All 291 fatal accidents (510 persons on board, 318 drowned) in water traffic in Finland in 1986-1988 were investigated by specific teams. Only some data of this extensive investigation are presented in this study. Staggering and falling in boat because of drunkenness, falling over and sinking of boat were the main causes of getting into water of the people aboard. Only 3.5% of the drowned had used life jackets and 9.7% of them could not swim. The reduced ability to swim because of alcohol and the exhaustion were in about half of the drowned the actual cause and the cold water in one third the background factor for drowning. The results indicate that fatal accidents in water traffic are a major problem of males (95.9%) and give important information for countermeasures.
Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self-poisoning and alcohol-/illicit drug-negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant-positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.
To determine the prevalence and context of alcohol use in the deaths of children and youth reviewed by the BC Children's Commission.
In 489 case reviews of BC children and youth, we examined the role that alcohol may have had at the time of death or whether there was a history of alcohol use either by the deceased child or another person in the child's life.
Alcohol is most prevalent in the lives of 15-18 year olds. It is present at the time of death in two fifths of Motor Vehicle Incidents (MVI) and one third of suicides and drownings.
Alcohol has a profound presence in the lives and deaths of children reviewed by the Children's Commission. Enhancing deterrence laws and alcohol control policies, and increasing public awareness are warranted.
Overweight and obesity is associated with lower rates of suicide. However, little is known about the association with different suicide methods. We studied the association between groups of body mass index and suicide methods. We identified all medicolegal autopsy cases with a cause of death due to external causes in Sweden during 1999-2013 (N = 39,368) and included 11,715 suicides and 13,316 accidents or homicides as controls. We applied multinomial regression models adjusted for age, sex, year and season of death. Obesity was associated with suicidal intoxication, OR 1.15 [95% confidence interval (CI) 1.02, 1.30] and negatively associated with all other suicide methods studied. Underweight showed a negative association with suicidal drowning and there was an indication towards a negative association with hanging in men OR 0.81 (95% CI 0.65, 1.01). We conclude that body mass index (BMI) is associated with the choice of suicide method. This may be of importance in a public health perspective, e.g. potential for prevention of intoxications. In the practice of forensic medicine, the physician's level of suspicion may rise if the apparent suicidal method is less common for the individual characteristics of the deceased, such as BMI.
The goal of this research project was to explore circumstances surrounding each drowning death occurring to children and adolescents ages 0-17 in Sweden during the years 1998-2007.
Records from the National Board of Forensic Medicine (NBFM) and other sources were analysed. We collected information on children's personal characteristics (sex, age, ethnic background, weight, height, physical condition, and pre-existing health conditions) and the circumstances of deaths (time and place of occurrence, type of drowning, resuscitation efforts and medical care given, for example). We also collected information on prevention factors: the physical environment, adult supervision, whether or not the child could swim, and if the child was using a personal flotation device at the time of death.
Our analysis showed that 109 children had drowned in Sweden during the study period - of this group, 96 had died from unintentional causes. Children from immigrant backgrounds, particularly with families coming from the Middle East and Iran, were inordinately represented in the group of victims who had died from unintentional drowning deaths. Other risk factors included: coming from a single parent-headed family, alcohol use by older victims and a lack of ability to swim.
Prevention efforts to prevent drowning in the future should focus on preventing alcohol use by young bathers; better fencing around swimming sites; improved coverage of swimming lessons to all children in Sweden, especially children from immigrant families; more education on drowning risks for single parents; and better awareness by adults on the need for constant supervision of children and adolescents in and near water.
AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.
Studies of cause-specific mortality show that deaths of epileptic people can be classified into those directly or indirectly related to epilepsy; those related to the underlying pathology giving rise to epilepsy; and those unrelated to either epilepsy or its causes. In this descriptive retrospective study, medical examiner's cases that occurred in Manitoba, Canada during 2004 were reviewed. One hundred and seventeen cases (4.06%) had epilepsy in their history. Cause of death was related directly to seizure in 12 cases (10.3%) and indirectly in six cases (5.1%); related to underlying pathology giving rise to epilepsy in 33 cases (28.2%); and unrelated to either of them in 60 cases (51.3%). Cause of death was unknown in six cases (5.1%). The causes of death, in order of frequency, were cardiac pneumonia, cerebrovascular accident and seizure disorder. Manner of death was natural in 86 cases (73.5%), accidental in 19 cases (16.2%), suicidal in five cases (4.3%), undetermined in five cases (4.3%) and homicidal in two cases (1.7%). While the mean age of the deceased persons with a positive history of seizure in this study was about 10 years less than those with a negative history of seizure, there was no significant difference between them in the manner of death. Epileptic people are not at greater risk for accidental death or suicide; however they are at greater risk for drowning. Recently diagnosed cases of epilepsy are at greater risk of dying from seizure or underlying pathology during the first year of their disease.
Specimens of blood and other body fluids were obtained at autopsy from all deaths in Sweden classified as suicide covering a 10-year period (N=11,441 cases). The mean age (+/-standard deviation, SD) of the victims was 51.3+/-18.8 years with a clear predominance of males 71% (mean age 51.3+/-18.8 years) compared with 29% females (mean age 51.4+/-18.9 years). The concentration of ethanol in blood samples was determined in duplicate by headspace gas chromatography and a mean blood-alcohol concentration (BAC) of 0.1g/L (10mg/100mL) was the cut-off used to identify ethanol positive cases. The suicides were coded (ICD-9) as self-poisonings (N=2462, 22%), hanging (N=4474, 39%), asphyxia by gas (N=509, 4.4%), drowning (N=803, 7.0%), gun shot (N=1307, 11.4%), fall from height (N=632, 5.5%), self-inflicted cuts or sharp-force injury (N=363, 3.1%) and miscellaneous ways (N=891, 7.8%). On average 34% of all suicide victims in Sweden had consumed alcohol before death, 36% of the males and 31% of the females had a positive BAC. The mean (median) concentration of alcohol in femoral blood for men was 1.34g/L (1.3g/L) compared with 1.25g/L (1.1g/L) for women. Many victims were heavily intoxicated and the 90th percentiles of the BAC distributions ranged from 2.3 to 2.8g/L depending on manner of death. Elevated blood-alcohol was most prevalent in poisoning deaths (45%) and gas asphyxia (51%) and least prevalent in falls from height (19%) and sharp-force injury (18%). Toxicological analysis for presence of drugs other than alcohol showed a predominance of paracetamol, SSRI antidepressants, anti-psychotics, sedative-hypnotics, and centrally acting opioids. A host of psycho-social factors drive a person to commit suicide and one of the catalysts is over-consumption of alcohol and acute alcohol intoxication. Heavy drinking leads to a loss of inhibitions, impulsive behaviour, poor judgment and a tendency to take risks, all of which might increase the propensity of predisposed individuals to take their own lives.