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1.
Matern Child Health J ; 23(12): 1613-1620, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31250240

RESUMEN

OBJECTIVE: Compare mothers' reports of injuries for infants and toddlers sleeping with crib-bumpers/mesh-liners/no-barriers and reasons for these sleep environment choices. METHODS: A cross-sectional survey of mothers subscribing to a parenting magazine and using crib bumpers (n = 224), mesh liners (n = 262), and no barriers (n = 842). Analyses of four possible injuries (face-covered, climb-out/fall, slat-entrapment, hit-head) including multivariate logistic regression adjusted for missing data/demographics and Chi squared analyses of reasons for mothers' choices. RESULTS: Maternal reports of finding infants/toddlers with face covered had 3.5 times higher adjusted odds (aOR) for crib bumper versus mesh liner use. Breathing difficulties and wedgings were reported for infants/toddlers using crib bumpers but not mesh liners. Climb-outs/falls showed no significant difference in aORs for crib bumpers versus no-barriers and mesh liners versus no barriers. Reports of slat-entrapment were less likely for mothers using crib bumpers and mesh liners than using no barrier (aOR = .28 and .32). Reports of hit-heads were less likely for crib bumpers vs no barrier (aOR = .38) with no significant difference between mesh liners versus no barrier use. Mothers using crib bumpers and mesh liners felt their choice prevented slat-entrapment (89%, 91%); 93.5% of crib bumper users felt their choice prevented hit-heads. Significantly more mesh liner than crib bumper users chose them because "There is no suffocation risk" (64.1% vs. 40.6%), while 83.6% of no-barrier users chose them because "I was concerned about suffocation risk." CONCLUSIONS FOR PRACTICE: Mothers appeared to be more concerned about preventing minor risks than suffocation. Understanding reasons for mothers' use of barriers/no-barriers is important in tailoring counseling for mothers with infants/toddlers.


Asunto(s)
Asfixia/prevención & control , Lechos , Conducta de Elección , Cuidado del Lactante/métodos , Equipo Infantil , Madres/psicología , Sueño , Heridas y Traumatismos/prevención & control , Asfixia/epidemiología , Preescolar , Femenino , Humanos , Lactante , Masculino , Encuestas y Cuestionarios , Heridas y Traumatismos/epidemiología
2.
Wilderness Environ Med ; 30(2): 191-194, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31005608

RESUMEN

INTRODUCTION: Understanding patterns of avalanche fatalities can aid prevention and rescue strategies. In 2007, we published a report reviewing avalanche deaths in Utah between the 1989-1990 and 2005-2006 winter seasons. In the current report, we discuss Utah avalanche fatalities from the 2006-2007 to 2017-2018 seasons. METHODS: Avalanche fatality data were obtained from the Utah Avalanche Center and Utah State Office of the Medical Examiner. Autopsy reports were reviewed to determine demographic information, type of autopsy (external vs internal), injuries, and cause of death. RESULTS: Thirty-two avalanche deaths occurred in Utah during the study period. The mean (±SD) age of victims was 32±13 (8-54) y. Thirty victims (94%) were male and 2 (6%) were female. Seventy-two percent of deaths were from asphyxiation, 19% from trauma alone, and 9% from a combination of asphyxiation and trauma. Snowmobilers accounted for the largest percentage of avalanche fatalities (15 victims; 47%) during the 2007-2018 period. CONCLUSIONS: Asphyxia continues to be the most prevalent killer in avalanche burial. Patterns of ongoing avalanche deaths continue to suggest that rapid recovery and techniques that prolong survival while buried may decrease fatality rates. Trauma is a significant factor in many avalanche fatalities. Education and technologies focused on reducing traumatic injuries such as improved education in techniques for avalanche risk avoidance and/or use of avalanche airbags may further decrease fatality rates. Snowmobilers represent an increasing percentage of Utah avalanche deaths and now make up the majority of victims; increased education targeting this demographic in the basics of avalanche rescue gear and avalanche rescue may also reduce fatalities.


Asunto(s)
Asfixia/mortalidad , Avalanchas/mortalidad , Causas de Muerte , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Asfixia/epidemiología , Autopsia/estadística & datos numéricos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vehículos a Motor Todoterreno/estadística & datos numéricos , Utah/epidemiología , Heridas y Traumatismos/epidemiología
3.
Pediatrics ; 143(5)2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31010907

RESUMEN

BACKGROUND: Unintentional suffocation is the leading cause of injury death among infants <1 year old in the United States, with 82% being attributable to accidental suffocation and strangulation in bed. Understanding the circumstances surrounding these deaths may inform prevention strategies. METHODS: We analyzed data from the population-based Sudden Unexpected Infant Death Case Registry from 2011 to 2014. Cases categorized as explained suffocation with unsafe sleep factors (suffocation), per the Centers for Disease Control and Prevention's Sudden Unexpected Infant Death Case Registry classification system, were included and assigned a mechanism of obstruction, including soft bedding, overlay, or wedging. We calculated frequencies and percentages of suffocation deaths by mechanism and selected demographic and sleep-environment characteristics. RESULTS: Fourteen percent of sudden unexpected infant death cases were classified as suffocation; these cases were most frequently attributed to soft bedding (69%), followed by overlay (19%) and wedging (12%). Median age at death in months varied by mechanism: 3 for soft bedding, 2 for overlay, and 6 for wedging. Soft-bedding deaths occurred most often in an adult bed (49%), in a prone position (82%), and with a blanket (or blankets) obstructing the airway (34%). Overlay deaths occurred most often in an adult bed (71%), and infants were overlaid by the mother (47%). Wedging deaths occurred most often when the infant became entrapped between a mattress and a wall (48%). CONCLUSIONS: Safe sleep environments can reduce infant suffocation deaths. Increased knowledge about the characteristics of suffocation deaths can help inform prevention strategies by targeting highest-risk groups.


Asunto(s)
Asfixia/epidemiología , Ropa de Cama y Ropa Blanca/efectos adversos , Equipo Infantil/efectos adversos , Sueño , Muerte Súbita del Lactante/epidemiología , Asfixia/prevención & control , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Posición Prona/fisiología , Sistema de Registros , Factores de Riesgo , Sueño/fisiología , Muerte Súbita del Lactante/prevención & control
4.
Acta Med Okayama ; 73(2): 117-125, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31015746

RESUMEN

According to the World Health Organization's World Report, approx. 950,000 children and young people < 18 years old die from an injury each year, and unintentional injury deaths account for a large portion of these cases. Here we used medico-legal documents to epidemiologically analyze the cases of unintentional injury deaths among children < 5 years old in Okayama Prefecture, Japan from 2001 to 2015. Age, sex, manner/cause of death, and various circumstances of the incident were investigated. There were 73 unintentional injury deaths during the study period. Drowning (n=29), suffocation (n=24), and transport accidents (n=13) were the major categories of unintentional injury deaths. Twenty-two cases (30.1%) were autopsied. Differences in the characteristics of the unintentional injury deaths by age were observed. Information which cannot be obtained from Vital Statistics was available from medico-legal documents, and detailed characteristics of unintentional injury deaths among children < 5 years old were elucidated. Investigating medico-legal information is one of the meaningful measures for the prevention of unintentional injury deaths among children in Japan.


Asunto(s)
Accidentes de Tránsito/mortalidad , Asfixia/epidemiología , Causas de Muerte , Ahogamiento/mortalidad , Autopsia/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Japón/epidemiología , Masculino , Estadísticas Vitales
5.
J Forensic Leg Med ; 61: 82-88, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30502590

RESUMEN

AIM: Infantile cerebral palsy (CP) severely affects the survival and quality of life of infants. CP is typically caused by multiple factors, leading to causal uncertainty of the role of medical errors in CP and resulting in frequent medical disputes. No relevant research exists on risk management and malpractice liabilities in CP, including in China. METHOD: A retrospective analysis of 400 CP malpractice litigation cases from 18th June 1999 to 23rd November 2017, collected from China Judgments Online, included basic case information, CP risk factors, medical errors, medical malpractice liability determination, and compensation. RESULTS: Up to 63.5% of infants with CP were affected by asphyxia, followed by hypoxic-ischemic encephalopathy (63.3%), neonatal infection (52.3%) and intracranial hemorrhage (36.0%). Most (89.1%) of civil judgments resulted in liability for medical errors, with the highest proportion of ultimate liability. The three most frequent medical errors were failure of completing delivery in time (30.2%), incomplete assessment of birth process detection (28.8%), and nonstandard medical records (25.3%). Each case involved 2.5 medical errors on average. No difference in the distribution of medical errors between premature and full-term CP infants (P > 0.05) was found. Compensation for damage was awarded in 91.4% of claims, and the mean value of compensation was $73,506. The mean value of the total actual loss of the family was $128,198. INTERPRETATION: Contradictions between the doctors and patients were prominent in malpractice CP litigation cases, with a total loss of $3.97 billion attributable to new CP cases in China in 2017. Asphyxia was the most frequent risk factor for CP since it may easily draw the attention of the sufferer's family. Medical service providers did not pay attention to risk management in preterm infants. The importance of fetal monitoring and standardized medical record writing should be emphasized.


Asunto(s)
Parálisis Cerebral/epidemiología , Compensación y Reparación/legislación & jurisprudencia , Responsabilidad Legal , Errores Médicos/legislación & jurisprudencia , Asfixia/epidemiología , China/epidemiología , Femenino , Humanos , Hipoxia-Isquemia Encefálica/epidemiología , Recién Nacido , Hemorragias Intracraneales/epidemiología , Masculino , Estudios Retrospectivos , Factores de Riesgo , Gestión de Riesgos
6.
Praxis (Bern 1994) ; 107(16): 886-892, 2018 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-30086689

RESUMEN

Domestic Violence at the University Emergency Department Bern: A Retrospective Analysis from 2006 to 2016 Abstract. Domestic Violence (DV) is considered as one of the largest medical risks worldwide. In Switzerland, DV is defined as offence requiring public prosecution since 2004. The present retrospective cohort study aims to investigate cases of DV in one of the largest Swiss emergency departments. The aggressors are predominantly male and either (ex-)partner or (ex-)husband of the victim. The head and the extremities are most often injured. Strangulation was documented in 16 % of the cases. Prevalence in our ED is very low with 0.07 % in 2016 (overall 0.09 % 2006-2016) and much lower compared with international data. We assume that we face many unreported cases and that victims are reluctant to seek medical help. Healthcare professionals should receive regular education in domestic violence, standards of care must be defined, and a sensitive and open-minded communication style is essential.


Asunto(s)
Violencia Doméstica/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Maltrato Conyugal/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asfixia/diagnóstico , Asfixia/epidemiología , Estudios de Cohortes , Traumatismos Craneocerebrales/diagnóstico , Traumatismos Craneocerebrales/epidemiología , Comparación Transcultural , Estudios Transversales , Violencia Doméstica/legislación & jurisprudencia , Violencia Doméstica/tendencias , Extremidades/lesiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta/legislación & jurisprudencia , Estudios Retrospectivos , Maltrato Conyugal/legislación & jurisprudencia , Suiza , Adulto Joven
7.
Ann Epidemiol ; 28(9): 612-618.e4, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30153910

RESUMEN

PURPOSE: Maternal asthma increases adverse neonatal respiratory outcomes, and pollution may further increase risk. Air quality in relation to neonatal respiratory health has not been studied. METHODS: Transient tachypnea of the newborn (TTN), asphyxia, and respiratory distress syndrome (RDS) were identified using medical records among 223,375 singletons from the Consortium on Safe Labor (2002-2008). Community Multiscale Air Quality models estimated pollutant exposures. Multipollutant Poisson regression models calculated adjusted relative risks of outcomes for interquartile range increases in average exposure. Maternal asthma and preterm delivery were evaluated as effect modifiers. RESULTS: TTN risk increased after particulate matter (PM) less than or equal to 10-micron exposure during preconception and trimester one (9-10%), and whole-pregnancy exposure to PM less than or equal to 2.5 microns (PM2.5; 17%) and carbon monoxide (CO; 10%). Asphyxia risk increased after exposure to PM2.5 in trimester one (48%) and whole pregnancy (84%), CO in trimester two and whole pregnancy (28-32%), and consistently for ozone (34%-73%). RDS risk was associated with increased concentrations of nitrogen oxides (33%-42%) and ozone (9%-21%) during all pregnancy windows. Inverse associations were observed with several pollutants, particularly sulfur dioxide. No interaction with maternal asthma was observed. Restriction to term births yielded similar results. CONCLUSIONS: Several pollutants appear to increase neonatal respiratory outcome risks.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Asfixia Neonatal/inducido químicamente , Asfixia/inducido químicamente , Asma/inducido químicamente , Exposición Materna/efectos adversos , Asfixia/epidemiología , Asfixia Neonatal/epidemiología , Asma/epidemiología , Monóxido de Carbono/efectos adversos , Exposición a Riesgos Ambientales , Femenino , Humanos , Recién Nacido , Óxidos de Nitrógeno/efectos adversos , Ozono/efectos adversos , Material Particulado/análisis , Embarazo , Dióxido de Azufre/efectos adversos
8.
J Agric Saf Health ; 24(2): 73-88, 2018 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-29783793

RESUMEN

Since 1978, the Purdue University Agricultural Safety and Health Program has managed a surveillance effort and database to collect information on documented injuries and fatalities in all forms of U.S. agricultural confined spaces. The database currently contains 1,968 cases documented in the U.S. between 1964 and 2016. Of these cases, 174 (8.8%) involved entrapment or suffocation in grain transport vehicles (GTVs), including gravity-flow wagons, semi-truck trailers, and other agricultural transport vehicles that have limited access and are not considered normal work spaces or are classified as confined spaces. These GTV cases represent the overwhelming majority of documented cases involving all forms of agricultural transport vehicles, including forage and manure transport vehicles. Of the incidents documented, 64.3% resulted in fatalities and 71.8% involved children and youth age 20 years and under, when the age was determined. For the GTV cases, the typical victim was male (88.5%), and the average age of the victim was 19.9 (median 12), with over 63.5% of the cases involving children under the age of 15. In numerous incidents, more than one victim became entrapped, including one incident involving five victims. The number of documented cases decreased sharply from a peak of approximately 7 cases per year in the early 1990s to an average of 3.1 cases per year over the past two decades, with no cases documented in 1998 and 2013. However, there is a linear increase in the frequency of incidents since the first case was documented in 1964. This trend is partially due to peaks in 2011 and 2014, when 10 and 9 cases, respectively, were documented, along with more vigilant surveillance methods due to online search capabilities. The general decline, more recently, in the annual number of cases is attributed to increased awareness of the hazards to youth during transport in GTVs, increased use of warnings on GTVs, and the increased size of GTVs, which makes human access more difficult and less practical. Efforts over the past decade to bring attention to the risk of entrapment in GTVs should be recognized as a success of the educational and technological strategies initiated due to earlier high-profile incidents. However, with 6, 10, 9, and 4 cases documented in 2010, 2011, 2014, and 2016, respectively, continued efforts to address the problem are justified. Recommendations for future actions include development of a safety standard for GTVs that includes placement of safety messages on all new GTVs, use of windows above outlets, retrofitting older GTVs with appropriate warnings, and continuing to address the hazard with safety resources targeting all workers exposed to grain handling and transport.


Asunto(s)
Accidentes de Trabajo/estadística & datos numéricos , Asfixia , Grano Comestible , Traumatismos Ocupacionales/epidemiología , Accidentes de Trabajo/mortalidad , Adolescente , Agricultura , Asfixia/epidemiología , Niño , Espacios Confinados , Femenino , Humanos , Masculino , Traumatismos Ocupacionales/mortalidad , Transportes , Heridas y Traumatismos/epidemiología , Adulto Joven
9.
PLoS One ; 13(5): e0197805, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29787584

RESUMEN

OBJECTIVE: Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. METHODS: This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011-2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. RESULTS: An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. CONCLUSIONS: Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.


Asunto(s)
Asfixia/epidemiología , Sobredosis de Droga/epidemiología , Envenenamiento/epidemiología , Suicidio/estadística & datos numéricos , Heridas por Arma de Fuego/epidemiología , Adolescente , Adulto , Anciano , Autopsia , Femenino , Patologia Forense , Humanos , Masculino , Persona de Mediana Edad , Análisis Multinivel , Sistema de Registros , Estados Unidos/epidemiología , Adulto Joven
10.
Int Psychogeriatr ; 30(10): 1531-1540, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29560840

RESUMEN

ABSTRACTBackground:US suicide rates among older women have substantially increased over the past decade. We examined potential differences in sociodemographic and risk/precipitating factors among older female suicide decedents who died by drug overdose versus firearms, hanging/suffocation, and other means, and postmortem toxicology results by suicide means. METHODS: Data are from the 2005 to 2015 US National Violent Death Reporting System (N = 12,401 female decedents aged 50 years and over). We used three logistic regression models, with overdose versus firearms, overdose versus hanging/suffocation, and overdose versus "other" means as the dependent variables, to examine associations between suicide means and sociodemographic and risk/precipitating factors. χ2 tests were used to examine positive toxicology of prescription and illicit drugs by suicide means. RESULTS: Compared to firearm users, overdose users were younger and had higher odds of having had previous suicide attempts/intent disclosures, mental disorders (e.g. depression/dysthymia: AOR = 1.18, 95% CI = 1.05-1.34), and substance abuse other than alcohol, but lower odds of having had relationship problems and any crisis. Compared to hanging/suffocation, overdose declined (AOR = 0.95, 95% CI = 0.93-0.97) during the study period and was less prevalent among Hispanic and Asian women and those with job/finance/housing problems. Toxicology reports showed that 47%, 43%, and 45% of overdose users were antidepressant, opiate, and benzodiazepine positive, respectively. Firearm users had the lowest rates of positive toxicology results for these drugs. CONCLUSIONS: Suicide prevention should include limiting access to large quantities of prescription medications and firearms for those at risk of suicide. More effective mental health/substance abuse treatment and chronic illness management support are also needed.


Asunto(s)
Intoxicación Alcohólica/epidemiología , Asfixia/epidemiología , Sobredosis de Droga/epidemiología , Armas de Fuego/estadística & datos numéricos , Trastornos Mentales/epidemiología , Suicidio/estadística & datos numéricos , Violencia/estadística & datos numéricos , Anciano , Autopsia , Femenino , Humanos , Persona de Mediana Edad , Estados Unidos/epidemiología , Violencia/psicología
11.
PLoS Med ; 15(3): e1002531, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29558463

RESUMEN

BACKGROUND: While the high prevalence of preterm births and its impact on infant mortality in the US have been widely acknowledged, recent data suggest that even full-term births in the US face substantially higher mortality risks compared to European countries with low infant mortality rates. In this paper, we use the most recent birth records in the US to more closely analyze the primary causes underlying mortality rates among full-term births. METHODS AND FINDINGS: Linked birth and death records for the period 2010-2012 were used to identify the state- and cause-specific burden of infant mortality among full-term infants (born at 37-42 weeks of gestation). Multivariable logistic models were used to assess the extent to which state-level differences in full-term infant mortality (FTIM) were attributable to observed differences in maternal and birth characteristics. Random effects models were used to assess the relative contribution of state-level variation to FTIM. Hypothetical mortality outcomes were computed under the assumption that all states could achieve the survival rates of the best-performing states. A total of 10,175,481 infants born full-term in the US between January 1, 2010, and December 31, 2012, were analyzed. FTIM rate (FTIMR) was 2.2 per 1,000 live births overall, and ranged between 1.29 (Connecticut, 95% CI 1.08, 1.53) and 3.77 (Mississippi, 95% CI 3.39, 4.19) at the state level. Zero states reached the rates reported in the 6 low-mortality European countries analyzed (FTIMR < 1.25), and 13 states had FTIMR > 2.75. Sudden unexpected death in infancy (SUDI) accounted for 43% of FTIM; congenital malformations and perinatal conditions accounted for 31% and 11.3% of FTIM, respectively. The largest mortality differentials between states with good and states with poor FTIMR were found for SUDI, with particularly large risk differentials for deaths due to sudden infant death syndrome (SIDS) (odds ratio [OR] 2.52, 95% CI 1.86, 3.42) and suffocation (OR 4.40, 95% CI 3.71, 5.21). Even though these mortality differences were partially explained by state-level differences in maternal education, race, and maternal health, substantial state-level variation in infant mortality remained in fully adjusted models (SIDS OR 1.45, suffocation OR 2.92). The extent to which these state differentials are due to differential antenatal care standards as well as differential access to health services could not be determined due to data limitations. Overall, our estimates suggest that infant mortality could be reduced by 4,003 deaths (95% CI 2,284, 5,587) annually if all states were to achieve the mortality levels of the best-performing state in each cause-of-death category. Key limitations of the analysis are that information on termination rates at the state level was not available, and that causes of deaths may have been coded differentially across states. CONCLUSIONS: More than 7,000 full-term infants die in the US each year. The results presented in this paper suggest that a substantial share of these deaths may be preventable. Potential improvements seem particularly large for SUDI, where very low rates have been achieved in a few states while average mortality rates remain high in most other areas. Given the high mortality burden due to SIDS and suffocation, policy efforts to promote compliance with recommended sleeping arrangements could be an effective first step in this direction.


Asunto(s)
Asfixia , Certificado de Nacimiento , Certificado de Defunción , Mortalidad/etnología , Atención Perinatal , Muerte Súbita del Lactante , Nacimiento a Término , Asfixia/epidemiología , Asfixia/mortalidad , Causas de Muerte , Anomalías Congénitas/epidemiología , Anomalías Congénitas/mortalidad , Escolaridad , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Masculino , Evaluación de Necesidades , Atención Perinatal/normas , Atención Perinatal/estadística & datos numéricos , Muerte Súbita del Lactante/epidemiología , Muerte Súbita del Lactante/prevención & control , Estados Unidos/epidemiología
12.
Epidemiol Serv Saude ; 27(1): e20171971, 2018 02 01.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-29412350

RESUMEN

OBJECTIVE: to describe sociodemographic aspects and time evolution of mortality due to suicide among elderly individuals in Bahia State, Brazil, from 1996 to 2013. METHODS: time series descriptive and ecological study, with data from the Mortality Information System (SIM); Prais-Winsten regression was used for trend analysis and to calculate annual percent change (APC). RESULTS: 858 deaths due to suicide were identified in elderly in Bahia; 85.4% were men, and 53.8% were in the 60-69 age group; 64.3% of deaths resulted from hanging/strangulation, followed by self-poisoning by pesticides and chemical products (13.1%); there was an increasing trend in suicide mortality rate in the general elderly population (APC 11.0; 95%CI 6.9;15.3) and in the male sex (APC 12.1; 95%CI 7.1;17.3), whilst in the female population it remained stable. CONCLUSION: in Bahia, mortality due to suicide among elderly individuals presented an increasing trend in the period studied and was higher among males.


Asunto(s)
Asfixia/epidemiología , Envenenamiento/epidemiología , Suicidio/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Asfixia/mortalidad , Brasil/epidemiología , Causas de Muerte , Femenino , Humanos , Sistemas de Información , Masculino , Persona de Mediana Edad , Envenenamiento/mortalidad , Análisis de Regresión , Factores Sexuales , Suicidio/tendencias , Factores de Tiempo
13.
J Emerg Nurs ; 44(4): 384-393, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29292069

RESUMEN

INTRODUCTION: Nonfatal strangulation by a current or former intimate partner is a distinct mechanism of violence with the potential for severe injury or death. As nonfatal strangulation has gained recognition for its significant medical and legal implications, there have been multiple calls for nursing and other health care providers to improve practices related to strangulation screening, assessment, and treatment. Given that US estimates suggest higher prevalence of strangulation of women than of men, this integrative evidence review examines existing literature related to women's injuries and their subsequent experiences in seeking health care after surviving intimate partner strangulation. METHODS: Following PRISMA guidelines, 5 electronic databases were searched, ultimately resulting in 13 articles for inclusion. RESULTS: Overall, nonfatal intimate partner strangulation was associated with multiple negative physical and psychological outcomes for women, although only 5% to 69% of strangled women sought health care in studies reporting this finding. DISCUSSION: Nonprobability sampling, participant self-reports, and relatively small sample sizes were frequently encountered limitations across studies. Heterogeneity of women's ages and race/ethnicities also limited comparisons. However, existing research provides a beginning framework to support practice and future inquiry.


Asunto(s)
Asfixia/epidemiología , Servicio de Urgencia en Hospital , Violencia de Pareja/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Sobrevivientes/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Adulto , Enfermería de Urgencia/métodos , Femenino , Humanos , Autoinforme , Adulto Joven
14.
Medimay ; 26(1)ene. 2018. tab
Artículo en Español | CUMED | ID: cum-74709

RESUMEN

Introducción: las muertes violentas, y dentro de ellas las asfixias mecánicas, representan un porciento elevado de los fallecidos en todo el mundo, por lo que se hace necesario dotar a la comunidad científica de datos actualizados sobre el comportamiento de las mismas que respalde la toma de decisiones ante estas muertes. Objetivo: caracterizar el comportamiento epidemiológico de las muertes por asfixias mecánicas en la provincia Mayabeque. Métodos: se realizó un estudio descriptivo, de corte transversal en pacientes fallecidos por asfixias mecánicas en la provincia Mayabeque del 2013 al 2017. El universo estuvo constituido por 175 fallecidos por asfixias mecánicas y los datos se obtuvieron del registro del Departamento de Medicina Legal, así como de los expedientes médico legales. Se utilizaron técnicas estadísticas de distribución de frecuencia absoluta y valor porcentual y la comparación de proporciones se realizó calculando desviación estándar considerándose un nivel de significación de P<0.05. Resultados: predominó el sexo masculino en 93.71 por ciento y la edad de 60 años y más en 36.57 por ciento. Según el mecanismo de producción, el tipo de muerte más frecuente fue el ahorcamiento de etiología suicida (69.71 por ciento), donde el alcohol prevaleció como factor de riesgo asociado en 48.00 por ciento. Conclusiones: las muertes por asfixias mecánicas se identifican con elevada frecuencia en el sexo masculino, la edad de 60 años y más, el ahorcamiento de etiología suicida y el alcohol como factor de riego asociado, existiendo relación estadísticamente muy significativa entre el mecanismo de producción por asfixias mecánicas y su etiología(AU)


Introduction: violent deaths, and among them mechanical asphyxias, represent a high percent of dead people all over the world so it is necessary to give the updated information to the scientific community in relation to their behavior in order to take decisions about them. Objective: to characterize el epidemiologic behavior of deaths by mechanical asphyxias in Mayabeque. Methods: a descriptive, transversal study was carried out in dead patients for mechanical asphyxias in Mayabeque province from 2013 to 2017. The universe was formed by 175 dead patients because of mechanical asphyxias and the information was obtained from the Forensic Medicine Department, as well as from the forensic physicians records. Statistical techniques related to absolute frequencies and percentages were used, as well as the comparison of proportions calculating the standard deviation considering a level of meaning of P<0.05. Results: male sex prevailed with a 93.71 percent and he 60 and older age group in a 36.57 percent. According to the production mechanism, the most frequent type of death was hanging of suicide etiology (69.71 percent), where alcohol prevailed as associated risk factor in 48.00 percent. Conclusions: deaths because of mechanical asphyxias identified with a high frequency in the male sex, age of 60 years old and more, hanging of suicide etiology and alcohol as associated risk factor existing a significant statistical relation between the production mechanism for mechanical asphyxias and their etiologies (AU)


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Asfixia/epidemiología , Muerte , Medicina Legal , Factores de Riesgo , Suicidio/prevención & control , Suicidio/psicología , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/mortalidad , Trastornos Relacionados con Sustancias/prevención & control , Epidemiología Descriptiva , Estudios Transversales
15.
PLoS One ; 12(10): e0186432, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29040329

RESUMEN

METHODS: We conducted a retrospective national mortuary based study to identify all adult female homicides (18 years and older) and all child homicides (boys and girls < 18 years) in 2009 in a randomly selected, proportionate sample of mortuaries. Victim, perpetrator and crime data were collected in three processes: from the mortuary register, the autopsy report and from police with the identification of sexual homicides validated across the data collection processes. FINDINGS: Among the 2670 (95% CI: 2311-2979) adult women killed in 2009, 494 (95% CI: 406-574) were identified as sexual homicides which was 19.8% (95% CI: 17.6-22.0) of all adult female homicides and among 1277 (95% CI: 1091-1462) children killed in SA, sexual homicides were found in 104 (95% CI: 77-132) of the child homicides which was 8.7% (95% CI: 10.9-11.2%) of these murders. Strangulation was the most common cause of death for both children and adult females. A distinct age and sex pattern was found among children with only 1% boy child death identified as a sexual homicide and 92% of all the child sexual homicides were among girls. Strangulation was the most common manner of death among children (35.5%) and perpetrators were seldom strangers. However, no difference in the proportion of convictions between the sexual homicides and non-sexual homicides were found for both adult females and children. CONCLUSION: Rape homicide is not a rare event in South Africa, with one in five female homicides and nearly one in ten child homicides identified with an associated sexual crime. These high prevalences are amongst the highest levels reported in the literature with our study among the few reporting on the epidemiology of child sexual homicide. Reducing mortality is an important policy goal for South Africa and for the rest of the world and the prevention of female and child homicide is an important part of attaining this goal.


Asunto(s)
Asfixia/epidemiología , Abuso Sexual Infantil/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Violación/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Asfixia/mortalidad , Autopsia/estadística & datos numéricos , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Morgue/estadística & datos numéricos , Prevalencia , Estudios Retrospectivos , Distribución por Sexo , Sudáfrica/epidemiología
16.
Acad Pediatr ; 17(8): 893-901, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28723589

RESUMEN

OBJECTIVE: To investigate the circumstances of death and types and roles of objects present in the sleep environment at the time of death for infants who died from suffocation or strangulation during sleep. METHODS: This study analyzed 1736 reported incidents of accidental suffocation and strangulation in bed (ASSB) of infants younger than 1 year of age. These fatalities occurred from 2000 through 2012 and were reported to the United States Consumer Product Safety Commission. RESULTS: The mean age of ASSB death was 3.76 months (SD, 2.51). Infants younger than 5 months accounted for 67.3% (1168 of 1736) of all reported fatalities and 58.3% (1009 of 1731) were male. Deceased infants were often found in a crib or bassinet (30.6%; 383 of 1253) or in the prone orientation (84.9%; 595 of 701). The most common objects associated with infant ASSB were pillows (24.5%; 425 of 1736), mattresses (21.0%; 364 of 1736), blankets (13.1%; 228 of 1736), and walls (11.5%; 199 of 1736). Wedged (43.3%; 616 of 1424) or positioned on top of an object (25.9%; 369 of 1424) were the most common positions associated with death. Infants were often found wedged between a mattress and wall (30.2%; 181 of 599) or oriented face-down or prone on top of a pillow (52.2%; 187 of 358). Sleep surface sharing was associated with 6.5% (112 of 1736) of ASSB deaths. CONCLUSIONS: Pillows and blankets are objects in sleep environments frequently associated with unintentional suffocation and strangulation of infants. Increased efforts should be made to remove these and other objects from sleep environments of infants.


Asunto(s)
Asfixia/epidemiología , Ropa de Cama y Ropa Blanca , Lechos , Equipo Infantil , Muerte Súbita del Lactante/epidemiología , Seguridad de Productos para el Consumidor , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Posición Prona , Sueño , Estados Unidos/epidemiología
17.
Am J Geriatr Psychiatry ; 25(12): 1404-1414, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28689643

RESUMEN

OBJECTIVE: To examine 1) temporal trends between 2005 and 2014 in the three most frequently used suicide means (firearms, hanging/suffocation, alcohol/drug/medicine overdose) by decedents aged 50+ years and 2) associations of suicide means with sociodemographic and precipitating factors. METHODS: The National Violent Death Reporting System, 2005-2014, provided data (N = 46,857). Suicide means were identified from ICD-10 codes for underlying cause of death and coroner/medical examiner (CME) reports. Precipitating factors are based on either CME or law enforcement report. Age-group (50-64 and 65+ years) and gender-separate logistic regression analyses were used to examine study questions. RESULTS: In the 50-64 years age group, each advancing year (i.e., from 2005 to 2014) was associated with a 1% decrease in the odds of firearm use and a 6% increase in the odds of hanging/suffocation among men; a 9% increase in the odds of hanging/suffocation among women; and a 4% decrease in the odds of overdose among each gender. In the 65+ years age group, each advancing year was associated with a 4% increase in the odds of overdose among men. Physical health was a significant factor for firearm use among men (adjusted odds ratio: 1.47; 95% CI: 1.39-1.55) only. Regardless of gender and age, mental health and substance abuse problems and prior suicide attempts were associated with hanging/suffocation and overdose. CONCLUSIONS: Firearm use decreased among men aged 50-64 years between 2005 and 2014, but its use did not change among the other gender by age groups. With rapidly growing numbers of older adults, routine suicide risk assessments, firearm safety monitoring, and interventions to improve quality of life are needed.


Asunto(s)
Asfixia/epidemiología , Causas de Muerte , Sobredosis de Droga/epidemiología , Armas de Fuego/estadística & datos numéricos , Estado de Salud , Trastornos Mentales/epidemiología , Suicidio/estadística & datos numéricos , Anciano , Causas de Muerte/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Suicidio/tendencias , Estados Unidos/epidemiología
18.
Am J Emerg Med ; 35(11): 1672-1676, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28551089

RESUMEN

INTRODUCTION: Patients surviving a self-attempted hanging have a total neurological recovery in 57-77% of cases at hospital discharge, but no long-term data are available. METHODS: In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2+3+4 (bad recovery) vs. CPC1 (good recovery). RESULTS: Of 231 patients included, 104 (47%) were found to have cardiac arrest (CA). Ninety-five (41%) patients died in the ICU: 93 (89%) in the CA group and 2 (1.6%) in the group without CA. Neurological evaluations at 6 and 12months were obtained in 97 of the 136 surviving patients. At 6months, in the CA group (n=9), the CPC score was 1 for 6 patients, 2 for 2, and 4 for 1 patient. In the group without CA (n=88), 79 patients had normal neurological status at 6months and 78 at 12months. Among these patients, 96% returned home, 77% returned to work, 16 (18%) patients re-attempted suicide within the year. Risk factors of neurological sequelae at 6months were a CA at the hanging site (P=0.045), an elevated diastolic blood pressure (87 vs. 70 mm Hg; P=0.04), a lower initial Glasgow score (4 vs. 5; P=0.04), and an elevated blood glucose level (139 vs. 113 mg/dL; P<0.001). CONCLUSION: Patients surviving a self-attempted hanging who did not have a CA had a good neurological outcome. The rate of suicidal recidivism is particularly important, which justifies joint work with psychiatrists.


Asunto(s)
Asfixia/complicaciones , Paro Cardíaco/etiología , Enfermedades del Sistema Nervioso/etiología , Intento de Suicidio , Adolescente , Adulto , Anciano , Alcoholismo/epidemiología , Asfixia/epidemiología , Trastorno Bipolar/epidemiología , Glucemia/metabolismo , Presión Sanguínea , Niño , Trastorno Depresivo/epidemiología , Diástole , Femenino , Estudios de Seguimiento , Escala de Coma de Glasgow , Paro Cardíaco/epidemiología , Humanos , Hiperglucemia/epidemiología , Hipertensión/epidemiología , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/fisiopatología , Pronóstico , Estudios Retrospectivos , Reinserción al Trabajo , Factores de Riesgo , Esquizofrenia/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven
19.
Wilderness Environ Med ; 28(1): 23-42, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28257714

RESUMEN

To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.


Asunto(s)
Prevención de Accidentes/métodos , Avalanchas , Accidentes/mortalidad , Asfixia/epidemiología , Humanos , Hipotermia/mortalidad , Hipotermia/fisiopatología , Nieve , Sociedades Médicas , Medicina Silvestre/normas
20.
Cien Saude Colet ; 22(3): 867-878, 2017 Mar.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-28300994

RESUMEN

The 'choking game' is a risk-taking behavior that has spread quickly among children and young people, causing dependence, accidents and even death, including in Brazil. These activities are performed in order to experience fleeting euphoric sensations, attracting numerous participants through the thousands of videos posted on YouTube. The problem of 'asphyxial games' can be observed in the Brazilian digital media, although there is a lack of scientific studies. Through a systematic review of the literature and complementary material, this paper aims to address the 'asphyxial games', warning about the psychophysiological and behavioral effects of these practices, while also presenting international epidemiological data. Sharing this information in academic circles is extremely important given the need to acquire more knowledge on the topic, train professionals and propose preventive measures that raise awareness among children and young people of the potential danger of voluntary fainting. It is equally important to raise awareness among parents and teachers so they can identify the warning signs that children may be engaging in these practices. And finally, it is also necessary to request government support to control exposure to videos that encourage the behavior.


Asunto(s)
Obstrucción de las Vías Aéreas/enzimología , Asfixia/epidemiología , Conducta Autodestructiva/epidemiología , Accidentes/estadística & datos numéricos , Adolescente , Conducta del Adolescente/psicología , Obstrucción de las Vías Aéreas/psicología , Asfixia/psicología , Brasil/epidemiología , Niño , Humanos , Internet , Asunción de Riesgos , Conducta Autodestructiva/psicología
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