Contributing Causes of Injury or Death in Grain Entrapment,Engulfment, and Extrication

Objectives: Grain entrapments and engulfments are one of most common hazards associated with grain storage facilities, with over 1,140 such entrapments/engulfments documented since the 1970s. The objective of the study was to determine the factors that contribute to injury or death in grain entrapment, engulfment, and extrication cases. Methods: A literature review, including data contained in the Purdue Agricultural Confined Spaces Incident Database (PACSID), was conducted to determine the conditions that the body experiences during an entrapment or engulfment in grains and during extrication efforts. Results: Based on the review, the conditions a human body faces during an entrapment, engulfment, or extraction can be split into two broad categories—environmental and physiological/psychological. The environmental factors depend on the grain’s properties, depth of entrapment or engulfment, position of the victim’s body, and characteristics of the storage unit, which include the grain’s lateral pressure, vertical pressure, and weight, as well as friction, oxygen availability and diffusion rate, and grain temperature. The physiological and psychological factors are related to the individual’s age and physical and psychological conditions, and manifest themselves in terms of oxygen consumption, asphyxiation (including aspiration, lack of oxygen, compression or splinting of the thorax), blood flow, and heart rate. Conclusion: Of all the above factors, a review of fatality data contained in the PACSID indicate that aspiration, asphyxiation, grain weight, and lateral pressure are most likely the primary cause of death for most entrapment victims. Research gaps found by this study include an understanding of the impact of lateral pressure on lung expansion and oxygen availability and consumption rate, and the need for more case studies to accurately determine cause of death.     

Fatal injuries and alcohol

We reviewed fatal injuries in Fulton County, Georgia, in collaboration with the medical examiner's office. This county encompasses most of the city of Atlanta and has a population of approximately 600,000 persons. Information collected for 1981 and 1982 was analyzed; and the results of blood alcohol content (BAC) testing and toxic screens were reviewed for all victims of homicide, suicide, and unintentional fatal injuries who died within six hours of being injured. Seventy-one percent of 271 homicide victims had been drinking, and 51 percent had BACs greater than or equal to 0.1 mg/dL. Of 153 suicide victims, 37 percent had been drinking and 20 percent had BACs greater than or equal to 0.1 mg/dL. Of 54 drivers who died in single-vehicle collisions, 78 percent had been drinking; 54 percent of 162 victims of nonvehicular unintentional fatal injuries had positive blood alcohol levels. There was little evidence of the use of psychotropic drugs among victims of fatal injury. Most of the victims of homicide and unintentional fatal injuries who had positive toxic screens also had a positive blood alcohol tests.     

Effects of legislative reform to reduce drunken driving and alcohol-related traffic fatalities

From 1980 through 1985, considerable progress was made across the Nation in reducing drunken driving and fatal automobile crashes. More than 400 chapters of local citizen groups concerned with reducing drunken driving were formed. New media coverage, measured in number of stories, increased fiftyfold from 1980 to 1984. More than 500 legislative reforms were passed. All States now have adopted a legal drinking age of 21. Many also adopted criminal and administrative per se laws and instituted penalty increases for drunken driving. By 1985, the total number of fatal crashes declined to 39,168, a decrease of 6,116, or 16 percent, from the 1980 level of 45,284. Single-vehicle fatal crashes occurring at night, those most likely to involve alcohol, declined by 20 percent, with 3,674 fewer crashes in 1985 than in 1980. Among teenage drivers, declines in fatal crashes were steeper: Fatal crashes decreased 26 percent, and single-vehicle night fatal crashes were down 34 percent. After 1984, however, the number of new citizen groups established and the number of stories appearing in the media began to decline. In 1986, after decreasing for several years, the number of fatal crashes rose 5 percent, and single-vehicle night fatal crashes rose 7 percent, up 1,060 from 1985. Among teenage drivers, the increase in single-vehicle night fatal crashes was even higher, up 17 percent. In 1987, single-vehicle night fatal crashes declined slightly but still remained higher than in 1983, 1984, or 1985.(ABSTRACT TRUNCATED AT 250 WORDS)     

The geography of self-injury: spatial patterns in attempted and completed suicide

This study uses hospital discharge data, death certificates and medical examiner data for New Jersey for 1999-2001 to investigate whether fatal and non-fatal self-injury exhibit similar geographic patterns. Findings show that the demographic characteristics of individuals committing fatal and non-fatal self-injury are quite different. Furthermore, attempted and completed suicides have a somewhat different geographical pattern. Municipality-level determinants of suicide and non-fatal self-injury were estimated in two separate models. While measures of isolation such as low population density and high proportions of households with only one member were predictive of completed suicides, non-fatal self-injury was related to unemployment and median age. Both types of self-injury were more common in municipalities which lost population between 1990 and 2000, and where divorce rates were high. Population-based suicide prevention efforts should be aided by the knowledge that although there are some similarities in the spatial pattern of completed and attempted suicides, there are some important differences in significant determinants.     

Social Networks and the Risk of Gunshot Injury

Direct and indirect exposure to gun violence have considerable consequences on individual health and well-being. However, no study has considered the effects of one’s social network on gunshot injury. This study investigates the relationship between an individual’s position in a high-risk social network and the probability of being a victim of a fatal or non-fatal gunshot wound by combining observational data from the police with records of fatal and non-fatal gunshot injuries among 763 individuals in Boston’s Cape Verdean community. A logistic regression approach is used to analyze the probability of being the victim of a fatal or non-fatal gunshot wound and whether such injury is related to age, gender, race, prior criminal activity, exposure to street gangs and other gunshot victims, density of one’s peer network, and the social distance to other gunshot victims. The findings demonstrate that 85 % all of the gunshot injuries in the sample occur within a single social network. Probability of gunshot victimization is related to one’s network distance to other gunshot victims: each network association removed from another gunshot victim reduces the odds of gunshot victimization by 25 % (odds ratio = 0.75; 95 % confidence interval, 0.65 to 0.87). This indirect exposure to gunshot victimization exerts an effect above and beyond the saturation of gunshot victimization in one’s peer network, age, prior criminal activity, and other individual and network variables.     

Characteristics of non-fatal opioid overdoses attended by ambulance services in Australia

OBJECTIVE: To examine the feasibility of establishing a database on non-fatal opioid overdose in order to examine patterns and characteristics of these overdoses across Australia. METHODS: Unit record data on opioid overdose attended by ambulances were obtained from ambulance services in the five mainland States of Australia for available periods, along with information on case definition and opioid overdose management within these jurisdictions. Variables common across States were examined including the age and sex of cases attended, the time of day and day of week of the attendance, and the transportation outcome (whether the victim was left at the scene or transported to hospital). RESULTS: The monthly rate of non-fatal opioid overdose attended by ambulance was generally highest in Victoria (Melbourne) followed by NSW, with the rates substantially lower in the remaining States over the period January 1999 to February 2001. Non-fatal opioid overdose victims were most likely to be male in all States, with the proportion of males highest in Victoria (77%), and were aged around 28 years with ages lowest in Western Australia (m=26) and highest in NSW (m=30). Most of the attendances occurred in the afternoon/early evening and towards the later days of the working week in all States. The rates of transportation varied according to ambulance service practice across the States with around 94% of cases transported in Western Australia and around 18% and 29% of cases transported in Melbourne and NSW respectively. CONCLUSIONS: It is feasible to establish a database of comparable data on non-fatal opioid overdoses attended by ambulances in Australia. This compilation represents a useful adjunct to existing surveillance systems on heroin (and other opioid) use and related harms.     

Undernotification of diagnosed cancer cases to the Stockholm Cancer Registry

A study of undernotification to the Stockholm Regional Cancer Registry comprised cancer diagnosed in 1978. Non-notified cases were identified by linking the cancer register with two independent sources of information viz. the Swedish cause-of-death register (fatal cases) and the regional in-patient care register (non-fatal cases). The estimated deficit in the cancer register for 1978 was 4% of the total cancer incidence for that year. The unreported non-fatal cases were followed up for five years, during which time more than half of the cancer diagnoses were entered on death certificates. If the cancer register had been supplemented with information from death certificates, therefore, only about 1% of all non-notified cases would have remained unregistered five years after diagnosis.     

Malignancy in nonagenarians

In a series of 143 necropsies on aged subjects, age range 90 to 100, 20 patients were found to have died of malignant disease and a further 16 patients had a total of 20 non-fatal malignant tumours. The rate of clinical recognition was lower than would be expected in other age groups. Adenocarcinomas of the digestive system predominated in the fatal group. This study confirms previous reports of a high incidence of non-fatal tumours and a diminished tendency to metastasis in both fatal and non-fatal cases. These features are not thought to imply diminished aggressiveness of malignant tumours in extreme old age, since analysis of individual cases provided other explanations such as death from unrecognised local complications of the tumour or the intervention of an unrelated cause of death. There was, however, an unexpectedly high number of cases of long survival after excision of a malignant tumour, including a case of spontaneous regression.     

Statistische Erfassung von Ertrinkungsnotfällen in Deutschland

Background

Germany currently does not yet have a nationwide drowning prevention strategy. In addition, there is no statistical reporting regarding fatal cases of drowning and non-fatal cases of near-drowning. Several hundreds of fatal drowning cases and a presumably several times higher unknown number of non-fatal cases of near-drowning occur every year in Germany. Thus, there is unquestionably room for improvement concerning statistics on drowning and near-drowning.

Method and results

Based on an analysis of existing drowning statistics in Germany the authors recommend the implementation of a web-based German drowning database providing information about fatal cases of drowning and non-fatal cases of near-drowning.

Conclusion

The implementation of a German drowning database via Internet can vastly enhance knowledge about drowning in Germany. Information specifically pertaining to non-fatal cases of near-drowning can be significantly improved. The background and details of these cases would provide better quality information.     

Costs differences across demographic groups and types of occupational injuries and illnesses

BACKGROUND: Little is known about cost differences for demographic groups or across occupational injuries and illnesses. METHODS: In this incidence study of nationwide data for 1993, an analysis was conducted on fatal and non-fatal injury and illness data recorded in government data sets. Costs data were from workers' compensation records, estimates of lost wages, and jury awards. RESULTS: The youngest (age < or = 17) and oldest (age > or = 65) workers had exceptionally high fatality costs. Whereas men's costs for non-fatal incidents were nearly double those for women, men's costs for fatal injuries were 10 times the costs for women. The highest ranking occupation for combined fatal and non-fatal costs--farming, forestry, and fishing--had costs-per-worker (5,163 US dollars) over 18 times the lowest ranking occupation-executives and managers (279 US dollars). The occupation of handlers, cleaners, and laborers, ranked highest for non-fatal costs. Gunshot wounds generated especially high fatal costs. Compared to whites, African-Americans had a lower percentage of costs due to carpal tunnel syndrome, circulatory, and digestive diseases. CONCLUSIONS: Costs comparisons can be drawn across age, race, gender, and occupational groups as well as categories of injuries and illnesses.     

Construction equipment and motor vehicle related injuries on construction sites in Turkey

Research on occupational accidents on construction sites in Turkey is very few. Moreover, research on motor vehicle and equipment accidents also do not exist. Investigation in the scope of this study shows that after falls and contact with electricity, accidents involving heavy equipment and motor vehicles rank third and fourth, respectively. This study aims to reveal the characteristics of these types of accidents, deduct the prominent causes that lead to fatalities as well as permanent disabilities using the present data. With the aid of obtained results, recommendations are made for safety experts on how to derive data from insufficient sources in Turkey and to evaluate these data for prevention and mitigation of the risks that construction workers are exposed to. 168 fatal and 38 non-fatal traffic accident-caused incidents as well as 206 fatal and 97 non-fatal construction equipment accidents, which were selected from official statistics and expert reports, were taken into consideration. Analysis and classification of these accidents were done according to the way they happened, the type of construction site and the occupation of the victims. Moreover, the leading causes of fatal and non-fatal injuries, to which drivers, operators and co-operators are exposed, are presented. Critical findings concerning prominent ways of occurrence, type of construction work and occupation are presented; and a number of measures for reducing the present risks are suggested. Some approaches for analysing relevant data are proposed for further research.     

Deaths from external causes of injury among construction workers in North Carolina, 1988-1994

Records from the Office of the North Carolina Chief Medical Examiner were used to describe 3955 deaths, both on and off the job, between 1988 and 1994 from external causes of injury (E-codes) among individuals whose usual occupation was in the construction trades. For the calculation of rates, population sizes were estimated using 1980 and 1990 census data. Deaths from injuries occurred at an average rate of 226 per 100,000 population; 213 per 100,000 for non-work-related fatalities and 13 per 100,000 for work-related fatalities. Overall, deaths were most often from guns or motor vehicle accidents. Work-related deaths were most often caused by motor vehicles (21%); falls (20%), most commonly from roofs or scaffolds; and machinery (15%), electrocutions (14%), and falling objects (10%). Three major causes of work-related motor vehicle accidents were identified including injuries to pedestrians in highway work zones and in backovers on construction sites, and injuries to drivers caused by shifting loads while transporting construction materials. The circumstances surrounding deaths involving scaffolding document the need for training and safety procedures for erecting, moving, and disassembling scaffolds, but also for safe work practices on scaffolds. Training and safety procedures to avoid electrocutions must involve workers who are not in the electrical trades, as these deaths often occurred among individuals who were not electricians or linemen. Significant differences were observed in the proportion of victims having elevated blood-alcohol levels depending on whether the injury was work-related; 57 percent of victims were impaired at the time of fatal non-work-related injuries compared to 5 percent of work-related injuries. Interventions to treat and prevent alcohol abuse among construction workers could have a significant public health impact in the prevention of premature death from injury, particularly outside the workplace.     

Leisure time physical activity and long-term cardiovascular and cancer outcomes: the Busselton Health Study

The study aimed to investigate whether meeting leisure time physical activity recommendations was associated with reduced incident and fatal cancer or cardiovascular disease (CVD) in a community-based cohort of middle- to late-aged adults with long-term follow-up. At baseline, 2,320 individuals were assessed on a large number of lifestyle and clinical parameters including their level of physical activity per week, other risk factors (e.g. smoking and alcohol use) various anthropometric measures, blood tests and medical history. Individuals were linked to hospital and mortality registry data to identify future cancer and cardiovascular events (fatal and non-fatal) out to 15 years of follow-up. Cox regression analyses adjusted for relevant confounders identified a priori were used to estimate risk for all-cause, cancer-specific and CVD-specific mortality. In the full cohort an estimated 21 % decreased risk for all-cause mortality (HR 0.79; 95 % CI 0.66–0.96) and 22 % decreased risk for fatal/non-fatal CVD events (HR 0.78; 95 % CI 0.66–0.92) was associated with baseline self-reported physical activity levels of 150 min or more. After exclusion of those with chronic co-morbidities (CVD, cancer, diabetes, chronic obstructive pulmonary disease, hypertension treatment) at baseline, lower risk for fatal/non-fatal CVD events remained significantly associated with 150 min or more of physical activity (HR 0.77; 95 % CI 0.62–0.96). Results from this well established prospective community-based cohort study support the role of leisure time physical activity in reducing all-cause mortality and CVD events (fatal/nonfatal) in the broader population studied. The data also suggest that physical activity associated reductions in risk for CVD events (fatal/nonfatal) were not overly impacted by prevalent key non-communicable diseases.     

致死性机动车车祸流行病学特征及其多因素分析

本文描述了１９８５～１９８９年广州市区１５３２宗致死性机动车车祸的流行病学特征，并运用多元逐步回归方法分析某些有关致死性机动车车祸的影响因素。结果显示，３９．４９％的车祸是由于机动车与自行车相撞。车祸的死亡者中小于２５岁和大于５０岁者所占比例最大（各占２８．８５％和２８．４２％），１／３受伤者年龄在２５岁以下，伤亡者中均以农民为最多。车祸中负主要责任的驾驶员３６．８４％，年龄在２０～２４岁，显著高于其他年龄组。逐步回归分析表明，取ｄ＝０．５时，车祸发生数与机动车拥有量、车祸中主要及次要（无）责任者的男女比例、主要责任者平均年龄和主要责任驾驶员持驾驶证的平均年限呈正相关关系。取ｄ＝０．０６时，则机动车拥有量和男女性比例进入回归方程。     

The global burden due to occupational injury

BACKGROUND: Occupational injuries are a public health problem, estimated to kill more than 300,000 workers worldwide every year and to cause many more cases of disability. We estimate the global burden of fatal and non-fatal unintentional occupational injuries for the year 2000. METHODS: The economically active population (EAP) of about 2.9 billion workers was used as a surrogate of the population at risk for occupational injuries. Occupational unintentional injury fatality rates for insured workers, by country, were used to estimate WHO regional rates. These were applied to regional EAP to estimate the number of deaths. In addition to mortality, the disability-adjusted life years (DALYs) lost, which measure both morbidity and mortality, were calculated for 14 WHO regions. RESULTS: Worldwide, hazardous conditions in the workplace were responsible for a minimum of 312,000 fatal unintentional occupational injuries. Together, fatal and non-fatal occupational injuries resulted in about 10.5 million DALYs; that is, about 3.5 years of healthy life are lost per 1,000 workers every year globally. Occupational risk factors are responsible for 8.8% of the global burden of mortality due to unintentional injuries and 8.1% of DALYs due to this outcome. CONCLUSIONS: Occupational injuries constitute a substantial global burden. However, our findings greatly underestimate the impact of occupational risk factors leading to injuries in the overall burden of disease. Our estimates could not include intentional injuries at work, or commuting injuries, due to lack of global data. Additional factors contributing to grave underestimation of occupational injuries include limited insurance coverage of workers and substantial under-reporting of fatal injuries in record-keeping systems globally. About 113,000 deaths were probably missed in our analyses due to under-reporting alone. It is clear that known prevention strategies need to be implemented widely to diminish the avoidable burden of injuries in the workplace.     

Effect of feeding various levels of sodium zeolite A on milk yield, milk composition and blood profiles in thermally stressed Holstein cows.

Mid-lactation Holstein cows (n = 48) were equally and randomly assigned to one of four feeding treatments of sodium zeolite-A (SZA). SZA was mixed in a grain mixture (50:50 grain to forage ratio) of 0% (control), 0.5%, 1.0% and 1.5% SZA on a dry matter intake basis. Cows were fed alfalfa hay in the first phase and corn silage in the second phase of the study as roughage sources. Milk samples were taken three times weekly (am and pm) and analyzed for milk fat, protein and lactose with blood profiles conducted from samples collected weekly. SZA significantly (P less than .05) increased feed intake at all three levels for both diets. Milk yield was significantly (P less than .05) greater in the alfalfa diet. However, milk fat percent and percent protein were greater (P less than .05) in the corn silage diet. The addition of SZA to the corn silage diet increased (P less than .05) milk fat percent at the 1.0% level and milk protein at the 1.5% level. Calcium in milk was significantly (P less than .01) increased and respiration rates significantly lowered (P less than .05) in both diets at the 1.0% level. Serum calcium was higher (P less than .05) at the 1.0 and 1.5% level in the hay diet and the 1.5% level in the corn silage diet. Also, serum glucose and alkaline phosphate levels were significantly (P less than .05) higher in the corn silage diet.     

Green space and cardiovascular health in people with type 2 diabetes

Associations between green space type and 9-year risk of incident cardiovascular disease (CVD) hospitalisations and deaths were analysed in 4166 people with type 2 diabetes in the Sax Institute's 45 and Up Study. Incidence of all-cause mortality, cardiovascular mortality, fatal or non-fatal CVD events and acute myocardial infarctions (AMI) were 14.67%, 7.23%, 47.36%, and 4.51%, respectively. After full adjustment, more tree canopy was associated with lower CVD mortality, lower fatal or non-fatal CVD events, and lower AMI risk. More open grass was associated with lower all-cause mortality, lower CVD mortality and lower fatal or non-fatal CVD events, but higher AMI risk.     

Sex-specific trends in validated coronary heart disease rates in southeastern New England, 1980-1991

Although the national decline in coronary heart disease mortality began earlier and was steeper in women relative to men, recent data suggest that the decline in women has slowed. The purpose of this study was to document sex-specific trends in coronary disease morbidity and mortality for the period 1980-1991 in two southeastern New England communities, and to determine whether temporal trends have been similar in men and women aged 35-74 years. Analyses were based on 6,282 validated in-hospital and out-of-hospital coronary disease events ascertained by the retrospective surveillance system of the Pawtucket Heart Health Program. Total (fatal plus non-fatal) coronary disease rates remained stable during this period. The flat trend was the result of an increase in non-fatal hospitalizations and a simultaneous decrease in both in-hospital and out-of-hospital mortality. The decline in fatal coronary disease was steeper for men, for both in- and out-of-hospital mortality, although the sex difference was statistically significant only for out-of-hospital deaths. In-hospital case-fatality for validated coronary disease declined for both men and women. The steeper decline in coronary disease mortality for men suggests the need for more information regarding sex differential trends in prevention, diagnosis, classification, and treatment.     

Female homicides in United States workplaces, 1980-1985.

BACKGROUND: Women, while noted for low occupational injury mortality rates, are more likely to die as victims of assault than from any other manner of injury at work. METHODS: From the National Traumatic Occupational Fatality surveillance data, 950 women were identified who were fatally assaulted at work. Homicide rates were calculated for the demographic and employment characteristics of these women. Risk ratios among types of lethal injuries were examined. RESULTS: During 1980-1985, the crude six-year workplace homicide rate was 4.0 deaths per million working women: one twentieth the homicide rate of the US female population. Decedents ranged from 16 years (the lowest age included in the data base) to 93 years of age. Working women older than 65 years had the highest age-specific homicide rate, 11.3 per million. Women younger than 20 had the lowest, 2.5 per million per year. Homicide rates for women of races other than White were nearly twice as high as those of Whites. The leading causes of death were gunshot wounds (64 percent), stabbings (19 percent), asphyxiations (7 percent), and blunt force trauma (6 percent). Nearly 43 percent of the deceased women had been employed in retail trade: 8.7 per million employed women annually. CONCLUSIONS: During 1980-1985, only 6 percent of the nation's victims of work-related injury deaths were female: 41 percent of those women were murdered. Homicide is currently the leading manner of traumatic workplace death among women in the United States.