The context of illicit drug overdose deaths in British Columbia, 2006

Background  

Programmatic data from New York City syringe exchange programs suggest that many clients visit the programs infrequently and take few syringes per transaction, while separate survey data from individuals using these programs indicate that frequent injecting – at least daily – is common. Together, these data suggest a possible "syringe gap" between the number of injections performed by users and the number of syringes they are receiving from programs for those injections.     

The context of illicit drug overdose deaths in British Columbia, 2006

Background  

Illicit drug overdose deaths (IDD) relate to individual drug dose and context of use, including use with other drugs and alcohol. IDD peaked in British Columbia (BC) in 1998 with 417 deaths, and continues to be a public health problem. The objective of this study was to examine IDD in 2006 in BC by place of residence, injury and death, decedents' age and sex and substances identified.     

Fire-related deaths among Aboriginal people in British Columbia, 1991-2001

BACKGROUND: Fire-related mortality rates are known to be higher in Aboriginal people in BC. The purpose of this study was to describe the epidemiology and context of fire-related deaths in this population. METHODS: All death registrations attributable to fires in the province were identified by the B.C. Vital Statistics Agency (1991-2001). Age-specific death rates (ASDR) and age-standardized mortality rates (ASMR) were calculated for Status Indians and other residents. Data from Coroner's reports from the B.C. Coroners' Service (1997-2001) were used to describe the context of Aboriginal fire-related deaths. RESULTS: The overall fire-related ASMR for Status Indians and other residents were 0.66 deaths and 0.07 deaths/10,000 population respectively. Annual ASMR for both populations were constant over the study period. ASDR were higher in every age category for Status Indians; children and seniors had higher rates in both populations. Twenty-seven Aboriginal fatalities (20 fires) were identified for the contextual analysis. Key findings were: 48% of the total sample had elevated blood alcohol levels; 30% of the fires were caused by lit cigarettes (majority of decedents were intoxicated); 15% of the fires were caused by electric heating sources; at least 34% of fires occurred in homes with absent or non-functional smoke alarms. INTERPRETATION: Fire-related mortality among Aboriginal people in BC is a preventable public health concern. In this population, fire safety and prevention programs should consider improving the prevalence of functioning smoke alarms, promoting the safe use of heat sources, and decreasing smoking behaviours and the use of alcohol.     

Drug-related deaths in Grampian, Scotland

AIMS: To analyse the demographic data from fatalities arising directly from illicit drug abuse in the Grampian area and compare the findings with trends in drug seizures in Grampian to ascertain if these reflect the recorded deaths, and to attempt to identify a subgroup of the abusing population which might be at greater danger from overdose of controlled substances. METHODS: Cases in which the cause of death was directly attributed to illicit drugs from the beginning of January 1995 until the end of December 1999 were identified, and their epidemiological and toxicological data were analysed. The information regarding drug seizures was gained from Home Office publications for the same time period. RESULTS: One hundred and thirteen cases were retrieved consisting of 93 males and 20 females, aged 16 to 43 years (Median 25). The most commonly isolated substance was morphine followed by benzodiazepines. In 97 cases two or more drugs were involved with five cases showing positive toxicology for four or more drugs. Of the female deaths 75% fell into the 16-25 year age range. Drug seizures rose by 49% from 1995 to 1998 with both heroin and benzodiazepine seizures increasing by more than five fold in the same period. CONCLUSIONS: Deaths directly due to illicit drugs showed a significant increase over the study period and were concentrated in the young male population. The drug seizures increased but the extent of this was not mirrored in the deaths. A shift in emphasis to an older age group is also indicated; drug misuse educational programmes should continue to be targeted at all populations but information may also be targeted at the older age groups and at females under 25 years of age.     

Age-related trends in the timeliness and prediction of medical visits, hospitalizations and deaths due to pneumonia and influenza, British Columbia, Canada, 1998-2004

The influenza immunization program in North America has been primarily designed to provide direct benefit to vaccinated individuals at highest risk of serious influenza outcomes. Some evidence suggests that immunization of certain age groups may also extend indirect protective benefit to vulnerable populations. Our goal was to identify age groups associated earliest with seasonal influenza activity and who may have the greatest indirect impact at the population level. We examined age-based associations between influenza medical visits and population-wide hospitalization/mortality due to pneumonia & influenza (P&I) using administrative datasets in British Columbia, Canada. A peak week was identified for each age group based on the highest rates observed in a given week for that study year. Mean rates at the peak week were averaged over the study years per age group. Timeliness (T) was defined as the mean difference in days between the first peak in influenza medical visits and population-wide P&I hospitalizations/deaths. Poisson regression was applied to calculate prediction (Pr) as the average proportion of deviance in P&I explained by influenza medical visits. T and Pr were derived by age group, and the product (T x Pr) was used as a summary measure to rank potential indirect effects of influenza by age group. Young children (0-23 months) and the elderly (> or = 65 years) had the highest peak rates of P&I hospitalization. Children < 6m and the elderly had the highest peak rates of P&I mortality. We found no significant differences by age for influenza medical visits in predicting population-wide P&I hospitalizations or deaths. School-aged children (5-19 years) showed the best relative combination of T x Pr, followed by preschool-aged children (2-4 years). We conclude that the very young and old suffer the greatest morbidity due to P&I, and an indirect role for school-aged children in anticipating the risk to others warrants further evaluation.     

Anthrax in eastern Turkey, 1992-2004

We investigated animal and human anthrax cases during a 13-year period in eastern Turkey. From 1992 to 2004, a total of 464 animal and 503 human anthrax cases were detected. Most cases occurred in summer. Anthrax remains a health problem in eastern Turkey, and preventive measures should be taken.     

Baler and compactor-related deaths in the workplace--United States, 1992-2000

Equipment that compacts and bales loose solid waste materials into denser, more easilytransported units is common in refuse disposal and recycling and is used routinely at recycling centers, manufacturing facilities, and retail and wholesale stores to compress paper, textiles, metals, plastic, and other material. Persons operating balers and compactors can become caught by the powered rams of the compression chambers while using these machines. Risk factors resulting from these incidents have been identified through surveillance findings and results of investigations conducted by CDC's National Institute for Occupational Safety and Health (NIOSH) Fatality Assessment and Control Evaluation (FACE) program and the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI), a nationwide multisource reporting system for occupational deaths. This report describes the results of two baler and compactor-related investigations conducted during 1992-2000, summarizes surveillance data from 1992 through 1998, which indicated that some employers and workers may have been unaware of the hazards of operating or working near compacting and baling equipment, and suggests safety recommendations for preventing future incidents.     

Geographic disparity in premature mortality in Ontario, 1992-1996

BACKGROUND: Standardized mortality ratios are used to identify geographic areas with higher or lower mortality than expected. This article examines geographic disparity in premature mortality in Ontario, Canada, at three geographic levels of population and considers factors that may underlie variations in premature mortality across geographic areas. All-cause, sex and disease chapter specific premature mortality were analyzed at the regional, district and public health unit level to determine the extent of geographic variation. Standardized mortality ratios for persons aged 0-74 years were calculated to identify geographic areas with significantly higher or lower premature mortality than expected, using Ontario death rates as the basis for the calculation of expected deaths in the local population. Data are also presented from the household component of the 1996/97 National Population Health Survey and from the 1996 Statistics Canada Census. RESULTS: Results showed approximately 20% higher than expected all-cause premature mortality for males and females in the North region. However, disparity in all-cause premature mortality in Ontario was most pronounced at the public health unit level, ranging from 20% lower than expected to 30% higher than expected. Premature mortality disparities were largely influenced by neoplasms, circulatory diseases, injuries and poisoning, respiratory diseases and digestive diseases, which accounted for more than 80% of all premature deaths. Premature mortality disparities were also more pronounced for disease chapter specific mortality. CONCLUSION: Geographic disparities in premature mortality are clearly greater at the small area level. Geographic disparities in premature mortality undoubtedly reflect the underlying distribution of population health determinants such as health related behaviours, social, economic and environmental influences.     

Work-related injury deaths among hispanics--United States, 1992-2006

Hispanics are among the fastest-growing segments of the U.S. workforce. In 2006, an estimated 19.6 million workers in the United States were Hispanic, 56% of whom were foreign born. To characterize work-related injury deaths among Hispanic workers in the United States, CDC, the Bureau of Labor Statistics (BLS), and certain state agencies analyzed data from 1992-2006. This report summarizes the results of that analysis, which indicated that, during 1992-2006, a total of 11,303 Hispanic workers died from work-related injuries. The death rate for Hispanic workers decreased during this period; however, the rate was consistently higher than the rate for all U.S. workers, and the proportion of deaths among foreign-born Hispanic workers increased over time. During 2003-2006, 34% of Hispanic worker deaths occurred in the construction industry. Additional efforts are needed to reduce the risk for death among Hispanic workers because of projected increases in their employment, involvement in work with high risk for injury, susceptibility to miscommunication caused by language differences, and other potential risks associated with culture and economic status.     

Progress in reducing global measles deaths, 1999-2004

Measles remains a substantial cause of global childhood mortality, particularly in developing countries. In their joint strategic plan for Measles Mortality Reduction, 2001-2005, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) targeted 45 priority countries with the highest measles mortality for implementation of a comprehensive strategy for accelerated and sustained measles mortality reduction. Components of this strategy include achieving high routine vaccination coverage (>90%) in every district and ensuring that all children receive a second opportunity for measles vaccination. In May 2003, the World Health Assembly endorsed a resolution urging member countries to achieve a goal (adopted in 2002 by the United Nations General Assembly Special Session on Children) to reduce 1999 deaths resulting from measles by half by the end of 2005. This report updates progress toward this goal and introduces a new goal for measles mortality reduction by 2010.     

Farm injuries and fatalities in British Columbia, 1990-2000

BACKGROUND: Farming is considered to be one of the most dangerous occupations in Canada and internationally, as it often involves work in a high-risk environment due to exposure to such hazards as machinery, large animals and noxious chemicals. The objective of this study was to describe the incidence and nature of farm-related deaths and injuries on British Columbian farms from 1990-2000, with reference to Canadian averages. METHODS: British Columbian farm fatalities and farm injury hospitalizations data from Canadian Agricultural Injury Surveillance Program for 1990-2000 were analyzed in conjunction with the 1996 and 2001 Canada Census of Agriculture. The incidence and nature of farm injuries were quantified and described for age, gender, cause of injury, primary diagnosis and agent of injury. RESULTS: There were 82 fatal injuries from 1990-2000 and 1,407 hospitalizations from 1991/92 to 1999/2000. No significant overall incidence trends were found during the study period. The rate of machinery-related injuries requiring hospitalization is lower in BC than in Canada as a whole. The net effect of higher than expected hospitalization rates in younger BC adults (age 20-49) and lower than expected hospitalization rates in older BC adults (age 70+) was a much slower increase in hospitalization rates as farmers get older. CONCLUSION: The current data suggest that higher than expected non-machinery-related injuries result in higher hospitalization rates of young adult BC farmers. The potential impact of farm fatalities and injury in youth on loss of productivity and quality of life years emphasizes the need for education and prevention.     

Drinking water supply and management practices in British Columbia, 1997-98

BACKGROUND: Questions regarding control over a water fluoridation system in a British Columbia (BC) community led to a drinking water management survey in 1997-98. METHOD: A questionnaire was constructed based on published drinking water control and management criteria and was sent to 91 communities. RESULTS: 73/91 surveys were returned (80% response rate); 31 reported a protected water supply system, 40 reported logging and/or cattle grazing in watershed areas, 25 reported a lack of primary disinfection. Water fluoridation was reported in 12 locations, 3 of which did not monitor fluoride levels. Testing for protozoans was done routinely in 19 locations, 15 using approved laboratories. 15 water contamination events were reported, 9 of biological origin. Statistically significant associations were found between contamination events and: wooden delivery systems, lack of primary chlorination, increased number of protozoan tests, and increased number of personnel. INTERPRETATION: At the time of the survey in British Columbia, a number of communities were vulnerable to preventable drinking water contamination.     

2004-2013年佛山市孕产妇死亡相关因素分析

目的了解2004-2013年佛山市孕产妇死亡率和死因的变化趋势及其影响因素。方法采用佛山市孕产妇死亡监测资料,应用χ2检验对2004-2013年佛山市孕产妇死因变化及死亡相关影响因素进行分析。结果 1.2004-2013年佛山市孕产妇死亡率由2004年的34.77/10万降至2013年的10.73/10万,降幅达69.14%,非户籍孕产妇死亡率下降速度明显快于户籍孕产妇。2.2004-2008年直接和间接产科原因孕产妇死亡分别占65.38%和34.62%,2009-2013年直接和间接产科原因孕产妇死亡分别占33.87%和66.13%,不同时间段的直接和间接产科原因孕产妇死亡差异有统计学意义(P0.001)。孕产妇死因构成中,2004-2008年前三位死因依次为产科出血34.62%、羊水栓塞12.82%和妊娠期高血压疾病10.26%,2009-2013年的死因顺位为静脉血栓形成及肺栓塞17.74%、妊娠合并心脏病11.29%和其他血管疾病及妊娠期高血压疾病各9.68%。3.户籍和非户籍死亡孕产妇相关因素进行分析显示文化程度低、多产、无产检、初入医院级别是乡镇医院为非户籍孕产妇死亡的重要影响因素。孕产妇死亡评审十二格表因素分析,发现2004-2008年孕产妇死亡评审第一、第二因素的三个环节中均以个人家庭因素为主,其次是医疗保健系统因素,2009-2013年则相反,差异均有统计学意义(P值分别是0.009和0.001)。结论 2004-2013年佛山市孕产妇死亡率呈明显下降趋势,非户籍孕产妇死亡率下降速度明显快于户籍。2004-2013年佛山市孕产妇的死因由直接产科原因转变为间接产科原因,主要死因构成由产科出血、羊水栓塞和妊娠期高血压疾病转变为静脉血栓形成及肺栓塞和妊娠合并心脏病。文化程度低、多产、无产检、初入医院级别为乡镇医院为非户籍孕产妇死亡的重要影响因素。孕产妇死亡评审十二格表因素由个人、家庭的知识技能问题转变为医疗保健系统的知识技能问题。