Changes in self-harm attempts after the COVID-19 pandemic based on pre-hospital medical records.

Although many concerns have been raised on increased self-harm or suicide attempts since the emergence of the coronavirus disease 2019 (COVID-19) pandemic, the numbers of studies reported no consistent increase. This study aimed to analyze the data on the request for emergency medical service (EMS) in Daegu Metropolitan City in Korea to investigate the effects of the COVID-19 pandemic on the incidence and types of suicidal patients. Data of 4480 cases requesting EMS related to self-harm or suicide 1 year before and after the COVID-19 pandemic were retrospectively comparatively analyzed (February 19, 2019-February 18, 2021). The number of EMS requests for self-harm and suicide increased after the pandemic compared to that before the pandemic (daily mean request 5.83 [±2.597] vs 6.43 [±2.918]). In particular, the number of female patients increased per day on average (2.61 [±1.717] vs 3.17 [±1.893]). With respect to the reasons for the request, committed self-harm and attempts to commit self-harm increased, whereas the presumption against suicide decreased. With respect to consciousness levels, the number of alert patients increased, whereas the number of transport cases decreased. For the method of the attempt, hanging and carbon monoxide/gas poisoning decreased, whereas jumping from a height and drowning increased. The number of patients with psychiatric history and those with other chronic illnesses increased. In multivariate regression analysis, women (OR 1.227, 95% CI = 1.072-1.405, P = .003), patients with psychiatric diseases (OR 1.223, 95% CI = 1.031-1.450, P = .021), patients with other chronic illnesses (OR 1.510, 95% CI = 1.127-2.023, P = .006), and CO or gas poisoning (not attempted) (OR 1.349, 95% CI = 1.038-1.753, P = .025) showed statistically significant differences. Among the request for EMS, requests for committed self-harm and attempts to commit suicide increased. Medical support and measures for mental health and emergency medical systems should be established for female patients and patients with psychiatric or other chronic diseases.

Associations between welding fume exposure and blood hemostatic parameters among workers exposed to welding fumes in confined space in Chonburi, Thailand.

BACKGROUND: Occupational welding fumes contain varieties of toxic metal particles and may affect cardiovascular system like the Particulate Matters (PM). Few studies have focused on the effects of toxic metals on the hemodynamic balance; however, the reporting results were not consistent. This study aimed to investigate the association between toxic metals exposure (Chromium (Cr), Manganese (Mn) and Lead (Pb)) and blood hemostatic parameters status after a 3-week exposure cessation among workers exposed to welding fumes. METHODOLOGY: Structured interviews and biological samplings were conducted for 86 male workers without a history of Anemia and Cardiovascular diseases (CVDs) and working in a confined space to construct crude oil tanks. Metal levels of Cr, Mn and Pb in urine were measured during the working days using Inductively Coupled Plasma Mass Spectrometer (ICP-MS) method. The concentrations of hemostatic proteins in blood (White blood cell counts (WBC), Lymphocytes, Monocyte, Eosinophil, Neutrophil, Hematocrit (Hct) were assessed after a 3 weeks exposure cessation. Workers were divided into groups based on occupation type (welder group and non-welder group), and based on metal levels (high and low exposure groups) for comparison. Linear regression models were used to explore the association between metal exposure and multiple blood hemostatic parameters adjusted for age, Body Mass Index (BMI), and smoking status. RESULTS: Urine Mn and Cr level of the welder group was significantly higher than the non-welder group (Mn: 0.96 VS 0.22 ug/g creatinine, p < 0.001; Cr: 0.63 VS 0.22 ug/g creatinine, p < 0.01). The mean value of Hct in the welder group was 44.58 ± 2.84 vol%, significantly higher than the non-welder group (43.07 ± 3.31 vol%, p = 0.026). The median value of WBC in the high Mn-exposed group (6.93 ± 1.59 X 106 Cell/ml) was significantly lower than the low Mn-exposed group (7.90 ± 2.13 X 106 Cell/ml, p = 0.018). The linear regression analyses showed that there was a significantly negative association between log transformed WBC value and the Mn exposure groups (high and low) after adjusting for age, BMI, and smoking status (ß = - 0.049, p = 0.045), but no significant result was found between WBC and occupation types (welder and non-welder) (p > 0.05). Multiple linear regression analysis also showed positive association between Hct and occupational types (welder and non-welders) (ß = 0.014, p = 0.055). The other hemostatic parameters were not different from controls when divided by occupation type or metal level groups. CONCLUSIONS: Our results showed that welders were exposed to about 3 to 4 times higher Mn and Cr concentrations than non-welders. Moreover, one third of the non-welders were exposed to high-exposure groups of Mn and Cr metals. Regression models revealed a significant association of the WBC counts with the Mn exposure group. Therefore, we infer that Mn exposure may play a significant role on the blood hemostatic parameters of workers in the confined space. Hazard identification for non-welders should also be conducted in the confined space.

Surveillance of suicide deaths involving gases in Australia using the National Coronial Information System, 2006 to 2017.

BACKGROUND: There have been concerns about the increased use of helium and nitrogen gas as a suicide mechanism in Australia. METHODS: National Coronial Information System data were used to investigate gas-specific suicides in Australia over the period 2006-2017. Characteristics were compared between helium or nitrogen, carbon monoxide and seven other gases. RESULTS: Gas inhalation accounted for 10% (3,103/31,002) of all suicide deaths in Australia between 2006 and 2017. The mean age of individuals who died by suicide was 47.6 years (SD 16.9, R 14-97) and 83.3% were male. The number of gas suicides declined over the study period (IRR=0.96). The fall was associated with a 47% decline in carbon monoxide suicides (IRR=0.93). There was an increase in deaths due to argon (IRR=1.60) and nitrogen (IRR=1.27). Compared to individuals using other non-carbon monoxide gases, individuals who died by suicide from helium or nitrogen were significantly more likely to be older, have a physical illness and/or disability, have contacted a euthanasia group and have accessed instructional material and purchased gas online. CONCLUSIONS: Suicides by carbon monoxide decreased between 2006 and 2017 alongside an increase in argon and nitrogen gas use - particularly among older adults. The ease of access to these gases points to new targets for means restriction. Implications for public health: Identifying the types of gases used in suicide deaths and emerging trends may enable targeted interventions that could potentially reduce access.

Chronic respiratory morbidity in the Bhopal gas disaster cohorts: a time-trend analysis of cross-sectional data (1986-2016).

OBJECTIVES: In 1984, nearly 500,000 inhabitants of Bhopal city, India, were exposed to toxic gases that leaked from a nearby pesticide manufacturing plant. In 1985, four cohorts were established to assess the long-term health impact of exposure, namely, mild, moderate, severely exposed and unexposed groups. The self-reported morbidity data of these cohorts were collected by follow-up cross-sectional surveys at regular intervals over the last 35 years. The present study aimed to analyse the long-term trend of chronic (duration of symptoms >3 months) respiratory morbidity in the four cohorts, stratified by age groups. STUDY DESIGN: The design of this study is a longitudinal analysis of cross-sectional respiratory morbidity data. METHODS: Chronic respiratory morbidity data within the cohorts were analysed at 5-year intervals (first recorded data from 1986). Based on age at the time of exposure, subjects were stratified into four age groups: children (aged <10 years), teenagers (aged ≥10 to <20 years), younger adults (aged ≥20 to <40 years) and older adults (aged ≥40 years). RESULTS: During the first decade, after exposure to the toxic gases, chronic respiratory morbidity in children and teenagers was high (up to 9.1%), which declined thereafter. Progressively increasing chronic respiratory morbidity was observed in both the younger and older adult age groups within all cohorts during the initial 5-10 years after exposure. Respiratory morbidity in both the younger and older adult age groups remained high for 15-20 years and thereafter recorded a declining trend. The highest respiratory morbidity observed during this study in the younger and older adult age groups was 38.6% and 59.5%, respectively; these values were both recorded in the severely exposed cohort. CONCLUSIONS: Exposure to toxic gases released during the Bhopal gas disaster has resulted in chronic respiratory morbidity of the exposed population; this morbidity has continued over decades. The age of the individuals at the time of exposure and exposure severity were crucial determinants of the long-term trend of respiratory morbidity.

Carbon monoxide and cyanide gas poisoning in fires. / Forgiftning med karbonmonoksid og cyanidgass ved brann.

Acute poisoning caused by inhalation of carbon monoxide and other toxic substances is the primary cause of death in fires and may occur without signs of external injury. Life-threatening symptoms may arise immediately, as in cyanide poisoning, or over a longer period, as in carbon monoxide poisoning. Severe inhalation injury may also occur independently of systemic poisoning and should always be suspected in patients with soot on their face and in the respiratory tract, or hoarseness and wheezing.

Time trends in suicide rates by domestic gas or car exhaust gas inhalation in Japan, 1968-1994.

AIMS: A reduction in the carbon monoxide content of domestic gas and car exhaust gas has been associated with a decrease in gassing suicides in many western countries. In Japan, a reduction in the carbon monoxide content of domestic gas supply began in the early 1970s, and carbon monoxide emissions standards of new passenger cars were significantly strengthened in 1978. However, little is known about the impact of detoxification of these gases on gassing-related suicides in Japan. Therefore, we examined the changing patterns of suicide due to domestic gas or car exhaust gas inhalation by gender and age in Japan between 1968 and 1994. METHODS: Suicide mortality data were obtained from the Vital Statistics of Japan. In this study, age was divided into four groups: 15-24, 25-44, 45-64 and 65+ years. Method of suicide was divided into three groups: domestic gas, car exhaust gas and non-gases. We calculated method-specific age-standardised suicide rates by gender within each of the four age groups. We applied joinpoint regression to the data and quantified the observed changes. RESULTS: Suicide rates by domestic gas, regardless of gender and age, increased from 1968 to the mid-1970s and then decreased sharply. The proportion of all suicides accounted for by domestic gas was comparatively high in the mid-1970s among females aged 15-24 and 25-44 years, while for other gender-age-groups the proportion of domestic gas suicides remained small, even at the peak. For females aged 15-44 years, the decrease in domestic gas suicides appeared to cause a substantial decrease in overall suicides in this gender/age group. Car exhaust gas was a more common method for males, particularly those aged 25-64 years. Car exhaust gas suicide rates for males aged 25-64 years peaked in the mid-1980s, followed by a sharp decrease. CONCLUSIONS: A reduction in the carbon monoxide content of the domestic gas, which began in the early 1970s in Japan, was associated with a decrease in domestic gas suicides for both genders of all ages. Concerning females aged 15-44 years, a decrease in domestic gas suicides caused a substantial decrease in overall suicides in this gender/age group since the proportion of domestic gas suicides among all suicides combined was comparatively large. However, it remains uncertain whether the introduction of catalytic converters in the 1970s in Japan resulted in a reduction of suicides from car exhaust gas inhalation.

Suicide deaths by gas inhalation in Toronto: An observational study of emerging methods of suicide.

BACKGROUND: Suicide death by gas inhalation has been the subject of global scientific interest due to a rapid increase in the use of helium and charcoal gas for suicide. These may be particularly amenable to means restriction strategies. There has been little scientific attention of this phenomenon in Canada. METHODS: A review of coroner records was conducted for all suicide deaths in Toronto (1998-2015). Deaths were categorized as due to inhalational asphyxia by compressed gas (i.e. helium or nitrogen), charcoal burning or motor vehicle exhaust, with suicide deaths by other methods as a comparator. Demographic, clinical and suicide specific differences between decedents in these four categories were compared using chi-squared or ANOVA global test of significance with additional pairwise comparisons where appropriate. Secular trends were also examined. RESULTS: Gas inhalational deaths accounted for 190 (4.7%) of all suicides in Toronto (n = 4062) over the study period and a higher proportion of males used compressed gas or motor vehicle exhaust gases than those who died by other methods (83.3% and 84.0% vs.69.7%, both p = 0.01). Comparing 1998-2003 to 2010-2015 there was a 1075% increase in deaths by helium (4 vs. 43 deaths) and a 533% increase in deaths by charcoal burning (3 vs. 16 deaths) although helium and charcoal burning deaths still accounted for only 4.2% of total suicides 2010-2015. Deaths by helium were more likely to be accompanied by the book "Final Exit" than those by non-inhalational methods (15% vs. 0.7%, p < 0.0001) while 13 of 14 people who died by charcoal burning whose ethnicity could be determined were Asian. LIMITATIONS: Ethnicity and specific details of procurement of suicide methods were not systematically available in coroner records. DISCUSSION: Suicide by inhalational asphyxia, particularly by compressed gases, has increased substantially over time in Toronto consistent with observations in other countries. Increased surveillance of these deaths, efforts to restrict access to these methods, and timely interventions including minimizing media reporting are all warranted.

Impact of the Aliso Canyon Gas Leak on Respiratory-Related Conditions Among US Department of Veterans Affairs (VA) Users.

BACKGROUND: The largest gas leak in United States history occurred October 2015 through February 2016 near Porter Ranch (PR), California, and prompted the temporary relocation of nearby residents because of health concerns related to natural gas exposure. METHODS: A retrospective cohort study was conducted using US Department of Veterans Affairs (VA) administrative and clinical data. On the basis of zip codes, we created two groups: PR (1920 patients) and San Fernando Valley (SFV) (15 260 patients) and examined the proportion of outpatient visits to VA providers with respiratory-related diagnoses between October 2014 and September 2017. RESULTS: We observed an increase in the proportion of visits in the PR group during the leak (7.0% vs 6.1%, P<0.005) and immediately after the leak (7.7% vs 5.3%, P<0.0001). For both groups, we observed a decrease in respiratory diagnoses one year after the leak (7.0% to 5.9%, P<0.05 PR; 6.1% to 5.7%, P<0.01 SFV). CONCLUSION: Exposure to natural gas likely led to the observed increase in respiratory-related diagnoses during and after the PR gas leak. Early relocation following natural gas leaks may mitigate respiratory exacerbations. (Disaster Med Public Health Preparedness. 2019;13:419-423).

Poisoning deaths in Poland: Types and frequencies reported in Lódz, Kraków, Sosnowiec, Gdansk, Wroclaw and Poznan during 2009-2013.

OBJECTIVES: The aim of this study has been to assess the characteristics of acute poisoning deaths in Poland over a period of time 2009-2013. MATERIAL AND METHODS: The analysis was based on the data obtained from the patient records stored in toxicology departments in 6 cities - Lódz, Kraków, Sosnowiec, Gdansk, Wroclaw and Poznan. Toxicological analyses were routinely performed in blood and/or urine. Major toxic substances were classified to one of the following categories: pharmaceuticals, alcohol group poisonings (ethanol and other alcohols), gases, solvents, drugs of abuse, pesticides, metals, mushrooms, others. Cases were analyzed according to the following criteria: year, age and gender of analyzed patients, toxic substance category and type of poisoning. The recorded fatal poisonings were classified according to the International Classification of Diseases. RESULTS: The record of 261 deaths were retrospectively reviewed. There were 187 males (71.64%) and 74 females (28.36%) and the male to female ratio was 2.52. Alcohol group poisonings were more frequently responsible for deaths in men compared to all poisonings, 91.1% vs. 71.6%, respectively (p < 0.05), and pharmaceutical agents were more frequently responsible for deaths in women, 47.4% vs. 28.4%, (p < 0.05). Methanol was the most common agent in the alcohol group poisonings, accounting for 43.75% (N = 49), followed by ethylene glycol, 39.29% (N = 44), and ethanol, 16.96% (N = 19). CONCLUSIONS: Epidemiological profile data from investigation of poisoning deaths in Poland may be very useful for the development of preventive programs. Int J Occup Med Environ Health 2017;30(6):897-908.

Mental health status following severe sulfur mustard exposure: a long-term study of Iranian war survivors.

INTRODUCTION: This study aimed to describe the mental health status of sulfur mustard-exposed survivors suffering from severe respiratory and ophthalmological problems. METHODS: Out of 450 invited Iran-Iraq War survivors of sulfur mustard exposure with severe symptoms, 350 participated in this cross-sectional study. Mental health status was assessed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria. Fisher exact test, Pearson chi-square test, and chi-square test were used to assess any relationship, and the independent-sample t test was employed to compare differences between the veterans with ocular and pulmonary injuries. RESULTS: There were 60.9% (n = 213) survivors who suffered from mental disorders. Among them, 39.7% (n = 139) were previously untreated and required the initiation of psychiatric treatment. The prevalence of anxiety and mood disorders among all survivors was 40.6% (n = 142) and 32.0% (n = 112), respectively. The most common anxiety and mood disorders were posttraumatic stress disorder (32.9%, n = 115) and major depressive disorder (22.3%, n = 78), respectively. Psychiatric disorders were more prevalent in cases with severe pulmonary chemical injury than in subjects with severe ophthalmologic chemical injury. Significant relationships were found between the types of psychiatric disorders and age, education, and occupation (P < .05). CONCLUSION: The psychiatric morbidity in the chemically injured populations was remarkable and significantly different between the populations. The prevalence of mental illness in these groups highlights the need for the appropriate provision of mental health services.

Identifying and Tracking Gas Suicides in the U.S. Using the National Violent Death Reporting System, 2005-2012.

INTRODUCTION: Identifying the source and specific type of gas used in suicides is difficult using most data systems owing to limitations in ICD-10 coding. The National Violent Death Reporting System (NVDRS), with its rich collection of both coded and free-text variables, has the potential to overcome these limitations. This study used a multipronged approach to identify gas-specific suicides in NVDRS and to track the incidence of these suicides over time. METHODS: Using suicide cases from the 16 NVDRS states that participated throughout 2005-2012, free-text and code searches were conducted for four types of variables-incident narratives, coroner/medical examiner cause-of-death statements, cause-of-death codes, and substance names-to identify suicides by carbon monoxide, helium, hydrogen sulfide, and four other gases. All analyses were conducted in 2015. RESULTS: Approximately 4% (3,242 of 80,715) of suicides recorded in NVDRS over the study period were the result of gas inhalation. Of these, the majority (73%) were carbon monoxide suicides (almost exclusively from motor vehicle exhaust and charcoal burning). Other types of gas (most notably helium), once rare, are now more common: At the start of the study period non-carbon monoxide gas suicides represented 15% of all gas suicides; at the end of the study period, they represented 40%. CONCLUSIONS: Public health policies to reduce a suicidal person's access to more lethal suicide methods require a reliable source of surveillance data on specific methods used in suicide. Small changes to NVDRS could make it an efficient and nimble surveillance system for tracking these deaths.

Situación epidemiológica de intoxicación por monóxido de carbono (CO) / Epidemiological situation of carbon monoxide intoxication (CO)

El monóxido de carbono es un gas tóxico, incoloro, inodoro e insípido que se produce durante la quema de combustible. Las intoxicaciones por monóxido de carbono (CO) constituyen causa de enfermedad y muerte. Además del evento agudo, los cuadros de intoxicación graves pueden dejar secuelas cognitivas. La exposición crónica también es importante dado que puede producir sintomatología neurológica y cognitiva. Se presentan diferentes análisis de la serie histórica que va desde 2005 a la Semana Epidemiológica 38 de 2016, de las intoxicaciones por Monóxido de Carbono asistidas en la Ciudad de Buenos Aires. Los datos para la construcción de indicadores del presente informe provienen del registro de casos individuales de intoxicación por CO, en el módulo C2 de Vigilancia Clínica del Sistema Nacional de Vigilancia de la Salud (SNVS)

Suicide by gassing in Hong Kong 2005-2013: Emerging trends and characteristics of suicide by helium inhalation.

BACKGROUND: Increased use of lethal suicide methods can have a profound impact on overall suicide incidence; the epidemic of suicide by barbecue charcoal gas poisoning in some East Asian countries is a recent example. There have been concerns about recent rises in suicide using gases in some Western countries. METHODS: We investigated suicide by gassing in Hong Kong (2005-2013) using Coroner's files data. The characteristics were compared between suicide by helium inhalation, charcoal gas poisoning, and other methods. RESULTS: About one sixth (1407/8445, 16.7%) of all suicides used gases. Charcoal-burning suicides constituted the majority (97.5%) of them but showed a reduction over the 9-year period (-33%). Helium suicide was not recorded in 2005-2010 but increased from one in 2011 to three in 2012 and 11 in 2013, accounting for 1.2% of all suicides in 2013. Similar to the profile of charcoal-burning suicides, helium suicides were younger and more likely to have debt problem and less likely to receive psychiatric treatment than other suicides. Internet involvement related to the method was found in one third of cases of helium suicide. LIMITATIONS: The small number of helium suicides (n=15) limits the power to examine their characteristics. CONCLUSION: Suicide by charcoal burning showed a downward trend whilst there was an alarming increase in helium suicide in Hong Kong. Public health measures to prevent an epidemic of helium suicide similar to that of charcoal-burning suicide may include close monitoring of trend, responsible media reporting, and restricting online information about and access to this method.

Suicide by gases in England and Wales 2001-2011: evidence of the emergence of new methods of suicide.

BACKGROUND: Increases in suicide deaths by gassing, particularly carbon monoxide poisoning from burning barbecue charcoal, have occurred in many parts of East Asia and resulted in rises in overall suicide rates in some countries. Recent trends in gas poisoning suicides outside Asia have received little attention. METHODS: We analysed suicides by gassing in England and Wales (2001-2011) using national suicide mortality data enhanced by free text searching of information sent by coroners to the Office for National Statistics (ONS). We conducted specific searches for suicides involving barbecue charcoal gas, helium, and hydrogen sulphide. We analysed coroners' records of eight people who used helium as a method of suicide, identified from systematic searches of the records of four coroners. RESULTS: Gassing accounted for 5.2% of suicide deaths in England and Wales during 2001-2011. The number of gas suicides declined from 368 in 2001 to 174 by 2011 (a 53% reduction). The fall was due to a decline in deaths involving car exhaust and other sources of carbon monoxide. There was a rapid rise in deaths due to helium inhalation over the period, from five deaths in the two year period 2001-2002 to 89 in 2010-2011 (a 17-fold increase). There were small rises in deaths involving hydrogen sulphide (0 cases in 2001-2002 versus 14 cases in 2010-2011) and barbecue charcoal gas (1 case in 2001-2002 versus 11 cases in 2010-2011). Compared to individuals using other methods, those suicides adopting new types of gas for suicide were generally younger and from more affluent socioeconomic groups. The corones' records of four of the eight individuals dying by helium inhalation whose records were reviewed showed evidence of Internet involvement in their choice of method. LIMITATIONS: We were not able to identify the source of carbon monoxide (car exhaust or barbecue charcoal) for over 50% of cases. CONCLUSION: Increases in helium inhalation as a method of suicide have partially offset recent decreases in suicide by the use of car exhaust. Public health measures are urgently needed to prevent a potential epidemic rise in the use of helium similar to the recent rises in charcoal burning suicides in East Asia.

The impact of a celebrity's suicide on the introduction and establishment of a new method of suicide in South Korea.

Unlike other East Asian countries, South Korea has until recently experienced relatively few charcoal burning suicides. We investigated trends in charcoal burning suicide immediately following the suicide by charcoal burning of the South Korean celebrity-Ahn Jae-Hwan-in September 2008. In the study, we compared the weekly number charcoal burning suicides 1 year before and after the celebrity's death. Before Ahn Jae-Hwan's suicide, charcoal burning accounted for <1% of suicides; his death was followed by an immediate and sustained increase in the use of this method-it accounted for nearly 5% of suicides (n = 772 suicides) in the subsequent 12 months. The demographic patterning (young male predominance) and location (inside cars) of the charcoal burning suicides further supported a copy-cat effect. Ahn Jae-Hwan's death appears to have triggered a rapid and sustained adoption of charcoal burning as a method of suicide in South Korea.

Methodological challenges in using the Finnish Hospital Discharge Register for studying fire-related injuries leading to inpatient care.

BACKGROUND: The objective was to examine feasibility of using hospital discharge register data for studying fire-related injuries. METHODS: The Finnish National Hospital Discharge Register (FHDR) was the database used to select relevant hospital discharge data to study usability and data quality issues. Patterns of E-coding were assessed, as well as prominent challenges in defining the incidence of injuries. Additionally, the issue of defining the relevant amount of hospital days accounted for in injury care was considered. RESULTS: Directly after the introduction of the ICD-10 classification system, in 1996, the completeness of E-coding was found to be poor, but to have improved dramatically around 2000 and thereafter. The scale of the challenges to defining the incidence of injuries was found to be manageable. In counting the relevant hospital days, psychiatric and long-term care were found to be the obvious and possible sources of overestimation. CONCLUSIONS: The FHDR was found to be a feasible data source for studying fire-related injuries so long as potential challenges are acknowledged and taken into account. Hospital discharge data can be a unique and powerful means for injury research as issues of representativeness and coverage of traditional probability samples can frequently be completely avoided.

Metal fume fever - a case review of calls made to the Victorian Poisons Information Centre.

OBJECTIVE: To determine the epidemiology of metal fume fever over an extended period in Victoria, Australia. METHODS: A retrospective case review of all metal fume fever related calls to the Victorian Poisons Information Centre. Specific defined criteria were used to identify cases of metal fume fever and a set of data points extracted for each. RESULTS: Eighty-four (99%) of the cases involved adults. Fifty-three percent of exposures occurred in the workplace. The most frequent day of symptom manifestation was Monday (24%). All of the calls concerned people involved in welding metal with subsequent inhalation of fumes. DISCUSSION: Calls were most common at the beginning of the week, reflecting the previously described phenomena of increased symptoms occurring after a period on nonexposure (loss of tolerance). Workplace safety and education is key to prevention of metal fume fever. Medical profession education may help prevent occurrences of metal fume fever at home, at school and in the workplace.

Suicide epidemics: the impact of newly emerging methods on overall suicide rates - a time trends study.

BACKGROUND: The impact of newly emerging, popular suicide methods on overall rates of suicide has not previously been investigated systematically. Understanding these effects may have important implications for public health surveillance. We examine the emergence of three novel methods of suicide by gassing in the 20th and 21st centuries and determine the impact of emerging methods on overall suicide rates. METHODS: We studied the epidemic rises in domestic coal gas (1919-1935, England and Wales), motor vehicle exhaust gas (1975-1992, England and Wales) and barbecue charcoal gas (1999-2006, Taiwan) suicide using Poisson and joinpoint regression models. Joinpoint regression uses contiguous linear segments and join points (points at which trends change) to describe trends in incidence. RESULTS: Epidemic increases in the use of new methods of suicide were generally associated with rises in overall suicide rates of between 23% and 71%. The recent epidemic of barbecue charcoal suicides in Taiwan was associated with the largest rise in overall rates (40-50% annual rise), whereas the smallest rise was seen for car exhaust gassing in England and Wales (7% annual rise). Joinpoint analyses were only feasible for car exhaust and charcoal burning suicides; these suggested an impact of the emergence of car exhaust suicides on overall suicide rates in both sexes in England and Wales. However there was no statistical evidence of a change in the already increasing overall suicide trends when charcoal burning suicides emerged in Taiwan, possibly due to the concurrent economic recession. CONCLUSIONS: Rapid rises in the use of new sources of gas for suicide were generally associated with increases in overall suicide rates. Suicide prevention strategies should include strengthening local and national surveillance for early detection of novel suicide methods and implementation of effective media guidelines and other appropriate interventions to limit the spread of new methods.

[Inhalation injury--epidemiology, diagnosis and therapy]. / Das Inhalationstrauma - Epidemiologie, Diagnostik und Therapie.

OBJECTIVE: Inhalation injury is a vitally threatening medical syndrome, which might appear in patients with or without burn injuries. Thus, knowledge about development, diagnosis and treatment of inhalation injury should be available for each physician working in an intensive care unit. METHODS: This review starts with the causal and formal pathogenesis of inhalation injuries. Furthermore, diagnosis and treatment in the critical care setting are presented, followed by the discussion of possible complications. Specific intoxications such as carbon monoxide are due to their importance separately discussed. CONCLUSIONS: Inhalation injury present with an attributable excess mortality and thus worsen the prognosis of burned patients. New insights into the pathogenesis of inhalation injury, however, have led to improved therapeutic possibilities with improved outcome. Necessary prerequisites are a timely diagnosis and restrictive volume management, especially in patients with extensive burns. Prospective studies are needed to be able to answer the many emerging questions.