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PubMed1986

Detection of enteropathogens in fatal and potentially fatal diarrhea in Cairo, Egypt.

A 1-year study of the etiology of acute diarrhea complicated by severe (10%) dehydration, active bleeding, shock and cardiovascular collapse, pneumonia, acute renal failure, or seizures in infants under 18 months of age was performed in Cairo, Egypt. Of 145 infants, 19 (13%) died or left the hospital moribund; the remaining 126 patients were classified as having potentially fatal illness. A variety of enteropathogens were identified with approximately equal frequency in the fatal and nonfatal complicated cases as well as in 135 controls with severe uncomplicated diarrhea. The agents most frequently detected in infants with severe diarrhea in this population which were felt to be etiologically important were rotavirus (33%), heat-stable enterotoxin-producing Escherichia coli (20%), heat-labile enterotoxin-producing E. coli (11%), enteropathogenic E. coli (8%), and Salmonella spp. (5%). The high rate of occurrence of Giardia lamblia (35%) probably represented the high carriage rate of the protozoan in this population. Complicated (fatal and potentially fatal) cases differed from control cases in a number of ways: the onset of diarrhea was more sudden, the course was progressive and of greater initial intensity, vomiting occurred more frequently, the patients more often had visited another physician before coming to the hospital, the patients more often had respiratory symptoms and pulmonary abnormalities on auscultation, hypoactive bowel sounds and abdominal distention were more common, as was oliguria, and the patients showed lower mean body weights.

Diarrhea↗

PubMed2006

Risk of fatal and non-fatal occupational injury in foreign workers in Spain.

STUDY OBJECTIVE: In the past decade, Spain has experienced dramatic growth of its immigrant population. Available information on the occupational conditions of foreign workers is scarce. This study aims to add to this information by describing occupational injuries in foreign workers in Spain. DESIGN, SETTING, PARTICIPANTS: Data were analysed from the 2003 Ministry of Labour and Social Issues registry of non-fatal and fatal occupational injury in insured workers. The population at risk was estimated from the Social Security Affiliation Registry as of 31 December 2003. Comparing Spanish with foreign workers and also considering age and sex, incidence rates and relative risks, and their confidence intervals at 95%, were calculated within each population group. MAIN RESULTS: In women and in men, and in every age group, foreign workers had an increased risk of non-fatal and fatal occupational injury compared with Spanish workers. The differences were especially notable in foreign women workers and in older workers. CONCLUSIONS: Many factors probably combine to cause the differences found in this study. Better data collection on the situation of foreign workers is needed to understand these facts and apply appropriate public health solutions.

Accidents, Occupational↗

PubMed2002

Level of fibrinogen and risk of fatal and non-fatal stroke. EUROSTROKE: a collaborative study among research centres in Europe.

BACKGROUND: It is well established that raised levels of fibrinogen increase the risk of coronary heart disease. For stroke, however, data are much more limited and restricted to overall stroke. This study investigated the association between fibrinogen and fatal, non-fatal, haemorrhagic and ischaemic stroke in three European cohorts participating in EUROSTROKE. METHODS: EUROSTROKE is a collaborative project among ongoing European cohort studies on incidence and risk factors of stroke. EUROSTROKE is designed as a nested case-control study. For each stroke case, two controls were sampled. Strokes were classified according to MONICA criteria or reviewed by a panel of four neurologists. Recently, data on stroke and fibrinogen became available from cohorts in Cardiff (79 cases/194 controls), Kuopio (74/124), and Rotterdam (62/203). Results were adjusted for age, sex, smoking, and systolic blood pressure. RESULTS: The risk of stroke gradually increased with increasing fibrinogen levels: the odds ratios per quartile increase were 1.08 (95% CI 0.63 to 1.84), 1.91 (1.12 to 3.26) and 2.78 (1.64 to 4.72), respectively. This association was similar for ischaemic (n=138) and haemorrhagic stroke (n=25). Associations between fibrinogen and stroke were similar across strata of smoking, diabetes mellitus, previous myocardial infarction, and HDL cholesterol. The odds ratio, however, tended to increase with increasing systolic blood pressure: from 1.21 among those with a systolic pressure <120 mm Hg to 1.99 among subjects with a systolic pressure of 160 mm Hg or above. CONCLUSION: This analysis of the EUROSTROKE project indicates that fibrinogen is a powerful predictor of stroke. Results did not disclose a differential in this relation of fibrinogen and fatal or non-fatal stroke, or with type of stroke (ischaemic or haemorrhagic).

Adult↗

PubMed1994

Patterns of increasing beta-agonist use and the risk of fatal or near-fatal asthma.

The association between the use of inhaled beta-agonists by metered-dose inhaler and the risk of fatal or near-fatal asthma has been demonstrated. It shows that asthmatics who use one canister of beta-agonist per month more than the number used by other similar asthmatics have twice the risk of fatal or near-fatal asthma. The present investigation assesses the magnitude of this excess risk when an asthmatic increases his/her own monthly use of inhaled beta-agonists over time. From a previous nested case-control study of 129 deaths and near-deaths from asthma (cases) and 655 controls from a cohort of 12,301 asthmatics, the subset using at least 12 inhalers during the 12 month study period was identified (97 cases and 258 controls). A profile score, ranging 0-11, was formed to quantify the patterns of beta-agonist use over time for each subject, covering the entire spectrum extending from decreasing to increasing use. The relative risk was 15.2 (95% confidence interval (CI) 2.4-96.2) per unit increase of the profile score in subjects with a pattern of increasing beta-agonist use (profile score of 6.5 or more), but this relative risk was only 1.5 (95% CI 0.8-2.6) per unit when the profile score was less than 6.5 (non-increasing use). This relative risk was independent of the risk associated with the total quantity of beta-agonist use in the 12 month period, which remained around 1.6 (95% CI 1.3-2.0) per inhaler per month.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗

PubMed2001

The work-related fatal injury study: numbers, rates and trends of work-related fatal injuries in New Zealand 1985-1994.

AIMS: To determine the number and rates of work-related fatal injuries by employment status, occupation, industry, age and gender in New Zealand 1985-1994. METHODS: Potential cases of work-related injury deaths of persons aged 15-84 years were identified from the national electronic mortality data files. Main exclusions were deaths due to suicide and deaths due to motor vehicle crashes. The circumstances of the deaths of each fatal incident meeting inclusion criteria were then reviewed directly from coronial files to determine work-relatedness. RESULTS: The rate of work-related fatal injury in New Zealand was 5.03/100000 workers per year for the study period. There was a significant decline in crude rate over the study period. However, this was in substantial part accounted for by changes in occupation and industry mix. Older workers, male workers, self-employed workers, and particular occupational groups, all had substantially elevated rates. Agricultural and helicopter pilots, forestry workers and fishery workers had the highest rates. Farmers, forestry workers, and fishery workers also had high numbers of deaths, together accounting for nearly 40% of all deaths. CONCLUSIONS: This study has demonstrated that work-related fatal injury remains a pressing problem for New Zealand. Several areas in urgent need of prevention efforts were highlighted.

Accidents, Occupational↗

PubMedDate not supplied

Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use.

OBJECTIVE: To examine the relationship between patterns of use of inhaled beclomethasone dipropionate and the risk of fatal and near-fatal asthma. DESIGN: Nested case-control analysis of a historical cohort; a further analysis. SETTING: The 12,301 residents of Saskatchewan aged 5 to 54 years who were dispensed 10 or more asthma drugs from 1978 to 1987. PATIENTS: The 129 persons who experienced asthma death (n = 44) and near-death (n = 85) and their 655 controls matched as to age and date of entry into the cohort, with the additional matching criteria of at least one hospitalization for asthma in the prior 2 years, region of residence, and having received social assistance. MAIN OUTCOME: Life-threatening attacks of asthma defined as death due to asthma or the occurrence of hypercarbia, intubation, and mechanical ventilation during an acute attack of asthma. RESULTS: After accounting for the risk associated with use of other medications and adjustment for markers of risk of adverse events related to asthma, subjects who had been dispensed, on average, one or more metered-dose inhalers of beclomethasone per month over a 1-year period had a significantly lower risk of fatal and near-fatal asthma (odds ratio, 0.1; 95% confidence interval, 0.02 to 0.6). CONCLUSION: These data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma.

Administration, Inhalation↗

PubMed1992

Fatal and near fatal asthma.

Despite the recent development of apparently effective asthma drugs, the number of deaths from asthma has not declined. The authors tried to establish an optimal strategy for the prevention of acute asthmatic death by analyzing the circumstances of acute fatal or near-fatal asthma. Data were collected from 51 adult patients admitted to Bokutoh Tertiary Emergency Center due to acute asthma between November 1985 and May 1990 and 38 asthmatic patients admitted to Yokohama City Hospital in 1990. Pre-admission data were obtained through interviews with the patients, their families, or doctors who had seen them. A total of 89 patients were classified into three subgroups: group 1 consisted of patients dead-on-arrival (DOA); group 2, non-DOA patients with disturbed consciousness; and group 3, patients with less severe episodes. Little background information was significantly different among groups, but symptomatic episodes in group 1 patients tended to occur more rapidly. The speed of onset of the episodes was also dependent on the asthma control status. Prehospital care of groups 1 and 2 patients was very poor despite severity of the symptoms. All patients in groups 2 and 3 were successfully treated and discharged, but five of the 26 patients in group 2 died during follow-up periods. Prognosis of patients after discharge appeared to be dependent upon asthma control status before the acute episodes. It was concluded that acute fatal or near fatal asthma could occur in apparently low-risk patients as well as high-risk ones. It was also suggested that the optimal strategy for preventing asthma deaths might be variable.

Adult↗

PubMedDate not supplied

[Air pollution and fatal and non fatal coronary events in Rome].

OBJECTIVE: To examine the relationship between air pollution and coronary events in Rome in the period 1998-2000, considering both out-of-hospital deaths and hospitalisations. DESIGN: Time-series of daily counts of out-of-hospital deaths and hospitalised events, implementation of Generalised Additive Models. SETTING: The air pollutants taken into account were PNC (Particle Number Concentration--a measure of ultrafine particles), PM10, CO, NO2, SO2 and O3. The association was studied with respect to either single days or the cumulative effect on more consecutive days; furthermore, effect modification by age was tested (for the age groups 0-64, 65-74 and 75+). PARTICIPANTS: People resident of Rome and died/hospitalised for coronary causes into the city in the period 1998-2000. MAIN OUTCOME MEASURE: Association between pollutants and out-of-hospital deaths/hospitalised events. Distinction between fatal events (out-of-hospital deaths + hospitalisations with death within 28 days of admission) and non fatal events (hospitalisations with survival longer than 28 days). RESULTS: Significant association between PNC, PM10, and CO with out-of-hospital deaths, smaller effect on hospitalised events. For a variation of PNC of 28000 particles per cm3 (interquartile range of the distribution) the increase in the risk of out-of-hospital coronary death at lag 0 was 8.1%; for hospital admissions, the risk increased by 4%. The association was stronger in subjects older than 65, and was more evident for total fatal events than for non-fatal hospitalisations. CONCLUSION: The study showed increased risks of coronary events associated with air pollution in Rome: ultrafine particles, directly generated by vehicular traffic, are the environmental indicator which best characterizes the health risk.

Adult↗

PubMed1980

Fatal and non-fatal deliberate self-harm in the Wellington region 1978: a social analysis.

Some characteristics of the people who deliberately harmed themselves in the Wellington Hospital Board region in 1978, and who were either admitted to hospital or died, are described. Records show 32 people killed themselves and 306 people were admitted to hospital. Twenty-six people were admitted twice. The rate of non-fatal events was nine persons per 10000 population. For fatal events, males and unemployed people were at greater risk. Drugs were used in nine out of 32 cases. The characteristics of people at greater risk in 1978 of non-fatal deliberate self-harm were female; aged 15 to 24 years if female and 15 to 29 years if male; unemployed, sickness beneficiary or in a service occupation; domiciled in the inner city; and separated from their spouse. Drugs were used in 96.5 percent of non-fatal events. The length of stay in hospital for 48.5 percent of admissions was one day.

Adolescent↗

PubMed2002

Fatal asthma from powdering shark cartilage and review of fatal occupational asthma literature.

BACKGROUND: Work-related asthma (WRA) is the most common work-associated respiratory disease in developed countries. METHOD: We report shark cartilage dust as a new potential cause of occupational asthma (OA) in the context of other fatal OA case reports. RESULTS: A 38-year-old white male worked for 8 years in a facility which primarily granulated and powdered various plastics. Sixteen months prior to his death, the plant began grinding shark cartilage. After 10 months of exposure, he reported chest symptoms at work in association with exposure to shark cartilage dust and a physician diagnosed asthma. Six months later, he complained of shortness of breath at work and died from autopsy-confirmed asthma. The latency from onset of exposure to symptoms and from symptom onset to death was shorter than 10 previously reported OA fatalities. CONCLUSION: Recognition of occupational causes and triggers of asthma and removal of affected individuals from these exposures is critical and can prevent progression to irreversible or even fatal asthma.

Adult↗

PubMed1990

TNF concentration in fatal cerebral, non-fatal cerebral, and uncomplicated Plasmodium falciparum malaria.

Plasma levels of tumour necrosis factor (TNF) were significantly higher in 178 Gambian children with uncomplicated malaria due to Plasmodium falciparum than in 178 children with other illnesses. 110 children with cerebral malaria were studied shortly after admission to hospital; 28 subsequently died. Compared with the children with uncomplicated malaria, mean plasma TNF levels were twice as high in cerebral malaria survivors and ten times as high in the fatal cases. Although high TNF levels were associated with high parasitaemia and with hypoglycaemia, they predicted fatal outcome in cerebral malaria independently of parasitaemia and glucose concentrations. Concentrations of interleukin-1 alpha, but not interferon gamma, were also related to the severity of malaria. We conclude that increased TNF production is a normal host response to P falciparum infection, but that excessive levels of production may predispose to cerebral malaria and a fatal outcome.

Animals↗

PubMed2005

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

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

Accidents, Traffic↗

PubMed2004

Fatal and non-fatal injuries caused by crossbows.

Today in modern times, traumatic injuries caused by crossbows are a rarity. The largest collection of cases so far is presented in this study, consisting of four fatalities (two homicides and two suicides) and two non-fatal injuries (grievous bodily harm and an accident). All the victims were male having an age between 31 and 54. The weapons, which were used, were mainly high-performance precision crossbows with telescopic sights and hunting bolts. The parts of the body involved were the facial/head area in three of the cases and the thorax in three of them. There were either deep or total penetration injuries to the cranium and thorax with the bolt remaining in the wound in four out of six cases. The persons with non-fatal crossbow injuries exhibited comparatively few symptoms, despite the sometimes extensive involvement of the interior of the cranium (cerebrocranial penetration, in one instance). The two cases of suicide favoured the body areas often found with gun-users. The aetiological classification of crossbow injuries may be difficult after the removal of the bolt. The external morphology is strongly dependent on the type of tip used. Multiple-bladed hunting broadheads produce radiating incised wounds, whereas conical field tips produce circular to slitlike defects. Correspondingly, the external injuries can be reminiscent of the effects of a violent attack by sharp force or of a gunshot wound. The possibility, supported by clinical data, that the victim might have the ability to act or even to survive for a period of time, even with penetration of the brain, should be taken into account when the cause of death is being investigated.

Accidents↗

PubMed2005

Analysis of non-fatal and fatal injury rates for mine operator and contractor employees and the influence of work location.

INTRODUCTION: Mining injury surveillance data are used as the basis for assessing the severity of injuries among operator and contractor employees in the underground and surface mining of various minerals. METHOD: Injury rates during 1983-2002 derived from Mine Safety and Health Administration (MSHA) database are analyzed using the negative binomial regression model. The logarithmic mean injury rate is expressed as a linear function of seven indicator variables representing Non-Coal Contractor, Metal Operator, Non Metal Operator, Stone Operator, Sand and Gravel Operator, Coal Contractor, and Work Location, and a continuous variable, RelYear, representing the relative year starting with 1983 as the base year. RESULTS: Based on the model, the mean injury rate declined at a 1.69% annual rate, and the mean injury rate for work on the surface is 52.53% lower compared to the rate for work in the underground. With reference to the Coal Operator mean injury rate: the Non-Coal Contractor rate is 30.34% lower, the Metal Operator rate is 27.18% lower, the Non-Metal Operator rate is 37.51% lower, the Stone Operator rate is 23.44% lower, the Sand and Gravel Operator rate is 16.45% lower, and the Coal Contractor rate is 1.41% lower. Fatality rates during the same 20 year period are analyzed similarly using Poisson regression model. Based on this model, the mean fatality rate declined at a 3.17% annual rate, and the rate for work on the surface is 64.3% lower compared to the rate for work in the underground. With reference to the Coal Operator mean fatality rate: the Non-Coal Contractor rate is 234.81% higher, the Metal Operator rate is 5.79% lower, the Non-Metal Operator rate is 47.36% lower, the Stone Operator rate is 8.29% higher, the Sand and Gravel Operator rate is 60.32% higher, and the Coal Contractor rate is 129.54% higher.

Accidents, Occupational↗

PubMed2006

Variations in case fatality and fatality risk factors of meningococcal disease in Western Norway, 1985-2002.

In a retrospective epidemiological study, 293 meningococcal disease patients hospitalized during 1985-2002, were examined for fatality and risk factors related to death. The overall case fatality rate (CFR) was 8.2%, but increased from 4% during 1985-1993 to 17% during 1994-2002. The latter 9-year period was characterized by more serogroup C infections and more patients with thrombocytopenia on admission to hospital. All patients categorized as meningitis on admission survived. Of the 24 patients who died, 21 had meningococcal skin rash on admission, 23 had an onset to admission time of < or =24 h, and 16 had severe septicaemia with hypotension and/or ecchymoses without meningitis on admission. By multivariate analyses, a short onset to admission time, >50 petechiae, thrombocytopenia and severe septicaemia on admission were associated with fatality. More lives could be saved through earlier admission to hospital. This can be achieved through more information to the public about the early signs of meningococcal septicaemia, with the recommendation to look for skin rash in patients with acute fever during the first day and night.

Adolescent↗

PubMed2000

The preventability of death in road traffic fatalities with head injury in Victoria, Australia. The Consultative Committee on Road Traffic Fatalities.

Since 1992 the Consultative Committee on Road Traffic Fatalities in Victoria (CCRTF) has examined the medical management of patients who died following motor vehicle accidents. Three hundred and fifty-five fatalities with head injury occurring between 1 July, 1992 and 31 December 1997 were assessed by the CCRTF. They represented 79% of the total 449 fatalities examined by the Committee. Following examination of the complete medical records and multidisciplinary discussion, the Committee considered 237 (67%) of the 355 neurotrauma deaths to be non-preventable, 105 (30%) potentially preventable and 13 (4%) preventable. The present analysis excludes the non-preventable deaths in order to focus on preventable factors. Problems identified in the 118 patients pre-hospital included: no intubation; prolonged scene time; and no intravenous access; in 139 emergency room attendances: inappropriate reception including delay in arrival of a consultant, no neurosurgical consultation, no CT scan of the head, inadequate blood gases and oxygen monitoring, inadequate fluid resuscitation, delayed respiratory resuscitation and delayed dispatch to the operating room; in 111 operating room visits: no ICP monitoring, inadequate fluid administration and inappropriate anaesthetic technique; and in 90 intensive care unit admissions: no ICP monitoring. Overall, 1745 individual problems in the various areas of care were identified, of which 1104 (63%) were judged to have contributed to death. Improved delivery and quality of trauma care could reduce the identified problems in emergency services and clinical management. Basic principles of trauma management remain the most important means of reducing morbidity and death following road trauma. The leadership role of the neurosurgeon in neurotrauma care is emphasised.

Accidents, Traffic↗

PubMed1992

Fatal and near-fatal anaphylactic reactions to food in children and adolescents.

BACKGROUND AND METHODS: Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients). RESULTS: Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days. CONCLUSIONS: Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.

Adolescent↗

PubMed1997

Reproducibility of preventable death judgments and problem identification in 60 consecutive road trauma fatalities in Victoria, Australia. Consultative Committee on Road Traffic Fatalities in Victoria.

BACKGROUND: Since 1992, the Consultative Committee on Road Traffic Fatalities in Victoria has identified problems in the management of traffic fatalities. Its two evaluative committees have additionally assessed the potential preventability of death. Previous studies have shown only poor to fair reproducibility of death judgments. METHODS: Problems in the management of 60 consecutive road traffic fatalities and the potential preventability of death were independently evaluated by the two committees. Inter-rater and inter-committee concordance were analyzed using the kappa statistic. RESULTS: Reproducibility was high. Inter-committee agreement on nonpreventable, potentially preventable, and preventable death judgments was high (kappa = 0.73, 95% confidence interval = 0.57-0.89). Agreement within the two evaluative committees was also high (average weighted kappa = 0.73 and 0.74). There was good agreement between committees on problems identified, including those contributing to death. CONCLUSION: The high kappa concordance on preventable death judgments and the agreement on problem identification supports the reproducibility of the methodology used.

Accidents, Traffic↗