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PubMed1988

[Fatal asthma].

Fatal asthma is rare but constitutes a serious public health problem on account of the raised prevalence of the disease. The incidence of fatal asthma is estimated at 3/100,000 people in France and the incidence of fatal asthma has not ceased to rise in the world despite therapeutic progress. The principal risk factors recognised are: 1. longstanding asthma, 2. unstable asthma, 3. acute severe asthma with a prior history, 4. insufficiently treated asthma or poorly compliant patient, 5. the absence of surveillance by peak flow measurements, etc. The socio-economic factors and above all the psychological factors play a role which is not negligible. A poor evaluation of the severity of the crisis by the asthmatic has been suggested as a factor, but it is possible that the rapidity of the progression of the crisis in fatal asthma may be responsible for the physical inability of the patient to react to the situation. There is no reason to incriminate beta-mimetic agents in fatal asthma. The prevention rests on an improvement in treatment, the education of the asthmatic and an improvement in medical teaching. However, only improvement in the speed of admission of emergency cases will effectively permit a reduction in the incidence of fatal asthma. The system of auto-admission of patients at risk should be reserved for co-operative patients but the systematic medicalization for urgent cases of asthma merits further development. A better definition of the asthmatic population at risk for fatal asthma is necessary.

Adolescent↗

PubMed1985

Fatal injuries to bicycle riders in Auckland.

Twenty bicycle riders were fatally injured in Auckland between 1974 and 1984. Eighteen were male and nine aged under 15 years. The age distribution of fatalities corresponds closely to the known age distribution of the cycling population. Few differences in pattern of injury were demonstrable between younger (under 15 years) and older riders. Sixteen died of fatal injury to multiple organ systems. Fourteen had fatal injury to brain, including four with no other significant organ injury. Fatal cardiopulmonary trauma was seen in seven riders and fatal abdominal trauma in seven. Cervical and high thoracic fracture dislocation with cord injury were seen in seven riders. Compared to the population base, incidence of fatalities is low, and no recent significant increase is detected.

Adolescent↗

PubMedDate not supplied

Fatalities associated with farm tractor injuries: an epidemiologic study.

Death certificates were used as a source of information to characterize fatalities associated with farm tractor injuries in Georgia for the period 1971-81. In this period, 202 tractor-associated fatalities occurred among residents of Georgia; 198 of these persons were males. The annual tractor-associated fatality rate for males based on the population of male farm residents was 23.6 per 100,000; rates of fatal injury increased with age for this population. Persons whose primary occupation was other than farming accounted for more than half of all tractor-associated deaths. Fatal injuries occurred throughout the year but predominantly during the planting and harvesting months. Injuries occurred throughout the day (7 a.m. to midnight), with a peak at 4 p.m. to 5 p.m. Most fatal injuries, 76 percent, resulted when tractors overturned. Fatalities were attributed to crushed chest, exsanguination, strangulation or asphyxia, drowning, and other injuries. Current safety standards for the operation of farm tractors are limited; rollover protective canopies are not required for farm owners or their family members. Descriptive epidemiologic information obtained from death certificates can be used to define injury determinants and to suggest approaches for the further study and prevention of specific types of injuries.

Accidents, Occupational↗

PubMed1998

Epidemiology of work-related aviation fatalities in Alaska, 1990-94.

Alaska, with less than one-half of 1% of the United States workforce, accounts for 9% of all occupational aviation fatalities nationally; 30% of all occupational fatalities in Alaska are related to aviation. To understand this high mortality, we investigated occupational aviation crashes to identify risk factors. Occupational aviation fatalities in Alaska during 1990-94 were examined using National Transportation Safety Board reports and merged with records from the Alaska Occupational Injury Surveillance System. There were 876 aircraft crashes; 407 (46%) were work-related. Occupational crashes were 2.2 times (CI: 1.5, 3.2) more likely to result in fatalities than non-occupational crashes. Risk factors identified included poor weather conditions defined as Instrument Meteorological Conditions (IMC). A crash during IMC was 5.3 times (CI: 3.5, 7.9) more likely to result in fatalities than crashes in other conditions. Of aircraft involved in fatal occupational incidents, 33% were not completely destroyed, allowing the potential for survivors. An estimated 30% reduction in fatalities could have occurred if current technology in occupant protection had been used.

Accidents, Aviation↗

PubMed1999

Evaluation of risk factors for fatal acute pancreatitis in dogs.

OBJECTIVE: To identify risk factors associated with fatal acute pancreatitis in dogs. DESIGN: Case-control study. ANIMALS: 70 case dogs with clinical evidence and histopathologic confirmation of fatal acute pancreatitis and 104 control dogs that had trauma, underwent necropsy, and did not have histologic evidence of acute pancreatitis. PROCEDURE: Information on signalment, weight, body condition, medical history, concurrent disease, and results of histopathologic examination was obtained by reviewing medical records. Logistic regression analysis included calculation of univariate and multivariate (adjusted) odds ratios and 95% confidence intervals. RESULTS AND CLINICAL IMPLICATIONS: Dogs with fatal acute pancreatitis were largely middle- to older-aged dogs. Risk of developing fatal acute pancreatitis was increased by overweight body condition, diabetes mellitus, hyperadrenocorticism, hypothyroidism, prior gastrointestinal tract disease, and epilepsy. Additionally, Yorkshire Terriers were at increased risk, and Labrador Retrievers and Miniature Poodles were at decreased risk, of developing fatal acute pancreatitis. Males and neutered females appeared to have an increased risk of developing fatal acute pancreatitis, compared with sexually intact females. Thrombus formation was more likely in dogs that developed fatal acute pancreatitis than in control dogs.

Acute Disease↗

PubMed1998

Denominator choice in the calculation of workplace fatality rates.

The U.S. government currently publishes workplace fatality rates, using employment as the denominator. However, employment may not be a good proxy for worker exposure to risk if groups of workers differ in their hours worked. Using micro data from the Census of Fatal Occupational Injuries and Current Population Survey, this paper presents alternative fatality rates calculated using employment and hours worked. Rates are compared for worker groups defined by gender, age, occupation, and industry. In general, both measures identify the same groups of workers as facing especially high and low fatality risks. The rank correlation of the employment- and hours-based fatality rates for 222 detailed occupations is very high, with a value of 0.99. However, for a few groups, the hours- and employment-based rates may differ more than 10%. Most notably, workers below age 20 and above age 64 have rates that are 60% and 37% higher, respectively, when hours is used in the denominator. This suggests that hours--the conceptually preferable denominator--should be used when possible to calculate workplace fatality rates.

Accidents, Occupational↗

PubMed1999

Comparison of fatal and severe nonfatal traumatic work-related injuries in Washington state.

OBJECTIVE: To compare fatal and hospitalized nonfatal work-related traumatic injuries by occupation and cause. METHODS: Fatal and hospitalized nonfatal injuries occurring from 1991-1995 were identified from Washington State workers' compensation claims data. Nonfatal injuries were classified as severe if they had at least one of the following criteria: a brain or spinal cord injury, an Injury Severity Score of >/=16, or were hospitalized for more than 7 days. The frequency and rate of fatal and severe nonfatal injuries were then described by industrial risk class and cause. RESULTS: The study identified 335 fatal injuries and 4,405 hospitalized nonfatal injuries, of which 1,105 were classified as severe. Tree topping and pruning, carnival work, roofing, and metal siding and gutters risk classes had several severe nonfatal injuries, but few, if any, fatalities. Causes of fatal and severe nonfatal injuries were notably different for the roofing, restaurant, and orchard workers risk classes. CONCLUSIONS: The inclusion of severe hospitalized injuries in occupational injury surveillance systems will provide a broader view of high-risk occupations and profile of injury causation with which to direct occupational injury prevention efforts.

Adult↗

PubMed2003

External cause-specific summaries of occupational fatal injuries. Part I: an analysis of rates.

BACKGROUND: Industries and occupations vary with respect to the incidence of fatal injuries and their causes. METHODS: Fatalities from the National Traumatic Occupational Fatality database (years 1983-1994) serve as the basis for examining external cause of death code specific rates. Industries and occupations are compared with respect to rate and frequency of fatal injuries. In addition, external causes of injury (E-codes) are examined across all industries and occupations as well as within industries and occupations to evaluate which events would be identified by frequency ordered comparisons versus injury rate ordered comparisons. RESULTS: Machinery, electric current, homicide, falls, and transportation-related events are identified by high frequency and rate of occurrence. CONCLUSIONS: The external cause categories of homicide, machinery-related, motor-vehicle-related, electric current, and falls, account for over one-half of all occupational fatal injuries. Targeted interventions in homicide may be especially warranted in sales and service occupations and in the retail trade and services industries. In addition, younger workers might be targeted for special interventions designed to identify hazardous practices, procedures, and solutions to reduce fatalities associated with electrocution or falls from buildings.

Accidental Falls↗

PubMed2004

Neglecting safety precautions may lead to trenching fatalities.

BACKGROUND: Trench collapses ranked as the seventh leading cause of the possible twenty-nine causes of OSHA-inspected fatal construction events during the period 1991-2001. This study aims to examine why these fatalities occurred. METHODS: Forty-four case files from OSHA inspections of fatal trench collapses were reviewed. RESULTS: Improper protection of the excavation site where work was taking place was the leading fatality cause. Several organizational or physical conditions were present at many fatal sites; the most frequent was that no training had been provided for trenching. CONCLUSIONS: Presence of a competent, diligent person at the site would have prohibited most fatalities. The top cited violation was lack of protection, that is, benching, shoring, sloping, trench boxes, etc. (29 CFR 1926.652 (a) (1)).

Accidents, Occupational↗

PubMed2004

Effects of data limitations when modeling fatal occupational injury rates.

BACKGROUND: Occupational fatal injury rate studies are often based upon uncertain and variable data. The numerator in rate calculations is often obtained from surveillance systems that can understate the true number of deaths. Worker-years, the denominator in many occupational rate calculations, are frequently estimated from sources that exhibit different amounts of variability. METHODS: Effects of these data limitations on analyses of trends in occupational fatal injuries were studied using computer simulation. Fatality counts were generated assuming an undercount. Employment estimates were produced using two different strategies, reflecting either frequent but variable measurements or infrequent, precise estimates with interpolated estimates for intervening years. Poisson regression models were fit to the generated data. A range of empirically motivated fatality rate and employment parameters were studied. RESULTS: Undercounting fatalities resulted in biased estimation of the intercept in the Poisson regression model. Relative bias in the trend estimate was near zero for most situations, but increased when a change in fatality undercounting over time was present. Biases for both the intercept and trend were larger when small employment populations were present. Denominator options resulted in similar rate and trend estimates, except where the interpolated method did not capture true trends in employment. CONCLUSIONS: Data quality issues such as consistency of conditions throughout the study period and the size of population being studied affect the size of the bias in parameter estimation.

Accidents, Occupational↗

PubMed1990

A methodology for the collection of supplemental information on agricultural fatalities.

Due to the lack of a standardized methodology to identify agriculturally related fatalities and the inaccuracy of data from death certificates, NSC's and NIOSH's estimates of the level of agriculturally related fatalities conflict, and the validity of both is subject to criticism. A follow-up survey with the next of kin of 107 potential agricultural fatalities, from a pool of 150 Pennsylvania cases, has been conducted. This paper details the methods and success in gaining supplemental information. Next of kin were generally willing to provide the information (67%), with both telephone (66%) and mail (68%) methods generating comparable levels of cooperation. The optimal time frame for finding current addresses and telephone numbers as well as for gaining cooperation appeared to be about 1 year after the fatality. However, a retrospective investigation of up to 3 years past the anniversary of the fatality produced an acceptable rate of cooperation. How the collected data compares with fatality data for agriculture published by NSC and N1OSH has been addressed in another paper.

Accidents, Occupational↗

PubMed1996

Fatal work-related injuries in the U.S. chemical industry 1984-89.

Several mortality studies of the chemical industry have examined fatal injuries, but most of these studies have been of employees of large chemical firms and have not separated work-related from non-work-related injuries. We examined all U.S. Occupational Safety and Health Administration (OSHA) investigation files in 1984-89 in 47 U.S. states of fatal injuries in the chemical industry, Standard Industrial Classification (SIC) 2800-2899. OSHA investigates all reported deaths over which it has jurisdiction; this includes most causes of work-related death except for homicide and motor vehicle crashes. For the 6 year period, there were 234 fatalities in the chemical industry, for a work-related fatality rate of 0.55 per 10,000 workers/year. The largest category of deaths was from explosions, with 99 (42%), followed by fire & burns, with 32 (14%), poisoning, with 31 (13%), and falls, with 18 (8%). Of the 99 deaths from explosions, 45 (45%) involved manufacture or handling of fireworks or other explosives. The fatality rate at firms with fewer than 50 employees was more than twice that of larger firms (P < 0.05) and employees at small firms were less likely to have been covered by a union contract (P < 0.05). OSHA issued citations for safety violations in 73% of the deaths. While regulatory authorities and the media often focus attention on large, multinational chemical corporations, the highest worker fatality rates are found at the smallest chemical firms.

Accidental Falls↗

PubMed2006

Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings.

We examined the relationship between provider fatalism, a belief that behavior change among HIV-infected patients is unlikely, and HIV-prevention counseling in 16 publicly funded clinics. HIV-seropositive patients (N = 618) completed surveys assessing prevention counseling in the past 6 months. Additionally, 144 interviews were conducted with providers, administrators, and patients to examine beliefs about prevention counseling. We summed the number of fatalistic comments made by providers and administrators in each clinic, and assigned these counts as clinic-level fatalism scores to survey participants. Patients in high fatalism clinics were less likely to report prevention counseling than patients in low fatalism clinics. This difference remained significant even after controlling for clinic characteristics or patients' sexual risk and health status. However, clients in high fatalism clinics were more likely to be White, gay, educated, and older. Provider fatalism is a barrier that must be addressed when implementing HIV-prevention counseling in primary care settings.

Adult↗

PubMed2006

Population-based mammography screening results in substantial savings in treatment costs for fatal breast cancer.

AIMS: The aim was to assess the effect of population-based mammography screening on treatment costs for fatal breast cancer in Turku, Finland. MATERIALS AND METHODS: The study included 556 women with invasive breast cancer, diagnosed at the age of 40-74 years in 1987-1993: 427 in the screened group (screen-detected or interval cancer) and 129 in the unscreened group (not yet invited or refused screening). Both groups were followed up for 8 years from diagnosis. RESULTS: In the unscreened group, 32 (25%) patients died of breast cancer versus 49 (12%) in the screened group (p < 0.001). The non-discounted mean treatment costs were 2.8-fold for those dying of breast cancer compared to survivors: 26,222 euros versus 9,434 euros; the difference between means was 16,788 euros (95% CI 14,915-18,660) (p<0.001). The mean costs for fatal cases were high, irrespective of the way cancer was detected: 23,800 euros in the unscreened group versus 27,803 euros in the screened group; the difference between means was -4,003 euros (-10,810 to 2802) (p=0.245). In the unscreened group, patients with fatal breast cancer accounted for 41% (0.76/1.87 million euros) of the total treatment costs versus 29% (1.36/4.76 million euros) in the screened group. It was estimated that about one third of costs for fatal breast cancer were avoided through mammography screening, accounting for 72-81% of the estimated total treatment cost savings achieved by screening. About 31-35% of the screening costs for 1987 to 1993 were offset by savings in treatment costs. CONCLUSIONS: Treatment costs for fatal breast cancer are high. Mammography screening results in substantial treatment cost savings, in which reduction of fatal disease is the key element.

Adult↗

PubMed1990

The effects of the new 65 mile-per-hour speed limit on rural highway fatalities: a state-by-state analysis.

This paper examines the effects of the new 65 mile-per-hour (mph) speed limit on U.S. rural highway fatality counts. Separate analyses are conducted for each of the 40 states that had adopted the new (higher) limit by mid-1988. Using monthly Fatal Accident Reporting System (FARS) data from January 1976 through November 1988, time-series regression equations--including policy variables, seasonal variables, and surrogate exposure variables--are estimated for each state. The results suggest that the new laws have increased fatalities on both rural interstate and rural noninterstate highways in most states, but also that these effects differ substantially across the states. For rural interstate fatalities the estimates suggest a median (among the 40 states) effect of the increased speed limit of roughly 15% more fatalities; the median estimates for rural noninterstates suggest a 5% increase in fatalities due to the increased speed limits. Estimates such as those reported here should be revised as more information becomes available.

Accidents, Traffic↗

PubMed1992

Restrained front seat car occupant fatalities--the nature and circumstances of their injuries.

The circumstances of a rural and urban sample of fatalities in vehicles less than six years old is described. The data originate from an in-depth, multidisciplinary study of accidents conducted in England since 1983. The sample is biased towards collisions that result in occupant injury, and this paper will concentrate on those accidents in which an occupant has been fatally injured. The initial police reporting of the fatalities included 11% of the deaths occurring from natural causes. Of the crash-related deaths with complete data, some 43% were frontal and lateral impacts, and they are analysed in greater detail. Thirty-six percent of restrained occupants died in lateral collisions. In both frontal and lateral crashes, large amounts of intrusion result in direct loading of the head and chest, particularly. Under-run crashes with large trucks constitute 30% of frontal death cases, and only 12% of fatalities received fatal injuries from belt loads. Of those cases, additional loading by unrestrained rear passengers could have been an important feature. Multiplicity of severe injuries is the rule for restrained fatalities, with head injuries as the most common cause of death. Eighty-two percent died within an hour of their crashes. Some consequences for vehicle compatibility in crashes are discussed.

Accidents, Traffic↗

PubMed1993

Single-vehicle crashes and alcohol: a retrospective study of passenger car fatalities in northern Sweden.

This retrospective study of fatal passenger car crash victims in northern Sweden compares 396 multiple-vehicle (MV) and 201 single-vehicle (SV) fatalities from 1980 through 1989. Compared to MV fatalities, SV victims were more frequently males, were younger, were more often inebriated, had higher blood alcohol concentrations, had a higher frequency of fatty liver, and were less often restrained. The SV fatalities occurred most often from May through October, from Fridays through Sundays, and from 9 p.m. to 6 a.m. The road surface was usually dry, especially for drunken SV drivers. The SV drivers also more often lacked a valid driver's license. The study confirms that alcohol is one of the most important factors associated with traffic fatalities, particularly in SV crashes. More than half (56%) of the SV victims were inebriated by alcohol (MV, 11%), had a mean blood alcohol concentration of 1.9 g/l (MV, 1.6 g/l), and one-third had a fatty liver (MV, 20%). We also found a relation between fatty liver and increased blood alcohol concentrations, suggesting that studies regarding the role of alcohol in traffic fatalities should also include an evaluation of liver morphology.

Accidents, Traffic↗

PubMed1996

Fatal occupational falls in the U.S. construction industry, 1980-1989.

Death certificate analyses were conducted on all fatal occupational falls occurring between 1980 and 1989 in the United States' construction industry using the National Traumatic Occupational Fatalities surveillance system at the National Institute for Occupational Safety and Health, Division of Safety Research. Fatality rates were calculated by geographic location (region and state), and year of injury. From 1980 to 1989, there were 2798 deaths due to occupational falls in construction, representing 49.6% of all fatal occupational falls across all industries. Most of these incidents occurred among young white males. By geographical location, the highest fatality rates were observed within the subregions of the Southern states in the United States. In observing the time between the date of injury and the date of death, 66% of the fall victims died on the same day as the injury, whereas 5.7% lived more than 90 days before dying. Further research needs to be targeted at what occupations are at highest risk for a fall injury, what circumstances are attributable to these falls, and prevention strategies to reduce fall injuries and fatalities. Research is also needed to explain why there are geographic differences in occupational falls in the construction industry.

Accidental Falls↗