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PubMed2006

A systematic review of the psychological risk factors associated with near fatal asthma or fatal asthma.

Psychological factors such as anxiety, depressive disorders and/or personality disorders may predispose patients with asthma to near fatal asthma (NFA) or fatal asthma (FA). NFA is defined by an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a pCO(2) >or=45 mm Hg. Most studies have used the case-control study design. Several studies analyzing the effects of psychological factors on the risk of NFA or FA have shown conflicting results. We reviewed all of the literature found by the systematic search done of psychological factors on the risk NFA or FA. A MEDLINE search identified 423 articles between 1960 and March 2006. Seven case-controlled studies were identified following strict applications of the inclusion and exclusion criteria. Due to the significant heterogeneity in the measurement of the psychological factors, a summary statistic was not calculated. The trial characteristics were tabulated and qualitative trends were observed to explain the heterogeneity in the results of the studies. Recommendations on future studies in the field are outlined in detail. Following a systematic assessment of all published studies, we cannot conclude that psychological factors increase the risk of NFA and FA.

Anxiety↗
PubMed2001

Hyperinsulinemia predicts fatal liver cancer but is inversely associated with fatal cancer at some other sites: the Paris Prospective Study.

OBJECTIVE: To investigate whether insulin is a risk factor for death by site-specific cancers. RESEARCH DESIGN AND METHODS: This was a prospective cohort study of 6,237 nondiabetic French working men between ages 44 and 55 years at baseline from the Paris Prospective Study cohort. Death by site-specific cancers was investigated in relation to baseline insulin concentrations during fasting and 2 h after a 75-g oral glucose tolerance test. RESULTS: Of the original 6,237 men in the cohort, 1.739 died over the 23.8 years of follow-up. 778 (45%) from cancer. Baseline hyperinsulinemia, both fasting and 2-h, was significantly associated with fatal liver cancer, with age-adjusted standardized hazards ratios of 2.72 (95% CI 1.87-3.94) and 3.41 (2.23-5.21). In contrast, fasting hyperinsulinemia was inversely associated with fatal lip, oral cavity, and pharynx cancer and larynx cancer, with hazards ratios of 0.55 (0.41-0.75) and 0.63 (0.47-0.83), respectively; 2-h insulin concentrations were inversely associated with stomach and larynx cancers (hazards ratios 0.62 [0.43-0.90] and 0.66 [0.50-0.891, rcspectively). These relationships were stable after adjusting for other risk factors. Insulin concentrations remained negatively associated with deaths from these cancers in analyses restricted to men who smoked and in those who were not chronic alcohol consumers.

Adult↗
PubMed2002

Preventing young worker fatalities. The Fatality Assessment and Control Evaluation (FACE) Program.

During the period between 1992 through 1998, the Bureau of Labor Statistics identified an average of 67 work related deaths of individuals younger than 18 each year. This article describes the Fatality Assessment and Control Evaluation (FACE) program and summarizes indepth data collected on 59 young worker fatalities in 26 states. These investigations were conducted between May 1986 and February 2002. Young workers ranged in age from 9 to 17 years, with a mean age of 15.3 years: 21 were working in the agriculture, forestry, and fishing industry; 12 in construction; 10 in manufacturing; 8 in services; and 8 in the retail industry. The majority worked as laborers. Ninety-three percent were young men. Each investigation resulted in the formulation and dissemination of strategies to help prevent future similar occurrences. As an example of state FACE activities, the article describes the Wisconsin FACE program's efforts to foster collaboration between regulatory agencies, researchers, educators, and occupational safety and health professionals, and to integrate efforts aimed at improving safety for young workers.

Accidents, Occupational↗
PubMed1987

[Fatal septicemias: factors of mortality. Analysis of 72 fatal cases in the series of 462 case reports collected by the Septicemia Expert System group in 1985].

During the year 1985, 462 cases of septicemia were collected by SES group; 417 observations could be exploited. 73 patients died (17.3%). The statistical analysis of epidemiological and clinical data argued to factors correlated with high mortality rate: a shock, an acute respiratory distress syndrome, a pulmonary portal of entry lead to a high mortality rate. The fatal outcome increased with the age of the patients. A documented immunodeficiency (granulopenia, cytotoxic chemotherapy...), a previous broncho-pulmonary, neurologic or cardiovascular disease were factors of risk. The pulmonary or cutaneous localisations occurring within a septicemic phase were significantly related to death. Among fatal cases of bacteremia, 25% were Staphylococci, 25% Enterobacteria, 20% Pneumococci, 7% Pseudomonas. Pseudomonas, then Pneumococcus, then Staphylococcus bacteremias looks to have a worse prognosis. The more serious cases were prescribed several antibiotics, significantly much more than the mild cases. These results are compared with the results of former series; the main prognosis factors of actual septicemia are elicited in here.

Adolescent↗
PubMed1997

Management deficiencies and death preventability in 120 Victorian road fatalities (1993-1994). The Consultative Committee on Road Traffic Fatalities in Victoria.

BACKGROUND: In 1992 a multidisciplinary committee was established to identify problems in the management of road fatalities in Victoria, Australia, to assess their contribution to death, and to identify preventable deaths (preventable: survival probability more than 75%; potentially preventable: survival probability between 25 and 75%). METHODS: For 1993-94, 120 consecutive fatality cases surviving until arrival of ambulance services were evaluated by analysis and discussion of their complete pre-hospital, hospital and autopsy records. RESULTS: A total of 1175 problems were identified in 455 admission to the various areas of care. A total of 949 problems (81%) were found to be management errors and 123 (11%) were found to be system inadequacies. Technique errors (35 (3%)), diagnosis delays (27 (2%)) and diagnosis errors (41 (4%)) were less frequent. The emergency department (ED) accounted for 662 (56%) problems, followed by 191 (16%) pre-hospital problems and 140 (12%) intensive care unit (ICU) problems. There were 598 (51%) problems that were assessed as contributing to death. A total of 308 (52%) problems occurred in the ED, 106 (18%) were pre-hospital problems and 71 (12%) occurred in ICU. Management errors comprised 465 (78%) problems contributing to death, and system inadequacies comprised 76 (13%) problems. Resuscitation problems accounted for 101 (40%) of the 254 ED management errors contributing to death. A total of 79 (66%) deaths were assessed as non-preventable, five (4%) were assessed as preventable and 36 (30%) were assessed as potentially preventable. CONCLUSIONS: Organization and educational countermeasures are required to reduce the high frequency of problems in emergency services and clinical management.

Accidents, Traffic↗
PubMed2001

One fatal and seven non-fatal cases of 4-methylthioamphetamine (4-MTA) intoxication: clinico-pathological findings.

We present a case history involving one fatal and seven survived cases of intoxication with 4-methylthioamphetamine (4-MTA), also called para-methylthioamphetamine (p-MTA) or methylthioamphetamine (MTA), a relatively new amphetamine analogue. Two of the seven survivors required a 24-h-period of observation in hospital. This report proves once again that the new amphetamine designer drugs are not without danger, as is thought by many young people. In addition, individually different subjective reactions are described. Finally, the medico-legal implications of new, as yet unregistered drugs are discussed.

Adolescent↗
PubMed2002

A nonfatal case and 2 fatal cases of paraneoplastic pemphigus: can a complement indirect immunofluorescent test help to identify fatal "group A" paraneoplastic pemphigus cases?

We studied 3 recent cases of paraneoplastic pemphigus (PNP) in detail. Two patients died despite concerted management efforts. One patient received no treatment after the appearance of PNP and recovered completely from both PNP and lymphoma. Multiple serum studies of these 3 patients plus 9 other proven PNP cases revealed that 8 of 9 fatal PNP cases (referred to here as "group A") had distinctive cell surface antibodies detected by complement indirect immunofluorescent (CIIF) tests on monkey esophagus sections. By contrast, none of the sera from 3 patients with PNP who experienced long-term survival (referred to here as "group B") and none of 20 pemphigus vulgaris or 10 pemphigus foliaceus control sera revealed similar beaded cell surface CIIF reaction patterns, a difference that is statistically significant (P <.0001). Cell surface CIIF reaction patterns of group A PNP antibodies resemble the pattern of pemphigus antibody reactions in indirect immunofluorescent tests on the same substrate; however, the latter tend to be thinner and more linear, whereas the cell surface CIIF pattern tends to be more beaded, suggesting possible desmosomal reactions. We believe this test is useful in identifying an aggressive group A form of PNP.

Antibodies, Antinuclear↗
PubMed2005

Electric shock: Cardiac effects relative to non fatal injuries and post-mortem findings in fatal cases.

The documented cardiovascular effects of an electrical shock include acute myocardial necrosis, myocardial ischemia with or without necrosis, heart failure, arrhythmias, haemorrhagic pericarditis, acute hypertension with peripheral vasospasm and anomalous, non specific ECG alterations. Studies documenting the development of acute left ventricular failure and pulmonary oedema sustain that the observed ECG changes are secondary to myocardial injury. The cause of death of victims of instantly fatal electrical accidents is ventricular fibrillation, but it is not clear if this fibrillation is due to purely electrophysiological changes or to identifiable structural abnormalities in the heart. Little is known about the morphological changes in the heart, as differing anatomical alterations are described. Data from such studies may aid in a more accurate comprehension of clinical and morphological alterations of the heart and in the development of therapeutic strategies that could counterbalance such effects.

Electric Injuries↗
PubMed1998

Quantitative electroencephalographic evaluation of non-fatal and fatal traumatic coma.

Diffuse axonal injury (DAI) is an important cause of morbidity and mortality after traumatic brain injury (TBI), and its severity is therefore a major determinant of outcome. There have been suggestions that the extent of DAI may be reflected in quantitative measures of cerebral function, including the electroencephalogram (EEG) and brain-stem auditory evoked potentials (BAEPs). It has therefore been proposed that these quantitative methods of analysis may provide objective predictors of outcome following TBI. We prospectively investigated the relationship between quantitative EEG and BAEP measures and outcome, in 60 comatose patients (47 male and 13 female; age range 1-80 years, mean 36.4) after severe, closed head injury (post-resuscitation Glasgow Coma Scale (GCS) of 8). The Spearman correlation coefficients (rs) have been calculated for quantitative EEG measures (mean regional power and interhemispheric coherence) and BAEPs with patient outcome on the Glasgow Outcome and Disability Rating Scales at 6 months and 1 year. The measures most significantly correlated with outcome (P < 0.001) are over the left hemisphere, beta activity power (amplitude squared) in the fronto-central and centro-temporal regions, and alpha activity power in the centro-temporal region. We found no correlation between interhemispheric coherence (a statistical measure of cross-correlation in the frequency domain) and outcome at either 6 months or 1 year post-injury. In 10 fatalities, we examined the relationship between interhemispheric EEG coherence prior to deaths and the histopathological severity of DAI, in concordant regions. The only significant correlation between DAI and interhemispheric coherence is seen in the alpha band at the temporo-occipital site (rs = -0.79, P = 0.007). Our data indicate that there is regional information in EEG power spectra over the left hemisphere, which could be used in prognostic predictions for patients in coma after severe TBI. We were unable to demonstrate a correlation between interhemispheric coherence and outcome, or any clear and consistent evidence of a relationship between interhemispheric coherence and the severity of DAI.

Adolescent↗
PubMed1980

[Administration of D-penicillamine instead of penicillin with fatal results: allergy of the delayed type with protracted shock as fatal complication of treatment with D-penicillamine for rheumatoid arthritis in a child (author's transl)].

Following one-week treatment with D-penicillamine for rheumatoid arthritis a seven-year-old girl died with the clinical features of protracted circulatory shock. Several doctors had mis-diagnosed the skin changes and mistakenly prescribed penicillamine, given for the rheumatoid arthritis, instead of plenicillin at the latter's dosage. By the administration of penicillamine a hypersensitivity reaction of the delayed type had been induced which ended fatally due to severe shock.

Arthritis, Rheumatoid↗
PubMed1979

Aggregation of coronary risk factors in families of men with fatal and non-fatal coronary heart disease.

The occurrence of main coronary risk factors was assessed in the families of 211 men under age 56 from East Finland. Fifty men were survivors of a recent myocardial infarction, 55 had died of myocardial infarction, 53 suffered from uncomplicated angina, and 53 were healthy reference men. Familial hyperlipidaemia was twice and familial hypertension three times as common in case as in reference families; other risk factors were equally common in both. Familial hypercholesterolaemia was commonest in the families of men with fatal myocardial infarction, and multiple type familial hyperlipidaemia in those of men with angina. Any increase in familial aggregation of coronary heart disease was invariably paralleled by increased aggregation of hyperlipidaemia and hypertension, with the most impressive aggregation of both traits in case families with a maternal history of early coronary death. It is concluded that most of the familial aggregation of coronary heart disease is mediated by familial aggregations of hyperlipidaemia and hypertension.

Adolescent↗
PubMed1999

House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury.

OBJECTIVE: To summarize house fire injury risk factor data, using relative risk estimation as a uniform method of comparison. METHODS: Residential fire risk factor studies were identified as follows: MEDLINE (1983 to March 1997) was searched using the keywords fire*/burn*, with etiology/cause*, prevention, epidemiology, and smoke detector* or alarm*. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by the above keywords, as well as safety, skills, education, and training. Other sources included: references of retrieved publications, review articles, and injury prevention books; Injury Prevention journal hand search; government documents; and internet sources. When not provided by the authors, relative risk (RR), odds ratio, and standardized mortality ratios were calculated, to enhance comparison between studies. RESULTS: Fifteen relevant articles were retrieved, including two case-control studies. Non-modifiable risk factors included young age (RR 1.8-7.5), old age (RR 2.6-3.6), male gender (RR 1.4-2.9), non-white race (RR 1.3-15.0), low income (RR 3.4), disability (RR 2.5-6.5), and late night/early morning occurrence (RR 4.1). Modifiable risk factors included place of residence (RR 2.1-4.2), type of residence (RR 1.7-10.5), smoking (RR 1.5 to 7.7), and alcohol use (RR 0.7-7.5). Mobile homes and homes with fewer safety features, such as a smoke detector or a telephone, presented a higher risk of fatal injury. CONCLUSIONS: Risk factor data should be used to assist in the development, targeting, and evaluation of preventive strategies. Development of a series of quantitative systematic reviews could synthesize existing data in areas such as house fire injury prevention.

Accidents, Home↗
PubMed1992

Long-term prognosis of near-fatal asthma. A 6-year follow-up study of 145 asthmatic patients who underwent mechanical ventilation for a near-fatal attack of asthma.

The objective of the present study was to investigate the long-term prognosis of near-fatal asthma. A retrospective cohort study design was used. Cases were defined as any asthmatic individual requiring mechanical ventilation for the first time for an asthma exacerbation between January 1, 1983 and December 31, 1988. The consecutive sample of patients was drawn from four study sites, specifically four intensive care units (ICU), based in a large urban area (1 million inhabitants). These four ICU total approximately 5,000 admissions per year and are the referral centers for more than 95% of patients requiring respiratory intensive care in the area. Data collection was obtained by questionnaires addressed to the patients and to their attending physicians and was completed by telephone calls if necessary. A total of 147 patients entered the study. The long-term outcome could be evaluated in all but two patients. The follow-up period ranged from 1 to 75 months. In-hospital mortality was 16.5%. Among the 121 patients discharged from the ICU, 18 subsequently died, 17 of whom died from a new attack of asthma. Post-hospitalization mortality was 10.1% (95% CI, 5.9 to 16.8%) after 1 yr, 14.4% (CI, 9 to 22.3%) after 3 yr, and 22.6% (CI, 12.7 to 36.8%) after 6 yr. Nearly two-thirds (61.5%) of these secondary deaths occurred within the year following discharge from the ICU. Smoking was associated with a higher in-hospital mortality, as well as with a higher posthospitalization mortality. Age was also independently associated with a higher posthospitalization mortality. It is noteworthy that the secondary deaths were mostly observed in patients over 40 yr of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

Fatal and non-fatal stingray envenomation.

A fatality occurred in a previously healthy 12-year-old boy after a penetrating chest injury from a stingray barb. The injury occurred under freak circumstances. Death was a result of cardiac tamponade which was secondary to venom-induced, localized myocardial necrosis and spontaneous perforation, six days after the direct penetration of the right ventricle by the barb. Three other cases of less serious stingray envenomation are described which illustrate the significant localized morbidity that may occur without immediate wound exploration and toilet after adequate anaesthesia. We also report a study of a series of 100 minor stingray envenomations which, when treated, resulted in no morbidity. It is possible that local infiltration with 1% plain lignocaine may have a direct counteraction against stingray venom that remains in the wound area. Stingray venom has insidious, but powerful, localized tissue necrosing properties in humans.

Adult↗
PubMed2003

Fatal distraction: a case series of fatal fall-asleep road accidents and their medicolegal outcomes.

Obstructive sleep apnoea is associated with an increased risk of sleep-related motor vehicle accidents. Seven recent legal cases of fatal motor vehicle accidents on NSW roads are presented, where the driver who caused the accident was suffering from an unrecognised or under-treated sleep disorder. The legal outcomes in these cases were variable: some of the drivers have been acquitted and others have been jailed. All remained licensed to drive immediately after their accidents. In some of the cases, the driver was cleared of any culpable driving offence because of a defence of sleepiness or a sleep attack without warning ("Jiminez defence"). This appears at odds with current medical research and legal opinion in other countries. More research is needed to understand the relation between sleep disorders and awareness of sleepiness. Medical practitioners need to be aware of current advice and guidelines with respect to obstructive sleep apnoea and driving.

Accidents, Traffic↗
PubMed1999

[Prognosis of individual survival in animals with fatal and non-fatal tumors].

Cohort analysis of life span in a uniform LIO rat population established a correlation between death cause and age-related death force parameters. It also demonstrated certain sex-related differences involved. The life span of males which had tumors at the time of death, whatever the real cause of death, was significantly longer than that in tumor-free animals. The life span of tumor-free females and those which died from cancer was shorter while the longest-surviving group bore non-fatal tumors. It is suggested that prognosis of individual survival be based on a combination of traditional procedures of mathematical evaluation of population mortality rates and complex assessment of individual health. This approach envisages formation of cohorts characterized by maximum differences in aging dynamics.

Aging↗
PubMed2001

[All traffic related deaths are not "fatalities"--analysis of the official Swedish statistics of traffic accident fatalities in 1999].

In 1997 the Swedish Parliament decided, in accordance with the so-called Vision Zero, that one official goal for the national traffic safety effort is that the number of traffic fatalities in the year 2007 must not exceed 270. In order to monitor efforts toward this hard-won goal, it is of course of utmost importance that official statistics on traffic deaths are reliable. In a meticulous analysis of all 580 officially registered traffic deaths in Sweden in 1999, we found that 490 were true accidental deaths, while 18 were suicides, 12 were deaths due to indeterminate causes, 59 were natural deaths and 1 case was not possible to evaluate due to missing data. Thus, only 84% of the officially registered "accidental traffic deaths" were bona fide accidents. In order to enhance the reliability of the official statistics, we suggest that regulations concerning police investigation and medicolegal autopsy of all unnatural deaths be adhered to all deaths reported to the Swedish National Road Administration should be checked in the database of autopsied cases in the National Board of Forensic Medicine in order to exclude natural deaths the time delay (1.5 years) to complete the official Cause-of-Death Register be shortened criteria for the classification of manner of death in "borderline" cases be suggested for international acceptance.

Accidents, Traffic↗