Spinal cord injuries in Australian footballers 1997-2002

OBJECTIVE: To review acute spinal cord injuries (ASCIs) in all Australian codes of football (rugby union [RU], rugby league [RL], Australian Rules football [ARF] and soccer) for 1997-2002 and to compare data with those of a 1986-1996 survey. DESIGN: Retrospective review of hospital records, and structured interviews with injured players. PARTICIPANTS AND SETTING: Patients admitted to any of the six Australian spinal cord injury units with a documented football-related ASCI over the period 1997-2002. OUTCOME MEASURES: Average annual incidence of ASCIs per 100,000 players in the different codes, final Frankel grading of injuries, and wheelchair status. RESULTS: Fifty-two footballers (45 adult men and seven schoolboys) suffered ASCIs between 1997 and 2002. The average annual incidence of ASCIs per 100,000 players was 3.2 for RU, 1.5 for RL, 0.5 for ARF and 0.2 for soccer. While there has been little change in incidence since the 1986-1996 survey, there has been a trend towards less severe injuries in RU and RL, but not in ARF. There have been no scrum injuries in RL since 1996, when the scrum stopped being contested. Seven injuries occurred in RU scrums, six at the moment of engagement of the opposing teams. The incidence of 2-on-1 and "gang" tackles (involving multiple tacklers) in RL is disturbing. Overall, 39% of injured players became permanently wheelchair-dependent. CONCLUSIONS: There continues to be good reason to revise the laws of scrum engagement in RU. The laws relating to multiple tacklers in RL should be examined. The insurance cover for injured players is grossly inadequate. The longstanding need for a registry of spinal cord injuries for all football codes regrettably remains unmet.     

Long-term trends in Indigenous deaths from chronic diseases in the Northern Territory: a foot on the brake, a foot on the accelerator

OBJECTIVE: To examine trends in Northern Territory Indigenous mortality from chronic diseases other than cancer. DESIGN: A comparison of trends in rates of mortality from six chronic diseases (ischaemic heart disease [IHD], chronic obstructive pulmonary disease [COPD], cerebrovascular disease [CVD], diabetes mellitus [DM], renal failure [RF] and rheumatic heart disease [RHD]) in the NT Indigenous population with those of the total Australian population. PARTICIPANTS: NT Indigenous and total Australian populations, 1977-2001. MAIN OUTCOME MEASURES: Estimated average annual change in chronic disease mortality rates and in mortality rate ratios. RESULTS: Death rates from IHD and DM among NT Indigenous peoples increased between 1977 and 2001, but this increase slowed after 1990. Death rates from COPD rose before 1990, but fell thereafter. There were non-significant declines in death rates from CVD and RHD. Mortality rates from RF rose in those aged > or = 50 years. The ratios of mortality rates for NT Indigenous to total Australian populations from these chronic diseases increased throughout the period. CONCLUSIONS: Mortality rates from IHD and DM in the NT Indigenous population have been increasing since 1977, but there is evidence of a slower rise (or even a fall) in death rates in the 1990s. These early small changes give reason to hope that some improvements (possibly in medical care) have been putting the brakes on chronic disease mortality among Aboriginal and Torres Strait Islander peoples.     

Sudden cardiac death in young Danes

Sudden Cardiac Death (SCD) in the young (aged 1-35 years), although presumably rare, is always a tragic and devastating event often occurring in apparently healthy persons. Through the last decades, research have been undertaken to estimate the incidence rate and underlying causes of these deaths. However, because autopsy is not always conducted, the true incidence of SCD might be underestimated. The incidence of sudden infant death syndrome (SIDS) has previously been thoroughly investigated, also in Denmark. However, data has not been precise in sudden unexpected death in infancy (SUDI) estimates. SIDS is a diagnosis of exclusion and an ICD-10 diagnosis (R95.9), but to what extent this diagnosis is being accurately applied has not been investigated in Denmark. A genetic screening for mutations in an otherwise unexplained death, might identify a likely cause of (inherited) death. It would be of great clinical interest if DNA derived from the Danish Neonatal Screening Biobank, containing DNA from all Danes born after 1981, could be used in this respect. In this thesis we provide nationwide data on SCD, SUDI and SIDS in Denmark for the period 2000-2006 by reading death certificates, autopsy reports, and registry data. We report the highest possible incidence rate of SCD in the young. We elaborate on regional differences in post-mortem investigations of sudden death cases in Denmark and validate a method for whole-genome amplification of DNA from Guthrie cards to be used in genetic screening for disease causing mutations. We found 7% of all deaths in the young could be attributed to SCD. A total of 25% of sudden unexpected death in the 1-35 years old were not autopsied. The incidence of SCD of 2.8 per 100,000 person-years--when including non-autopsied cases--was higher than previously reported. Unexplained deaths were abundant and accounted for 22% of all sudden unexpected deaths. Sudden deaths occurring during competitive sports, however, were only seen in few cases. We found that regional differences exist in the investigation of sudden unexpected deaths. Fewer deaths were medico-legally investigated by external examinations ("retsl?geligt ligsyn") in some parts of Denmark compared to other parts. The same was the case in autopsy ratios. In infant deaths we found that almost 1 in 2000 live-borns died suddenly and unexpectedly during their first year of life. The R95.9 diagnosis did not reflect the SIDS cases we identified. We were able to get DNA from the Danish Neonatal Screening Biobank on 93 cases of unexplained deaths (including SIDS). Due to the limited amount of DNA available from the dried blood spots, we performed whole-genome amplification on the DNA (wgaDNA). We investigated the use of wgaDNA for genetic screening and it completely resembled genomic DNA (gDNA). Future research will focus on the genetics substrate of sudden unexplained death. In addition, we will investigate the causes of death in the 36-49 years old, as these may also suffer from cardiac disease that can be predisposed in the family.     

Deaths due to brain injury among footballers in Victoria, 1968-1999

OBJECTIVES: To determine the frequency and nature of fatal brain injuries occurring in Australian football. SETTING: State of Victoria, January to July 1999. DESIGN: Retrospective case series of football-related deaths identified from the coronial autopsy records of the Victorian Institute of Forensic Medicine (1990-1999) and newspaper reports (1968-1989). MAIN OUTCOME MEASURES: Coronial autopsy findings and circumstances of injury. RESULTS: 25 deaths associated with Australian football were identified, nine due to brain injury. Coronial findings in the brain-injury deaths were intracranial haemorrhage in eight patients and infarct in the territory of the middle cerebral artery in one. In three of four cases of subarachnoid haemorrhage, vertebral artery trauma was noted. In all but one case, injury occurred as an accidental part of play. CONCLUSIONS: The most common findings in deaths due to brain injury in Australian football were intracranial haemorrhage, including subarachnoid haemorrhage from vertebral artery injury.     

Sudden cardiac death in Air Force recruits. A 20-year review

We reviewed the clinical and autopsy records of the 19 sudden cardiac deaths that occurred among the 1,606,167 US Air Force healthy, medically screened recruits (90% male; 17 to 28 years old) during a 42-day basic training period between 1965 and 1985. Sixteen (all male) died suddenly of underlying structural heart disease, whereas no anatomic cause of death was identified in the remaining three. Thirty-two nonsudden, noncardiac deaths occurred during the same period, and only two had structural heart disease. Strenuous physical exertion was associated with sudden death in 17 of 19 cases (0.017 deaths per 50,000 exercise-hours), and the most frequent underlying etiology was myocarditis. Sudden cardiac death, a rare event in healthy young adults, is usually associated with exertion.     

Causes of sudden cardiac death in young Australians

OBJECTIVES: To determine the causes of sudden cardiac death in people aged 35 years or younger. DESIGN AND SETTING: A review of all autopsies performed between 1 January 1994 and 31 December 2002 at a major Sydney forensic medicine department serving an area with over 2 million people. MAIN OUTCOME MEASURES: Incidence of various types of cardiac disease causing sudden death in those aged 相似文献   

Causes of death in young Australians with type 1 diabetes: a review of coronial postmortem examinations

OBJECTIVE: To determine the causes of death in Australians with type 1 diabetes mellitus who died aged 40 years or younger. DESIGN AND SETTING: Retrospective review of autopsy reports at the Department of Forensic Medicine, Sydney, New South Wales, 1 January 1994-31 December 2006. MAIN OUTCOME MEASURE: Causes of mortality in people with type 1 diabetes aged <40 years. RESULTS: Of the 26 682 autopsy reports, 1914 were for individuals with diabetes (type 1, 400; type 2, 1514). Cardiovascular disease accounted for 51% of deaths (169/333) in people with type 1 diabetes aged >40 years, versus 13% among those aged 相似文献   

Sudden death in young Aboriginal adults with rheumatic heart disease

A retrospective review for the period 1983 to 1988 was made of all sudden deaths in young Aboriginal adults from the Darwin and East Arnhem regions who had known rheumatic heart disease. A total of five cases was identified from autopsy reports. The age range was between 16 and 35 years. All were being treated for asymptomatic heart disease (grade I). The sudden, unexpected death in each of these patients resulted in their deaths all being reported to the coroner. In all cases there was no evidence at autopsy of significant coronary artery disease or bacterial endocarditis. All had evidence of rheumatic valvular heart disease affecting either one or both mitral and aortic valves to varying degrees. No other cause of death was found. This report serves to illustrate the fact that rheumatic heart disease is still a significant contributor to morbidity and mortality in Aborigines, and that while the usual picture of progressive deterioration in exercise tolerance may be the norm, sudden death without any apparent preceding symptomatology can occur.     

Injuries of the spine sustained in rugby

Between 1952 and 1982, 67 rugby players (63 rugby union, two rugby league, and two American football) sustained serious injuries of their spine. The injuries fell predominantly on the lower cervical spine. Forty eight of the players sustained serious injuries of the spinal cord, leading to paralysis and total incapacity. The incidence of such injuries appears to have increased in recent years, particularly those incurred in tackles and mauls and rucks, and particularly among schoolboys. Changes in the laws of the game and in the attitudes of the players over the past few years should improve play and lead to a lower incidence of injuries.     

Suicide by aboriginal people in South Australia: comparison with suicide deaths in the total urban and rural populations

OBJECTIVE: To ascertain the number of recorded deaths by suicide of Aboriginal people and non-Aboriginals in South Australian urban and rural areas over the period 1981-1988. METHOD: The South Australian Coroner's records were examined by one of the authors and an Aboriginal research officer in consultation with members of the South Australian Aboriginal community (who identified Aboriginal suicides wrongly recorded as non-Aboriginal suicides). RESULTS: There was a major increase in suicide by Aboriginal people, both urban and rural, over that period, not marked by a similar increase for non-Aboriginal South Australians. CONCLUSIONS: A comparison can be drawn with reports of suicide by American Indians. It is possible that Aboriginal deaths by suicide can be ascribed to "anomie" (a concept first developed by Durkheim of social disintegration affecting tribal peoples under colonisation). The paper highlights the need for the development of successful intervention programmes in Aboriginal health.     

End-stage renal disease in aboriginals in New South Wales: a very different picture to the Northern Territory

OBJECTIVES: To compare the incidence of end-stage renal disease (ESRD) among Aboriginals in New South Wales with the incidence among Aboriginals in the Northern Territory, and to compare the patterns of ESRD among Aboriginals and non-Aboriginals in NSW. DESIGN: Secondary data analysis of information from unpublished and published Australia and New Zealand Dialysis and Transplant Registry reports. MAIN OUTCOME MEASURES: Average annual incidence of ESRD (persons per million); form of renal replacement therapy; mortality at 31 March 1998; patient and graft survival one and five years after transplant. RESULTS: Each year in NSW, 5-17 new Aboriginal patients are treated for ESRD. There was no increase in the average annual incidence of ESRD among NSW Aboriginals (118 per million in 1988-1989 and 111 per million in 1996-1997), whereas incidence in the NT increased from 255 per million to 800 per million. In NSW, ESRD was attributed to diabetes in 32% of Aboriginal patients, compared with 13% of non-Aboriginal patients (P < 0.001). In NSW, Aboriginal patients were younger and more likely to be female, a pattern similar to that in the NT. The outcome of ESRD treatment is not significantly different between Aboriginals and non-Aboriginals in NSW. CONCLUSION: There is a different pattern of incidence of ESRD and of outcomes with treatment among Aboriginals in NSW compared with those in the NT. A possible explanation is that the lower incidence in NSW reflects less profound socioeconomic disadvantage and better access to primary and specialist care.     

Sudden cardiac death among competitive adult athletes: a review

Sudden cardiac death is the leading cause of mortality among young athletes with an incidence of 1-2 per 100,000 athletes per annum. It is described as 'an event that is non-traumatic, non-violent, unexpected, and resulting from sudden cardiac arrest within six hours of previously witnessed normal health'. Most predisposed athletes have no symptoms and there is no warning for the impending tragic event. The majority of cases are caused by an underlying structural cardiac abnormality, most commonly hypertrophic cardiomyopathy. More recently, the understanding of non-structural causes such as long QT syndrome and Brugada syndrome has grown and diagnostic criteria have been developed. This review presents the known aetiologies of sudden cardiac death among athletes and outlines their identification and management including implications for future sporting participation as laid out in the consensus documents produced by the European Society of Cardiology and the 36th Bethesda Conference.     

Snorkelling deaths in Australia, 1987-1996

OBJECTIVE: To examine the causes and circumstances of snorkelling deaths in Australia from 1987 to 1996. DESIGN: Retrospective case extraction. CASES AND DATA SOURCES: 60 snorkelling deaths extracted from an ongoing diving fatality survey and from coroners' reports. Further details were obtained from police reports, diving industry (incorporating commercial operators, relevant government departments and instructors' organisations) inquiries and coronal inquests. MAIN OUTCOME MEASURES: Cause of death (determined by the authors from information obtained and from detailed autopsy findings) and the circumstances surrounding death. RESULTS: 15 of the 60 snorkellers who died were female. The three major causes of death were drowning (27 cases), cardiac events (18) and hypoxia with breath-holding after hyperventilation and/or during ascent producing unconsciousness then drowning (12). Overseas tourists were notable among those who drowned, while middle-aged men dominated the group who died of cardiac events (mostly on the surface). Those who died of breath-holding hypoxia were all young, Australian and male. The use of "buddy" diving was infrequent overall, and many of those who drowned or suffered cardiac events were not wearing flippers to aid propulsion. Adverse environmental conditions were implicated in 14 deaths. CONCLUSIONS: Hyperventilation to increase breath-hold time is a dangerous practice which should be discouraged. Safety measures, such as the use of flippers for propulsion and employment of the "buddy" system, should be encouraged, and made mandatory in commercial diving operations.     

Classification and analysis of fetal deaths in Massachusetts

Fetal deaths, in contrast to infant deaths, have been subject to epidemiologic analysis infrequently. We characterized 574 Massachusetts resident fetal deaths from 1982 and assessed the accuracy of cause-of-death information available from vital records compared with that from corresponding fetal autopsies. The fetal death rate exceeded the neonatal mortality rate. Fetal mortality was higher among black, unmarried, and older mothers. Fetuses of multiple-gestation pregnancies had an unusually high risk of fetal death. Autopsy reports were obtained for 61% of fetal deaths. The underlying cause of death from the fetal death record differed from that on the autopsy report in 55% of cases. Systematic collection of population-based autopsy data is a useful approach for improving the quality and accuracy of mortality statistics on fetal deaths. Many stillbirths remain unexplained, however, and research is needed to identify pathological markers that might reduce the heterogeneity within the fetal deaths currently ascribed to unknown causes.     

Deaths as a result of work-related injury in Australia, 1982-1984

A comprehensive study of deaths of work-related injuries which occurred throughout Australia in the years 1982-1984 was undertaken by means of coroners' records. Of 16,246 coroner-certified deaths that were attributed to trauma or to acute poisoning (excluding deaths of suicide or medical misadventure), the coroners' files were located for 15,462 (95.2%) deaths. From the files, a total of 1738 fatalities was judged to be work-related during the three-year period; of these, 1544 fatalities occurred in persons who were employed in the civilian labour force, which gave an average annual fatality incidence of 8.06 fatalities per 100,000 persons in the labour force. The death rate was much higher in men (12.05 fatalities per 100,000 men) than it was in women (1.34 fatalities per 100,000 women), increased with age, and was highest for the traditionally-dangerous occupations (such as mining, transport and rural occupations). The distribution of work fatalities by the main cause of death, and the nature of the injury event is described.     

Natural deaths while driving: would screening for risk be ethically justified?

OBJECTIVES: To determine the epidemiology and the underlying pathological conditions of natural deaths among motor vehicle drivers. Sudden death while driving may cause damage to properties, other vehicles or road users. Although the Medical Commission on Accident Prevention recommended restrictions to drivers at risk of sudden death due to their medical conditions, these restrictions are useless if they do not result in greater safety to the public. DESIGN: A retrospective study of natural deaths of motor vehicle drivers. SETTING: Natural deaths of motor vehicle drivers reported to the coroner for Birmingham and Solihull. SUBJECTS: 86 consecutive natural deaths of motor vehicle drivers in a five-year period between 1984 and 1988. RESULTS: Of the 86 fatalities reviewed, 80 (93%) sudden deaths were caused by ischaemic heart disease. Fifty vehicles were involved in collision with 32 properties, 20 other vehicles and six pedestrians. Fifty-one out of 80 cardiac deaths had past cardiac history and three had reported chest pain prior to the sudden death. CONCLUSION: An applied normative ethical assessment based on the basic moral principles of autonomy, justice, beneficence and non-maleficence are discussed. We conclude that medical screening of drivers has little benefit for the drivers or other persons.     

Trends in Australian mortality of asthma, 1979-1985

Trends in Australian mortality rates that have been ascribed to asthma and to non-tuberculous, non-malignant respiratory diseases were examined for the period 1979-1985. Mortality rates of asthma and respiratory diseases increased substantially from 1979 to 1985, and in the case of asthma, the crude death rate in 1985 was higher than at the peak of the "epidemic" of the 1960s. The increase in mortality of asthma was most pronounced in those of greater than 60 years of age (from 11.5 per 100,000 such population in 1979 to 22.9 per 100,000 such population in 1985). Asthma mortality rates in five- to 34-year-old persons increased, although there were marked yearly fluctuations, and deaths of asthma in this age-group comprised only a small percentage (13% in 1985) of all deaths of asthma. Reasons that are considered for the rising death rate of asthma include changes in diagnostic fashion; an increase in the incidence or a change in the natural history of asthma; and an increased case fatality rate. With the presently-available data, it is not possible to distinguish among these possible explanations.     

Deaths from snake bite in Australia, 1981-1991.

OBJECTIVE: To obtain and analyse data relating to snake bite fatalities in Australia. DESIGN: Retrospective analysis of case reports and collation of studies carried out at the Commonwealth Serum Laboratories (CSL). RESULTS: 18 deaths attributed to snake bite were reported to CSL over a 10-year period. Eleven of the victims were males and four of these were bitten after either picking up the snake or playing with it. In most cases, no pathological findings of significance were found at autopsy. Venom was detected in post-mortem samples from nine cases. Brown snakes (genus Pseudonaja) were responsible for 11 deaths; tiger snake (Notechus scutatus) for four, taipan (Oxyuranus scutellatus) two and death adder (Acanthophis australis) one. Death after a brown snake bite was often sudden and unexpected. In three patients bitten by tiger snakes and in one bitten by a brown snake, the presence of cerebral haemorrhage was confirmed at autopsy. CONCLUSIONS: Not all snake bite deaths in Australia are adequately investigated or reported. Under some circumstances death from snake bite is almost inevitable; two infants who received unwitnessed massive envenomations are tragic examples. Had venom absorption from the bitten area been delayed by correct first aid, some of the patients might have survived. The brown snakes (genus Pseudonaja) must now be considered Australia's most dangerous group of snakes because their venom may cause sudden unexpected collapse and death. The increased incidence of intracranial haemorrhage may in some cases be related to the intravenous use of adrenaline. In at least one case, the prompt administration of a clearly needed antivenom might have altered the outcome.