 65-79 years).

RESULTS

Drivers aged 80 years and over represented 21 per 1000 injuries and fatalities in the 30 days prior to March 17, 2020 (95 % CI: 15-29), and 8 per 1000 injuries and fatalities in the 30 days beginning on that date (95 % CI: 2-20), a 64.7 % reduction (exp (β) post 0.353, 95 % CI 0.105-0.892). Drivers in the 35-54 year age range underwent a significant but smaller reduction of 22.9 %; no significant changes were seen for drivers in other age groups, or for pedestrians of any age.

CONCLUSIONS AND RELEVANCE

The physical distancing measures that aimed to reduce the spread of COVID-19 resulted in a marked reduction in driver injuries and fatalities in the oldest old, illustrating the impact of physical distancing recommendations in this population. The excess mortality burden faced by the oldest adults during the COVID-19 pandemic, by direct exposure to the virus, may be indirectly mitigated by the reduction in road-related deaths in this cohort.

Direct and specific analysis of nitrite and nitrate in biological and non-biological samples by capillary ion analysis for the rapid identification of fatal intoxications with sodium nitrite

In recent years, a significant increase of reports about suicidal cases due to intentional sodium nitrite intake has been described. In the forensic pathology context, the strategy to approach intoxication cases by sodium nitrite, without any preliminary information or hint, is not straightforward. Indeed, in a number of cases the lack of crime scene data and/or specific pathological signs makes difficult the identification of nitrite poisoning. Moreover, the analytical determination of nitrite in blood is challenging, due to its rapid oxidization to nitrate by hemoglobin. Although several methods have been proposed for the clinical analysis of nitrate and/or nitrite in biological samples, none of these is specifically focused on the determination of these ions in cadaveric samples. Consequently, the diagnosis of nitrite fatal intoxication is still based on methemoglobin analysis. The present paper reports the optimization and validation of an analytical method of capillary ion analysis (CIA) with UV detection, for the determination of nitrite and nitrate in biological fluids and its application to two authentic cases of death by nitrite intake. The analyses were carried out in a bare fused-silica capillary (75 µm inner diameter) using 100 mM sodium tetraborate (pH 9.24) as background electrolyte and applying a voltage of - 15 kV between the capillary ends. The detection was obtained by direct UV absorption recorded at 214 nm wavelength. Bromide was used as the internal standard. Linearity was established in the range of 0.25-5 mmol/L). Reproducibility (intraday and day-to-day) was characterized by relative standard deviations (RSDs) 14.7% for peak areas. The method was applied to the determination of nitrite and nitrate in two real forensic cases, where high concentrations of nitrate were found in cadaveric blood samples (6.5 and 4.4 mmol/L, respectively). Nitrite was found only in trace amounts, due to the instability of this ion in cadaveric blood where it is oxidized to nitrate. The present method represents a new tool for the direct and rapid determination of nitrite and nitrate in cases of forensic interest, and thus offers a diagnostic tool more sensitive and precise than the need methemoglobin analysis.

Fentanyl, Heroin, and Cocaine Overdose Fatalities are Shifting to the Black Community: An Analysis of the State of Connecticut

BACKGROUND

Historically, Blacks and Hispanics have had lower opioid-involved overdose death rates in Connecticut (CT). We examined if a shift has taken place where rates of Black fatal overdoses have now surpassed Whites in the state.

METHODS

Drug overdose fatality rates were calculated by number of deaths per year per 100,000 population from 2012 to 2019 in Connecticut. Measures were by race (White, Hispanic, Black, and Asian or Pacific Islander), age groups, and types of drugs, including fentanyl, heroin, cocaine, and other opioids. Poisson regression was used to test the interactions (race × age); joinpoint regression analysis was used to evaluate trend lines of fatality rate by racial/ethnic group within each age group with a significance level of p < 0.05.

RESULTS

Drug overdose fatality rates in CT from 2012 to 2019 showed a significant increase for all races combined, estimated 3.6 deaths per 100,000 population per year. For Whites, overdose deaths were 4.6 per year from 2012 to 2017 with no change from 2017 to 2019. The overdose fatality rate for Hispanics was 3.0 and for Asian or Pacific Islanders 0.6 per year from 2012 to 2019. For Blacks, the death rates were statistically flat between 2012 and 2014; however, from 2015 to 2019, this group saw the largest average increase of 6.0 overdose deaths per 100,000 population each year. By 2019, the overdose fatality rate was higher in Blacks than in Whites, (39 vs. 38 per 100,000, respectively). Further, Blacks ages 50 years and over reported the highest overdose fatality rates among all race/age groups, an increase of 8.5 deaths per 100,000 population since 2014.

CONCLUSIONS AND RELEVANCE

Connecticut is a microcosm of the opioid overdose trend in the New England region of our country. The majority of overdose deaths in CT involved illicit drugs, fentanyl, heroin, and cocaine, rather than prescription drugs. Blacks 50-years-old and over showed the fastest growing overdose death rates. Opioid deaths are now shifting to the Black community, creating an urgent public health crisis.

Defining crash configurations for Powered Two-Wheelers: Comparing ISO 13232 to recent in-depth crash data from Germany, India and China

The motorcyclist safety standard ISO 13232, based on crash data from Europe and the USA from the 1970s, still sets the direction for the development and evaluation of protective measures today. However, it is unclear how relevant the crash configurations in the standard are to present-day motorcycle crashes in Europe, the USA and other parts of the world. We analyzed recent in-depth crash data from Germany, India and China, examining powered two-wheeler (PTW) crash configurations in which at least one police-reported serious injury was present. After assessing the relevance of the ISO's PTW crash configurations to those we found in each country, we suggested new configurations to guide the development of safety systems that would be more effective at reducing PTW-related fatalities and serious injuries. In all three databases, passenger cars were among the top two most frequent collision partners and a car front impacting the side of the PTW was the most common configuration. Notably, although collisions with trucks constituted the most common scenario in India and ground impact (primary collision) was a common scenario in both Germany and India, the ISO did not include either configuration. Further, in three of the seven ISO crash configurations, one of the collision partners is stationary, although stationary collision partners were rare in our data. Our results show that the ISO crash configurations do not represent the most frequent PTW road crashes in Germany, India or China. However, the Chinese database was confined to crashes with a collision partner with four or more wheels. Further, weighting factors for these data were not available, so we could not extrapolate the frequency of the Chinese crash configurations across the entire population. A revised version of the ISO could serve as a basis for a full-scale PTW crash test program. However, the observed differences between countries imply that a single global standard may not be feasible. To optimize the evaluation of a PTW safety system, we recommend the inclusion of configurations which are frequent in the region or country of interest-in addition to common configurations occurring frequently all around the world.

Prevalence and trends of distracted driving in Canada

INTRODUCTION

This study evaluates prevalence and trends in distracted driving in Canada based on multiple indicators collected from the Road Safety Monitor (RSM) and Canada's National Fatality Database maintained by the Traffic Injury Research Foundation (TIRF).

METHOD

Data from the RSM on self-reported distracted driving behaviors were analyzed using multivariate techniques including logistic regression analysis in various years spanning from 2004 to 2019. Data from TIRF's National Fatality Database from 2000 to 2016 were also analyzed using piecewise regression analysis to evaluate trends and prevalence of driver distraction.

RESULTS

Significantly more Canadians reported talking on their phone hands-free or handheld phone while driving in 2019 compared to 2010. There was a 102% increase in the percentage that reported texting while driving in 2019 (9.7%) compared to 2010 (4.8%). For every 10-year increase in age, drivers were 44% less likely to text, 38% less likely to use a handheld phone, and 28% less likely to use a hands-free phone. Males were 62% more likely to use a handheld phone and 50% more likely to use a hands-free phone than females. Findings related to drivers' perceived danger of distracted driving and attitudes are also presented. Although the number of distraction-related fatalities has not increased substantially from 2000 to 2016, the percentage of all fatalities where distraction was a contributing factor has increased. Unlike drinking drivers, distracted drivers more often kill other road users in crashes than kill themselves.

CONCLUSIONS

In conclusion, while most Canadians appear to understand that one of the high-risk forms of distracted driving (i.e., texting while driving) is indeed dangerous, there is a minority who are unaware of, or resistant to, this fact. Practical Applications: Enforcement activities and education initiatives to combat distracted driving ought to be tailored to the target audience based on the patterns uncovered.

Modeling dynamics of fatal opioid overdose by state and across time

Opioid overdose fatalities include deaths from natural opioids (morphine and codeine), semi-synthetic opioids (oxycodone, hydrocodone), synthetic opioids (prescription and illicit fentanyl, tramadol), methadone, and heroin. From 1999 to 2017, there were 702,568 drug overdose deaths in the U.S., with 399,230 attributed to opioids. This study aimed to assess the dynamics of opioid related fatalities throughout the U.S. from 2006-2016. This study is a secondary analysis of data obtained through the Kaiser Family Foundation's analysis of Centers for Disease Control and Prevention data, 1999-2016. The data obtained were from all 50 states and the District of Columbia. A total of 272,130 individuals were included in the analysis. This represents the number of opioid overdose deaths in the United States from 2006-2016. Descriptive analysis of overall rates was conducted and mapped for visualization. Novel predictive models of increase for each drug overdose category were developed and used to calculate rate changes. Finally, the elasticity of change in rate for each drug category was calculated annually for the past 11 years. The highest rate of opioid overdose-related death occurred in West Virginia (40.03 per 100,000). In our secondary analysis, we explored the change in the rate of opioid-related deaths from 2015 to 2016. The changing dynamics of fatal opioid overdose at the state level is critical to guiding policy makers in addressing this crisis. Rates of fatal opioid overdose vary across the states, but we identify some trends. Regional differences are identified in states with the highest overdose rates from all opioids combined.

A fatal case after an intravenous injection of levamisole

Levamisole is a drug originally prescribed as an antihelmintic. Because of the occurrence of severe cases of agranulocytosis and leukoencephalitis it was removed from the French market in 1998 for human use, while it remains available for veterinary use. Nowadays in France its only use in humans is regulated by authorization for temporary use for its immunomodulatory properties in the treatment of nephritic syndrome.A 52-year-old man was found dead at his farm. Injection points were observed on his arm and a syringe containing a dark orange-brown liquid was found near the body. At his home, the discovery of a letter highlighted suicidal intent. Analysis of the aforementioned liquid, peripheral blood and urine confirmed the unique presence of levamisole. The femoral blood concentration of levamisole was of 25 mg/L whereas the femoral blood concentrations reported in cases of fatalities after cocaine use do not exceed 0.0056 mg/L. In humans, levamisole can be detected in biological samples after cocaine use as this drug is also an adulterant and one of its metabolites (aminorex) seems to have amphetamine-like properties. In this case, the man consumed levamisole from time to time for its stimulant and strengthening effects.Cases of fatal poisoning using levamisole are very rare and poorly documented, which makes the interpretation of postmortem blood levamisole concentration difficult.

Number of long-term inpatients in Japanese psychiatric care beds: trend analysis from the patient survey and the 630 survey

BACKGROUND

The number of psychiatric care beds and the mean length of stay in psychiatric care beds in Japan have decreased over the past 10 years. However, as has long been indicated here and elsewhere, Japan lags behind other countries in terms of deinstitutionalization. Furthermore, the population of inpatients in psychiatric care beds is aging dramatically. In addition to the diversification of mental illness, the question of what measures to implement going forward regarding current psychiatric bed resources has emerged as a new challenge.

METHODS

Using data from the Patient Survey and the 630 Survey, we examined trends in the number of long-term inpatients in psychiatric care beds in Japan through 2040. Population estimation was used for estimating long-term hospital bed demand because of small fluctuations in the admission and discharge of long-term inpatients.

RESULTS

In 2017, nearly one-third of all long-term hospitalized patients were aged ≥75 years, and an estimated 47% of the total are expected to die by 2040. Thus, the overall demand for long-term hospitalization is forecast to decrease sharply due to aging of currently hospitalized long-term inpatients. The number of long-term inpatients in 2017 was 167,579, and this is projected to decrease to 103,141 in 2040.

CONCLUSIONS

We believe it is necessary to adopt a multifaceted approach to promote hospital discharge and transition to the community, and to address the diversification of mental illness and the issue of psychiatric care bed supply/availability, which are forecast to decrease due to the natural decrease in long-term inpatients.

Low incidence of COVID-19 in the West African sub-region: mitigating healthcare delivery system or a matter of time?

Background

This study examines the growth trends in the COVID-19 pandemic and fatalities arising from its complications among tested patients in West Africa. Countries around the world have employed several measures in order to control the spread of the disease. In spite of the poor state of the healthcare delivery system in West Africa, the spread of the pandemic is relatively low compared to reported cases in other regions of the world. The study addresses this phenomenon by asking the question: is the low incidence of COVID-19 in the West African sub-region a mitigating healthcare delivery system or just a matter of time?

Methods

The study adopted a cross-sectional time series method. Data for Ghana, Nigeria, Burkina Faso, Ivory Coast, Senegal, Niger Republic, and global data were extracted from the World Health Organization COVID-19 databank. Data were extracted in intervals of 7 days from March 15 through April 19, 2020. Data regarding the incidence growth rate and fatalities arising from COVID-19 complications were generated from the total reported cases and fatalities over specified periods. Descriptive and inferential statistical analyses were carried out using Stata version 14.

Results

Results showed that the trends in growth patterns of COVID-19 for Senegal, Nigeria, Ghana, Republic of Niger, and West Africa generally followed the same fluctuating curves. The COVID-19 pandemic accounted for 92.3%, 97.8%, 90.3%, 65%, 90.4%, 93.6%, and 97% of complications that led to deaths of patients in Burkina Faso, Nigeria, Senegal, Ghana, Niger Republic, Ivory Coast, and West Africa, respectively. Also, the results established that there was a significant positive association between increased incidence of COVID-19 and percentage increase in fatalities arising from its complications in West Africa (ß = 0.032; t = 12.70; p < 0.001).

Conclusion

The threat presently posed by COVID-19 seems to be minimal in West Africa despite the poor state of the healthcare delivery system in the region. It is unlikely, however, that the region is well prepared for the pandemic in the event that it escalates out of control with time.

alcohol associated traffic injuries and fatalities from 2014 to 2018

BACKGROUND

Alcohol-impaired motor vehicle collision (MVC) fatalities comprise almost a third of total crash fatalities in the United States (U.S.). They also impose 20% of the total costs of MVCs annually. This study aims to evaluate an association between blood alcohol concentration (BAC) and number of crash injuries and fatalities from 2014 to 2018 in the U.S. Additionally, we aim to recommend solutions to reduce alcohol-impaired driving related injuries and fatalities.

METHODS

A retrospective analysis of National Highway Traffic Safety Administration (NHTSA) data of crash injuries, fatalities, and BAC levels (0.00 g/dl, 0.01-0.07 g/dl, and ≥ 0.08 g/dl) from 2014 through 2018. Descriptive statistical analysis and independent sample t-tests were conducted, with significance defined as p < .05.

RESULTS

Compared to BAC 0.01-0.07 g/dl,BAC ≥0.08 g/dl resulted in significantly more injuries (6779 vs. 1357, p < .001) and fatalities (10,522 vs. 1894, p < .001).

CONCLUSION

BAC level ≥ 0.08 g/dl produced significantly greater injuries and fatalities in comparison to lower BAC levels evaluated. Given the effects of alcohol-impaired driving on MVCs, the legal BAC level should be re-evaluated to protect citizens and reduce incidence of alcohol related traffic injuries and fatalities. Educational programs promoting responsible alcohol consumption need to be in place for individuals at high risk for driving under the influence.

Coronavirus disease 2019 and gender-related mortality in European countries: A meta-analysis

•

The article presents a meta-analysis of COVID-19-related mortality data from the Global Health 50/50 repository.

•

COVID-19-related mortality is higher in European men than in European women.

•

The male–female mortality risk ratio is 1.60 (95 % CI 1.53, 1.68).

Objective

To examine mortality rates related to coronavirus disease 2019 (COVID-19) by gender among European countries.

Methods

PubMed, preprint medRxiv and bioRxiv repositories, and Google were searched for the terms COVID-19, mortality rates, gender, and Europe. Only Google provided a website with appropriate information. COVID-19 cases and deaths from European countries were extracted by gender from the Global Health 50/50 repository up to May 23, 2020. Extracted data included country, the total number of COVID-19 cases and the number of related deaths by gender. Random effects models with the inverse variance method were used for meta-analyses. Results are reported as death risk ratios (RRs).

Results

We identified information from 23 European countries that reported separately by gender mortality rates related to COVID-19. The sample comprised 484,919 men and 605,229 women positive for COVID-19. The mortality rate was significantly higher in men than in women (risk ratio = 1.60, 95 % confidence interval [CI] 1.53, 1.68). The trend was similar when countries reporting < 5000, or < 10,000 cases were excluded from the analysis (RR = 1.60, 95 % CI 1.52, 1.69 and RR = 1.68; CI 1.62, 1.76, respectively).

Conclusion

In Europe, the new zoonotic coronavirus causes significantly more deaths in men than in women.

An analysis of fatal iatrogenic therapeutic errors reported to United States poison centers

OBJECTIVE

This is a descriptive study evaluating fatal iatrogenic and in-hospital medication errors reported to United States poison centers.

METHODS

A retrospective evaluation of the National Poison Data System from 2000-2017 of all therapeutic errors with a scenario coded as iatrogenic/healthcare professional or occurring in a healthcare facility. Death abstracts were reviewed for details of the exposure and therapeutic error scenarios were recoded or added to the case as appropriate. Cases, where death was considered not related to the exposure, were excluded. Additionally, we created one additional scenario (rate-related) and one additional route of administration (intrathecal) to better describe the cases.

RESULTS

A total of 172 cases were evaluated. The majority of the patients were female (52.3%) with a median age of 58.5 years (range: 2 days to 96 years). The most commonly reported medication error was "other incorrect dose" (22.7%) followed by other/unknown error (15.1%). The route of exposure was primarily parenteral (54.9%), followed by ingestion (30.2%), then intrathecal (7.0%). The most common medications were cardiac drugs, chemotherapeutics, opioids, anticoagulants, and sedative-hypnotic/antipsychotics.

CONCLUSIONS

Iatrogenic and in-hospital medication errors have been studied extensively with goals to reduce their occurrence. Specific controls to prevent incorrect dosing routes, 10-fold overdoses, and incorrect intrathecal administration have been instituted. Despite interventions, all three of these therapeutic errors continued to occur in 2017, suggesting that more preventive controls should be instituted.

Toxicological analysis of serious drug-related harm among electronic dance music festival attendees in New South Wales, Australia: A consecutive case series

BACKGROUND

A substantial increase in drug-related harm was observed during the 2018-2019 music festival season in New South Wales, Australia, including the deaths of five young people. As part of a rapid public health response, the New South Wales Ministry of Health referred samples from patients with suspected severe drug-related illness for forensic toxicological testing to identify the type and concentration of substances associated with the presentations.

METHODS

Cases were identified through a variety of active and passive surveillance systems, and selected consecutively based on indicators of clinical severity. Comprehensive toxicology testing of blood and urine samples was expedited for all cases. Demographic and clinical characteristics were collated, together with quantitative toxicology results. Results were analysed using descriptive statistics.

RESULTS

Forty cases from eleven different music festivals were included. The majority of cases (80.0%) were aged 25 years and under. There were five fatalities, and 62.5% of cases were admitted to intensive care units. MDMA was the most frequent substance, detected in 87.5% of cases. In 82.9% of cases with MDMA, blood concentrations were above thresholds that have been associated with toxicity. Multiple substances were detected in 60.0% of cases. Novel psychoactive substances were not detected.

CONCLUSIONS

Our findings strongly suggest that MDMA-related toxicity was a major factor in the severity of the clinical presentations among these cases. Other substances may have enhanced MDMA toxicity but appear unlikely to have caused severe toxicity in isolation. These findings have important implications for harm reduction strategies targeted to music festival settings.

Impacts of graduated driver licensing regulations

We evaluate the impact of the Graduated Driver Licensing (GDL) system introduced in Victoria, Australia as they influence both injury and fatality rates. Since 1990, the Victorian GDL scheme has undergone several modifications including the introduction of new requirements and the stricter enforcement of existing regulations. Our evaluation of the GDL is based on monthly mortality and morbidity data for drivers 18-25 for the period January 2000 to June 2017. We estimate the immediate and long-term impacts of each policy change to the GDL system. Our results indicate that several initiatives in the GDL system have had impacts on both fatalities and injuries requiring hospitalisation when differentiated by gender. In a number of cases we observe that reactions to these measures are common to both genders. These include: the signalling of the proposed GDL changes in the media, the introduction of an extra probationary year for those under 21, the total alcohol ban for the entire probationary period, and limits on peer passengers for the first year. Stricter mobile phone restrictions appear to have had no impact on injuries for either males or females although they were associated with lower fatality rates for both. In addition, we found an indication that in the period prior to the introduction of the mandatory requirement of 120 h supervised driving, there was a rise in male driver injuries possibly caused by a rush of more inexperienced learners to obtain their probationary licence.

Fatal outcomes following immunization errors as reported to the EudraVigilance: A case series

BACKGROUND

Serious adverse reactions after immunization are rare but do occur. In very rare instances, cases with fatal outcome have been reported. These reports can have a huge impact and even more so when due to an immunization error. The aim of this study is to systematically review immunization errors with fatal outcomes in EudraVigilance.

METHODS

This was a case-series analysis of Individual Case Safety Reports (ICSRs) reporting immunization errors and a fatal outcome. To determine the level of certainty of a causal association between the immunization errors and fatal outcomes two independent reviewers assessed all ICSRs using the WHO tool "Causality assessment of an Adverse Event Following Immunization (AEFI)". In accordance with the tool, the ICSRs were classified as consistent, indeterminate, inconsistent/coincidental, or unclassifiable. In addition, we estimated the contribution of reported errors to the fatal outcomes as large, moderate, small, none, or unclassifiable using a classification developed for this study.

RESULTS

A total of 154 ICSRs met the inclusion criteria. Vaccines reported most frequently were pneumococcal (33), rabies (27) and influenza vaccines (24). Most frequently reported errors were non-compliance with recommended schedules of immunization (63). The most frequently reported vaccine-error combination was rabies vaccines and non-compliance with a recommended schedule of immunization (23). Twelve cases were classified as consistent with causal association and had a large error contribution. These cases concerned a cluster of six cases reporting incorrect handling of multi-dose vials containing measles vaccine and six cases reporting administration of live-attenuated vaccines to immunocompromised patients.

DISCUSSION

In this study, we showed that fatal outcomes following immunization errors are very rare. Four key issues were the importance of: (1) quality control of multi-dose vaccines, (2) screening patients for immunocompromising factors, (3) education on the importance of adherence, and (4) measures to improve distinction between vaccines and medicines.

Why is the rate of annual road fatalities increasing? A unit record analysis of New Zealand data (2010-2017)

INTRODUCTION

Recent increases in road crashes have reversed New Zealand's formerly declining crash rates to produce annual fatal and serious injury counts that are 49% higher than the lowest rates achieved in 2013.

METHOD

We model twenty-one factors in fatal and serious injury crashes, four years before and after 2013 using logistic regression. Three major factors are significantly different in the period after 2013, when crash rates increased: (1) alcohol as a cause, (2) learner licence holders, and (3) a regional effect for Auckland. Newly defined speed zones are a more common setting for crashes in the period of upturn but there is no coinciding elevated likelihood of 'speed as a causal factor'. Three factors related to road safety were less common: aged under 25-years old, fatigue, and not wearing a seatbelt.

RESULTS

Results are compared to rates of prosecutions for alcohol-related driving offences over this period. It is possible that New Zealand's successful road safety initiatives of the past have been undermined by reduced levels of enforcement and an unexpected outcome from the graduated driving licence system.

Motor vehicle fatalities during Memorial Day weekends, 1981-2016

Objective

Motor vehicle crashes are a leading cause of injury death in the United States, and Memorial Day weekend is one of six holiday periods with an increased number of motor vehicle fatalities in the United States. However, few motor vehicle fatality comparisons were made between Memorial Day weekend and non-holiday periods. Our aims were to determine which day(s) during the holiday had highest motor vehicle fatality risk compared to non-holiday travel and to identify potential risk factors.

Results

Of 43,457 traffic fatalities studied, 15,292 (35%) occurred during the holiday, with Saturday being deadliest but Monday having highest odds of traffic fatality. Both sexes, all years, age < 65, drivers and passengers, rural and urban, and all regions in the United States were at increased risk during the holiday versus non-holiday periods.

Demographics, characteristics and chain of events

INTRODUCTION

The aim of this study was to identify characteristics of victims of fatal snorkelling and breath-hold diving accidents in Australia from 2001-2013, inclusive, to determine underlying factors and risks associated with such activities and inform appropriate countermeasures.

METHODS

The National Coronial Information System (NCIS) was searched to identify snorkelling and breath-hold diving-related cases reported to Australian coroners for the years 2001-2013, inclusive. Coronial data in the form of findings, witness and police reports, medical histories and autopsies were collected and collated, and descriptive statistics were used to analyse these data. A chain of events analysis was used to determine the likely sequence of events.

RESULTS

There were 175 identified snorkelling-related fatalities during the study period. Most victims were middle-aged males (mean age 49 years). Pre-existing health conditions were possible contributors to 41% of the deaths, the main being ischaemic heart disease. The majority of deaths occurred in Queensland in inexperienced snorkellers, often in commercial settings. The victim's plight often went unnoticed as they were alone, or poorly supervised, when the incident occurred. Apnoeic hypoxia appeared to have been associated with at least 12.5% of the deaths. The main disabling injuries were asphyxia (40%) and cardiac incidents (35%).

CONCLUSION

Human factors, such as chronic health conditions, poor skills and inexperience and poor planning can play a substantial role throughout the chain of events leading to a snorkelling fatality. It is important to educate the community, doctors and dive industry professionals about potential problems associated with the interaction between certain health-related conditions, especially cardiovascular conditions, and snorkelling. Close supervision is strongly recommended for inexperienced snorkellers due to their likely poor skills, as well as for experienced breath-hold divers due to the potential for apnoeic hypoxia.

Unintentional firearm deaths in the United States 2005-2015

Background

Unintentional gun death occurs four times more often in the United States than other high-income countries. Research on these deaths typically has a narrow scope. We believe this is the first study describing the circumstances of these deaths in the United States that covers more than a single state or municipality.

Methods

We use data on all unintentional firearm fatalities in the sixteen states reporting to the National Violent Death Reporting System (NVDRS) for all years 2005–2015. Our final count of unintentional firearm deaths in these states and years is 1260. The detailed nature of the data allows us to categorize and compare the circumstances of the incident.

Results

We estimate 430 unintentional firearm fatalities in the United States per year. The rate is highest for older children to young adults, ages 10 to 29, and the vast majority of the victims are male. Common circumstances include playing with the gun (28.3% of incidents), thinking the gun was unloaded (17.2%), and hunting (13.8%). The victim is suspected to have consumed alcohol in nearly a quarter of the deaths and in 46.8% of deaths among those aged 20–29.

Conclusions

Certain circumstances, such as consuming alcohol, playing with the gun, and hunting, are common settings for unintentional firearm deaths. Firearm safety instructors, firearm manufacturers, and firearm owners can all contribute to preventing these deaths.

Walking against or with traffic? Evaluating pedestrian fatalities and head injuries in Taiwan

BACKGROUND

Allowing contraflow cycling on one-way streets has been reported to reduce crash risks in Belgium and the United Kingdom. Similarly, walking against traffic on roadways without sidewalks substantially improves pedestrian safety. This study examined fatalities and head injuries sustained by pedestrians in against-traffic and with-traffic crashes.

METHODS

Using police-reported crash data in Taiwan between 2011 and 2016, fatalities and head injuries were compared for pedestrians involved in against-traffic and with-traffic crashes.

RESULTS

Of the 14,382 pedestrians involved in crashes, 10,749 and 3633 pedestrians in with-traffic and against-traffic crashes, respectively, were reported. Compared with pedestrians involved in against-traffic crashes, those in with-traffic crashes were more likely to sustain fatalities and head injuries. Results of logistic regression models revealed several influential factors on pedestrian fatalities and head injuries, including elderly pedestrians, male drivers, intoxicated drivers, rural roadways, unlit streets in darkness, limited sight distance, adverse weather conditions, midnight hours, and a heavy vehicle as the crash partner.

CONCLUSIONS

Pedestrians in with-traffic crashes were more likely to sustain fatalities and head injuries compared with those in against-traffic crashes. Furthermore, the negative effect of walking with traffic on injuries was more pronounced in reduced-visibility conditions.

Traverses, delays and fatalities at railway level crossings in Great Britain

This paper investigates relationships between traverses, delays and fatalities to road users at railway level crossings in Great Britain. A 'traverse' means a passage across a level crossing by a road user, who may be a pedestrian, cyclist, or occupant of a road vehicle. The paper finds that the road users with the highest fatality rate per traverse are pedestrians at passive crossings. Their rate is about three orders of magnitude higher than that of users with the lowest risk, who are road vehicle occupants at railway-controlled crossings. The paper considers the choice between automatic and railway-controlled crossings on public roads. Railway-controlled crossings are widely used in Britain. They are about one order of magnitude safer than automatic crossings, but they impose greater delays on users. A formula is developed to give the overall delay to road users at either type of crossing in terms of the numbers of road users and trains per day, and in terms of the length of time that the crossing must be closed to the road to allow the passage of one train. It is found that automatic level crossings cause substantially less delay than railway-controlled level crossings. The official monetary values of road user delay and of preventing a fatality were used to estimate the valuations of delays and fatalities at hypothetical but representative automatic and railway-controlled crossings. These valuations were then used to explore the effect of replacing representative railway-controlled with automatic crossings or vice-versa. It is found that the valuation of the reduced delays from adopting automatic crossings typically outweighs the valuation of the losses from the increased casualties. However, in practice Britain has chosen to retain a large number of railway-controlled crossings, which implies accepting the delays in return for a good level crossing safety record. Finally, an analysis is carried out to determine the additional risk of typical car and walk journeys that involve traversing a level crossing compared with similar journeys that do not. It is found that the additional risk is small for motor vehicle journeys, but substantial for walk journeys.

Road injury prevention in China: current state and future challenges

In just a few decades, China has undergone probably the fastest motorization of a transportation system in history. Now possessing the longest roadway network and the highest volume of car sales in the world, China has also faced major public health impacts from adopting automobiles, including air pollution and traffic fatalities. This paper synthesizes various sources to present the challenges to road safety in China. The country's rapid development expresses many patterns and features familiar to developed nations, such as declining urban density, increased use of sport utility vehicles, and strict drunk-driving laws. It also mirrors patterns familiar to developing nations-high-fatality rates for pedestrians and nondrivers, low salaries and corruption among police officers, and infrequent seat-belt use. Despite these similarities, China also exhibits particular attributes, such as a nationwide cadre evaluation system and tightly controlled media organization, which influence the traffic risks that receive national attention.

AAAAI/ACAAI Subcutaneous Immunotherapy Surveillance Study (2013-2017): Fatalities, Infections, Delayed Reactions, and Use of Epinephrine Autoinjectors

BACKGROUND

Subcutaneous allergen immunotherapy (SCIT) is highly effective but safety risks exist.

OBJECTIVE

The aims of this study were to: (1) identify clinical practices that could influence fatal and nonfatal systemic allergic reactions (SRs) to SCIT, and (2) identify SCIT-associated infections.

METHODS

From 2008 to 2016, 27% to 51% of American Academy of Allergy, Asthma, and Immunology/American College of Allergy, Asthma, and Immunology members completed an annual survey of SCIT-related SRs of varying severity. Injection-related local cutaneous and systemic infections were queried for 2014-2016. For 2014-2016, respondents were queried about timing of onset of SRs, postinjection waiting times, and prescription/use of epinephrine autoinjectors.

RESULTS

Data were gathered on 54.4 million injection visits (2008-2016). Two confirmed fatalities from SCIT occurred between 2008 and 2014. An additional 5 confirmed fatalities occurred between 2015 and 2017. No infections occurred in 17.3 million injection visits (2014-2016). Among practices monitoring patients for at least 30 minutes, 15% of SRs occurred after 30 minutes. Practices prescribing an epinephrine autoinjector >90% of the time (29% of practices) did not experience lower rates of delayed grade 3/4 SRs. Of patients experiencing grade 3/4 delayed SRs, 26% and 8% used prescribed self-injectable epinephrine devices during 2014-2015 and 2015-2016, respectively.

CONCLUSIONS

There is an unexplained slight increase in SCIT-related fatalities for 2015-2017, although mean annual reported events over 9 years (0.8 fatal reactions per year) have declined. SCIT-related infections were not identified during 2 years of surveillance. The 15% incidence of delayed-onset SRs (>30 minutes) is similar to a prior annual survey. Prescribing epinephrine autoinjectors for SCIT does not appear to improve outcomes, possibly due to low rates of self-administration.

An examination of the increases in pedestrian motor-vehicle crash fatalities during 2009-2016

INTRODUCTION

Pedestrian fatalities increased 46% in the United States during 2009-2016. This study identified circumstances under which the largest increases in deaths occurred during this period.

METHOD

Annual counts of U.S. pedestrian fatalities and crash involvements were extracted from the Fatality Analysis Reporting System and General Estimates System. Poisson regression examined if pedestrian fatalities by various roadway, environmental, personal, and vehicle factors changed significantly during 2009-2016. Linear regression examined changes over the study period in pedestrian deaths per 100 crash involvements and in horsepower per 1000 pounds of weight among passenger vehicles involved in fatal single-vehicle pedestrian crashes RESULTS: Pedestrian deaths per 100 crash involvements increased 29% from 2010, when they reached their lowest point, to 2015, the most recent year for which crash involvement data were available. The largest increases in pedestrian deaths during 2009-2016 occurred in urban areas (54% increase from 2009 to 2016), on arterials (67% increase), at nonintersections (50% increase), and in dark conditions (56% increase). The rise in the number of SUVs involved in fatal single-vehicle pedestrian crashes (82% increase) was larger than the increases in the number of cars, vans, pickups, or medium/heavy trucks involved in these crashes. The power of passenger vehicles involved in fatal single-vehicle pedestrian crashes increased over the study period, with larger increases in vehicle power among more powerful vehicles.

CONCLUSIONS

Efforts to turn back the recent increase in pedestrian fatalities should focus on the conditions where the rise has been the greatest.

PRACTICAL APPLICATIONS

Transportation agencies can improve urban arterials by investing in proven countermeasures, such as road diets, median crossing islands, pedestrian hybrid beacons, and automated speed enforcement. Better road lighting and vehicle headlights could improve pedestrian visibility at night.

New synthetic opioids: Part of a new addiction landscape

Synthetic opioids (SO) are a major risk for public health across the world. These drugs can be divided into 2 categories, pharmaceutical and non-pharmaceutical fentanyls. A new generation of SO has emerged on the drug market since 2010. North America is currently facing an opioid epidemic of morbi-mortality, caused by over-prescription of opioids, illegally diverted prescribed medicines, the increasing use of heroin and the emergence of SO. Furthermore, this opioid crisis is also seen in Europe. SO are new psychoactive substances characterized by different feature such as easy availability on the Internet, low price, purity, legality, and lack of detection in laboratory tests. They have not been approved or are not recommended for human use. Opioid misuse is associated with somatic and psychiatric complications. For many substances, limited pharmacological information is available, increasing the risk of harmful adverse events. Health actors and the general population need to be clearly informed of the potential risks and consequences of the diffusion and use of SO.

Impact of provincial characteristics on the number of traffic accident victims on interurban roads in Spain

This study has two aims. The first is to determine how various factors impact on the number of fatalities, serious injuries and slight injuries adjusted for the level of traffic on interurban roads in Spain. The second is to establish the number of victims per million vehicle-kilometres (veh-km) travelled on interurban roads in each province resulting from the effect of its specific characteristics. To this end, we developed six fixed effect panel data models with panel corrected standard errors for the 1999-2015 period. Our results show that while the proportion of high capacity roads, the unemployment rate and the motorization rate contribute to a reduction in the number of fatalities, serious injuries and slight injuries adjusted for level of traffic, the penalty-points licence system is effective in reducing the number of fatalities and serious injuries but not the number of slight injuries. Furthermore, the specific conditions in Ávila, Toledo, Madrid, Santa Cruz de Tenerife, Las Palmas de Gran Canaria, the Balearic Islands, Lleida and all the provinces on the Mediterranean coast cause a higher number of victims per million veh-km travelled than in the remaining provinces. Thus, greater public investment and more socially responsible behaviour are essential tools for reducing the number of traffic accident victims on Spanish interurban roads. Moreover, the provincial institutions emerge as key agents in improving road safety, due to their greater knowledge of the specific conditions and factors affecting each province.

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

INTRODUCTION

Little research has focused on the problem of alcohol impairment among pedestrians and bicyclists in the United States. The aim of the current study was to investigate the prevalence, trends, and characteristics of alcohol-impaired fatally injured pedestrians and bicyclists.

METHOD

Data from the Fatality Analysis Reporting System (FARS) were analyzed for fatally injured passenger vehicle drivers, pedestrians, and bicyclists 16 and older during 1982-2014. Logistic regression models examined whether personal, roadway, and crash characteristics were associated with high blood alcohol concentrations (BACs) among fatally injured pedestrians and bicyclists.

RESULTS

From 1982 to 2014, the percentage of fatally injured pedestrians with high BACs (≥0.08g/dL) declined from 45% to 35%, and the percentage of fatally injured bicyclists with high BACs declined from 28% to 21%. By comparison, the percentage of fatally injured passenger vehicle drivers with high BACs declined from 51% in 1982 to 32% in 2014. The largest reductions in alcohol impairment among fatally injured pedestrians and bicyclists were found among ages 16-20. During 2010-2014, fatally injured pedestrians and bicyclists ages 40-49 had the highest odds of having a high BAC, compared with other age groups.

CONCLUSIONS

A substantial proportion of fatally injured pedestrians and bicyclists have high BACs, and this proportion has declined less dramatically than for fatally injured passenger vehicle drivers during the past three decades. Most countermeasures used to address alcohol-impaired driving may have only limited effectiveness in reducing fatalities among alcohol-impaired pedestrians and bicyclists.

PRACTICAL APPLICATIONS

Efforts should increase public awareness of the risk of walking or bicycling when impaired. Results suggest the primary target audience for educational campaigns directed at pedestrians and bicyclists is middle-age males. Further research should evaluate the effectiveness of potential countermeasures, such as lowering speeds or improving lighting in urban areas.

A bibliometric analysis of the published road traffic injuries research in India, post-1990

BACKGROUND

Globally, road traffic injuries are the leading cause of death among those aged 15-29 years. However, road traffic injury research has not received adequate attention from the scientific community in low- and middle-income countries, including India. The present study aims to provide a bibliometric overview of research assessing road traffic injuries in India.

METHODS

We used Scopus to extract relevant research in road traffic injuries published from 1991 to 2017. This study presented the key bibliometric indicators such as trends of annual publications and citations, top 10 authors, journals, institutions and highly cited articles, citation analysis of articles, co-occurrence of keywords, etc. Analysis was performed using Scopus, Microsoft Excel, and VOS-viewer.

RESULTS

A total of 242 articles were retrieved with an h-index of 18, excluding self-citations. A steadfast growth of publications was documented in last decade, especially after the year 2010. The h-index of the top 10 authors, institutions, journals and highly cited articles did not surpass single digits. A network visualisation map showed that 'traffic accident', 'male', 'adolescent' and 'child' were the most commonly encountered key terms. The prominent authors were Gururaj G, Dandona R, and Hyder AA, whereas the top journals were the Indian Journal of Forensic Medicine and Toxicology, Medico Legal Update, and the International Journal of Applied Engineering Research and top institutions were the All India Institute of Medical Sciences, New Delhi, the Indian Institute of Technology, Delhi, and the Administrative Staff College of India.

CONCLUSION

In India, road traffic injuries research is inadequate in quantity and quality, warranting greater attention from researchers and policy planners to address the burden of road traffic injuries.

Life (and death) in Pink: The dangerous rise of synthetic opioids in the new psychoactive substances panorama

Novel psychoactive substances represent a recent and unprecedented challenge in the global health panorama. Recently, among these, synthetic opioids are growing in number and prevalence of use, leaving behind them severe intoxications and victims, and fuelling the illicit drug market, particularly on the Dark Net. Further attention should be drawn to this alarming phenomenon, from both clinicians and policymakers.

Injuries sustained in falling fatalities in relation to different distances of falls

BACKGROUND

Falling from a distance is an important issue worldwide, which happens in different ages, genders and circumstances. It is usually not considered a medicolegal case in many countries hence no autopsy is performed. This study focused on analyzing injuries sustained in victims of falling in relation to different distances of fall.

METHODS

Retrospective study of 352 autopsy reports of falling victims brought to the forensic pathology department at Jordan University Hospital during the period from January 1990 to March 2016.

RESULTS

Among 352 cases, 256 (72.7%) were males and 96 (27.3%) were females. 303 (86.1%) cases showed accidental fall, 31 (8.8%) were suicidal, 2 (0.6%) were homicidal and un-clarified death in 16 (4.5%). Time of death was directly proportionate with the distance of fall. Victims fell from distances less than 3 m were 123 (35%), most of them were children less than 7 years 50 (40.5%) and unemployed adults more than 45 years were 48 (39.1%). They showed multiple abrasions (62.6%), few contusions (64.2%) and absent laceration of the skin (84.5%). Victims fell from distances of 3-9 m were 123 (35%), most of them were male workers 56 (60.2%). They showed multiple abrasions (63.5%), few contusions (71%) and few lacerations of skin (50.5%). Victims fell from distances more than 9 m were 136 (38.6%), most of them were male workers 71 (52.2%) and female servants 23 (17%). They showed few abrasions (80.9%), multiple contusions (64.7%) and few lacerations of skin (48.5%). The number of fractured limbs increases obviously with distances more than 3 m. Skull vault fractures were found in all distances, while skull base fractures showed in distances of 3-9 m and more than 9 m. Head injury was the most common fatal injury in all distances. Chest injuries were prominent mainly in distances more than 3 m. While abdominal injuries were mainly prominent in distances more than 9 m.

CONCLUSIONS

This study showed the effect of different distances of fall in causing different types of injuries in falling fatalities. Internal injuries were in a direct proportion with distances of fall, while external injuries showed a great importance in interpretation of the way of fall.

MDPV and α-PVP use in humans: The twisted sisters

The new psychoactive substances phenomenon continues to represent a considerable public health challenge. Synthetic cathinones are β-keto amphetamine analogues, also known as legal highs, research chemicals, bath salts. These drugs have surfaced as a popular alternative to other illicit drugs of abuse, such as cocaine, MDMA, and methamphetamine, due to their potent psychostimulant and empathogenic effects. Pyrovalerone cathinones (a-pyrrolidinophenones) form a distinct group of designer cathinones, such as MDPV. After being listed as an illegal product, "second generation" compounds such as α-PVP, sharing a very similar chemical structure with MDPV, were developed. Clinical effects of these compounds are individual, dose- and route of administration-dependent. Both of them have been involved in an increased number of, not only acute intoxications but also fatalities over the past few years, raising concerns in the medical field. In this paper, we will review the available data regarding the use and effects of MDPV and α-PVP in humans in order to highlight their impact on public health. Health actors and general population need to be clearly informed of potential risks and consequences of these 2 novel psychoactive substances spread and use. The literature search conducted led to the identification of potentially 83 relevant articles. All articles were screened from their abstracts to determine their relevance in the framework of the current review. This article is part of the Special Issue entitled 'Designer Drugs and Legal Highs.'

Online news media reporting of football-related fatalities in Australia: A matter of life and death

OBJECTIVES

While deaths in sports settings are rare, they do occur. To develop an understanding of the sports and people most at risk, and to identify opportunities for prevention, routine and systematic data detailing the occurrence of these fatalities is required. There is currently no routine reporting of data of this nature in Australia. As there is often strong community interest in these incidents, the media offers an opportunity for surveillance. However before this can occur, understanding of the terminology used by the media is required. The aim of this study was to identify the terminology most frequently used in online Australian news media coverage of football-related deaths.

DESIGN

Retrospective review of online news media.

METHODS

Three databases were searched for online news media reports of people who died while participating in football (all football codes) in Australia. A descriptive analysis of terminology was undertaken to identify the common language applied.

RESULTS

Thirty-four football-related fatalities in Australia were identified between 2010-2016, via 149 separate articles. The most frequent terms identified in the media items were: Family; Club; Rugby; Football; Player; League; Died; Game; Death; Life; Loved; Hospital; Match; Young; Community; Playing; Friends; Sport; Heart; AFL [Australian Football League].

CONCLUSIONS

This study identified terminology used in reporting football-related fatalities in Australia, identifying common reference to terms relating to 'death' as metaphors and the frequent celebration of 'life.' The findings suggest that a reliance on researcher-generated terminology will be insufficient to reflect media discourse in prospective monitoring of sports deaths for surveillance.