Injury mortality and morbidity in New Zealand.

An overview of the injury problem in New Zealand is presented. National mortality and morbidity data demonstrate that relative to other diseases injuries represent a significant community health problem. Injuries are the fourth leading cause of death and account for 32% of Potential Years of Life Lost between the ages of 1 and 70. Injuries are the second leading cause of hospital admission and account for nearly 12% of all admissions. Injury rates vary dramatically by age, sex, socioeconomic status, and race. In general, males, particularly those 20-24 years old, have higher death and hospitalisation rates than females. A notably exception is elderly females, who have a hospitalisation rate nearly twice as high as elderly males. Maori and those from low socioeconomic levels have the highest injury rates. The leading causes of injury death are motor vehicle crashes (37%) and self-inflicted injury (21%). This contrasts to some extent with the two leading causes of hospitalisation, namely falls (25%) and motor vehicle crashes (19%). The road, home, and places of recreation and sport are the most common places of occurrence of serious injury. Head injuries, in particular concussions, and fractures of the lower limbs, particularly the femur, account for 35% of all injury morbidity. Treatment and rehabilitation costs for injuries that resulted in hospitalisations, visits to accident and emergency centres, and a claim on the Accident Compensation Corporation cost an average of $133 (1983) per head of population.

[Biopsychosocial profile of rural and metropolitan suicide in the Turin area]. / Profilo biopsicosociale del suicida rurale e metropolitano nell'area torinese.

The differences and similarities between urban and rural suicides in the province of Turin were examined. The study covered the 899 suicides recognised as such by the judicial authorities in the city and province of Turin in 1977-1981. Subsequently certain parameters were related to the geographical location of the suicide. With some significant exceptions a certain uniformity was identified in the urban and rural approaches to suicide in the Turin area.

[The suicidal patient. 2. Methods of suicide, diagnoses and social conditions]. / Den suicidale patient. 2. Selvmordsmetoder, diagnoser og sociale forhold.

By means of a multipractice investigation in which 347 general practitioners participated, 293 schemata were collected about patients who had undertaken suicidal acts. The material consists of 66 suicides and 227 attempted suicides. By and large, the sex and age distributions correspond to those in previous investigations. The number of attempted suicides in this investigation was only half of that anticipated. This may be due to lapse, seasonal variations, underrepresentation of urban practice etc. Strikingly many patients undertook acts in this material without having psychiatric diagnoses and the psychiatric diagnosis did not appear to play any part as regards whether the suicidal act lead to suicide. The methods employed appear otherwise to reflect development in society and pharmacotherapy. Where men were concerned, it appears that suicide is relatively most common among widowers, unemployed and early retirees while, where women were concerned, divorcees and early retirees were most frequently involved. Attempted suicide is most frequently carried out by unemployed men and by divorced and early retirees of both sexes. This investigation cannot indicate any definite occupational group which involves a risk as regards suicidal acts and economical factors appear only to play a part where attempted suicide is concerned.

Violent death in the pediatric age group: rural and urban differences.

Violent death (homicide and suicide) in the pediatric age group is a major public health problem. A descriptive study was undertaken to review retrospectively the 1077 pediatric coroner's cases in 11 California counties for differences between urban and rural violent death rates. Pediatric violent death was more prevalent in the urban region than in the rural region (P less than 0.0007). High urban homicide rates accounted for most of this difference. Suicide rates were not significantly different (P = 0.18). Seventy-four percent of the violent deaths were in the 15- to 18-year age group, and most of these deaths were caused by firearms (81%). Blacks had the highest homicide and suicide rates. Child abuse was an important cause of death for young children in the urban area only. Socioeconomic factors, cultural differences, high population density, and the availability of firearms were proposed as factors affecting violent death in the pediatric age group.

The cost of hospitalization for firearm injuries.

The hospital records for all patients (N = 131) admitted during 1984 to San Francisco General Hospital because of firearm injuries were studied to determine the hospital costs and sources of payment for these injuries. Because San Francisco General Hospital is the regional trauma center, the sample is population based, representing all firearm victims hospitalized in San Francisco during 1984. Only hospital costs (excluding professional fees) for the first hospitalization were studied. The total costs for the year were $905,809, an average cost per patient of $6915. Public sources paid 85.6% of this cost, while private sources paid only 14.4%. These findings have important implications for legislators considering bills to restrict the availability of firearms. These legislators must be aware that the issue is not simply one of individual rights, since taxpayers pay most of the costs (estimated to be more than $1 billion per year for the United States) associated with firearm injuries.

Mortality in the US rayon industry.

A retrospective cohort study was undertaken of the mortality of men exposed to carbon disulfide in the US rayon industry. The cohort consisted of 10,418 men employed between 1957 and 1979. Deaths to mid-1983 were ascertained by the Social Security Administration and the National Death Index. Total mortality in the group was slightly lower than that of the comparable US population. There was no significant difference in overall mortality between the 4,448 employees who had held jobs with the greatest potential for exposure to carbon disulfide and the 3,311 workers who had no exposure. However, there was an excess of deaths from arteriosclerotic heart disease among the potentially most heavily exposed (242 deaths observed, 195.6 expected). An excess of deaths from suicide (29 observed, 18.8 expected) was seen in only one of the four plants.

Suicide: a guide to risk factors, assessment, and treatment of suicidal patients.

This article summarizes what is known about risk factors for suicide in both adolescent and adult populations. It also translates this knowledge base into practical considerations for the physician on the assessment and treatment of suicidal patients. Since most patients who commit suicide have seen a physician in the weeks to month prior to their deaths, and many kill themselves with medications prescribed by their doctors, the physician's early detection and treatment of suicidal behaviors and associated psychiatric disorders in his or her patients becomes a major suicide prevention strategy.

Some differences between men and women who commit suicide.

Men have persistently had a several-fold higher suicide rate than women. In this study of 204 consecutive suicides, the authors examined three areas in which the men differed from the women. Men used more violent, immediately lethal methods of suicide, were almost three times more likely to be substance abusers, and were more likely to have economic problems as stressors. The authors conclude that while the difference in suicide rate between men and women is complexly determined, the weight of the evidence suggests that more men than women intend to commit suicide.

Study of fatal burns cases in Kanpur (India).

Epidemiological and medicolegal, including forensic pathological, aspects of 180 cases of fatal burns were studied in Kanpur (India) during the period of one year (October 1985 to September 1986). These constituted 10.79% of the total medicolegal deaths autopsied. Majority of the victims were young Hindu housewives burnt within 5 years of their marriage. The most common source of fire was cooking apparatus like chulha, coalfire, stove or cooking gas. In a substantial number of cases, kerosene oil was poured over the victims and fired with a match stick. About half of the burn cases were accidental, in which cooking on open unguarded flames and loose highly inflammable synthetic sarees of the victims can be blamed. Among the others who died in suspicious circumstances, i.e., burnt alive or forced to commit suicide by fire, dowry and family quarrels and marital disharmony were the two important predisposing factors. Illiteracy, arranged and child marriages, joint family structure, oedipal dominance of mother-in-laws, unemployment and economic dependence of the husband on the parents, near complete dependence of women on their husbands and inlaws, and lack of social security amongst Hindu females were other contributory factors affecting the incidence in some way. Male burn deaths were few and usually accidental.

Suicide in Cape Town--is the challenge being met effectively?

This cross-sectional descriptive study of 161 suicide inquests in the Cape Town area during 1983 and 1984 includes demographic characteristics of the study population and factors assumed to have had a determining influence on the act of suicide. The most striking finding was a much higher suicide rate among whites (14/100,000) than among coloureds (3/100,000) or blacks (0.7/100,000). Possible reasons for this are discussed. Disparity in the availability or utilisation of psychiatric help by different ethnic groups is highlighted, as well as the fact that many of those who receive help are not dissuaded from suicide.

Psychobiologic predictors of suicide.

Suicide is a significant cause of mortality in patients suffering from major affective disorders, schizophrenia, and alcoholism. Generally, several clinical and psychosocial factors combine to result in suicide. These risk factors have high sensitivity but low specificity; only a small minority of patients who meet risk criteria actually complete suicide. Therefore, clinicians have had great difficulty in assessing suicide risk; more clinically useful risk indicators are crucially needed. Biologic markers such as low cerebrospinal fluid levels of the serotonin metabolite 5-hydroxyindoleacetic acid and related indices of serotonergic function appear to correlate with violent and impulsive suicidal behavior. These and other biologic changes may have predictive value in determining suicide risk, as well as contributing to the formulation of a more complete model to explain suicidal behavior that combines genetic, biologic, psychologic, and social factors.

Seasonality of suicides: environmental, sociological and biological covariations.

The monthly rates of completed suicides in France from 1978 until 1982 were analyzed. The seasonal variations of environmental (daylight and sunlight durations, mean temperature, geomagnetism), sociological (unemployment, deaths of all causes, birth and conception rates), and biological (melatonin, cortisol and serotonin circannual rhythms) factors were compared to the seasonal patterns of suicides. A clear seasonal variation (with peaks in May and September) in suicidal behavior was detected. These patterns tended to differ as a function of age (bimodal in young, unimodal in old people). The component analysis clearly pointed out that seasonal patterns of suicides may be considered as the sum of two components, unimodal and bimodal. Almost similar covariations were found between the main seasonal (unimodal) component of suicides and environmental (daylight duration and mean monthly temperature) or sociological factors whereas the secondary component was more correlated to variations in environmental factors and, to some extent, to biological parameters.