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Cureus Jul 2023The opioid epidemic is a significant public health crisis that has caused extensive harm and devastation in the United States. This literature review aimed to identify... (Review)
Review
The opioid epidemic is a significant public health crisis that has caused extensive harm and devastation in the United States. This literature review aimed to identify the contributing factors and negative consequences of the epidemic, as well as best practices for healthcare providers in managing the epidemic. Overprescribing opiates and opioids, lack of education and opportunity, and being unmarried or divorced were some of the identified contributing factors to dependence on opioids. The epidemic's negative consequences are substantial, leading to increased access to opioids for vulnerable populations, which consequently cause accidental death among men and the degradation of rural community health services. As part of the literature review, we also analyzed the best practices for healthcare providers, including implementing prescription drug monitoring programs (PDMPs). However, we found that while PDMPs resulted in a decrease in opioid overprescription and an increase in provider confidence when prescribing medication, the evidence for their effectiveness in improving rural community health services or reducing opioid overdoses and opioid-related deaths was inconclusive. Our review highlights that the greatest challenge to overcome is a lack of legal mandates and proper education for healthcare providers on best practices for addressing the epidemic. To regulate and control opioids effectively, tracking and standardizing prescription models by federal agencies and medical institutions is necessary but not enough. Legal action is vital for the successful containment of the opioid crisis.
PubMed: 37565101
DOI: 10.7759/cureus.41621 -
Legal Medicine (Tokyo, Japan) Mar 2024Carbon monoxide (CO) poisoning is a significant concern in forensic medicine, as it often presents unique challenges in terms of diagnosis, investigation, and...
INTRODUCTION
Carbon monoxide (CO) poisoning is a significant concern in forensic medicine, as it often presents unique challenges in terms of diagnosis, investigation, and determination of the cause of death. CO is a colourless, odourless, and tasteless gas that can be lethal when inhaled in high concentrations. It binds strongly to haemoglobin, forming carboxyhaemoglobin (COHb), which reduces the oxygen-carrying capacity of the blood, leading to tissue hypoxia and ultimately death.
MATERIALS AND METHODS
Circumstantial data, medical history information, autopsy findings, and toxicological analysis results related to 24 CO poisoning cases at the Institute of Legal Medicine in Verona were collected and analysed. The data were examined in an integrated manner to identify correlations and common patterns. A comparison was also made with the data available in the literature.
RESULTS
The male gender was confirmed to be the most frequently involved. COHb levels were found to be less than 50% in 6 cases. Three individuals had concurrent cardiovascular pathologies, while 11 subjects tested positive for various substances, including alcohol, benzodiazepines, and morphine. In most cases, the manner of fatal intoxication was accidental, although 6 suicides and 1 homicide are reported.
CONCLUSIONS
The Verona case series demonstrates that deaths due to CO poisoning require a multidisciplinary approach. The integration of diverse expertise is essential for assessing the manner of death. This approach enables a comprehensive evaluation of the available data, aids in distinguishing between accidental, suicidal, and homicidal deaths, and ensures accurate and reliable forensic conclusions.
Topics: Humans; Male; Carbon Monoxide; Suicide; Accidents; Homicide; Carbon Monoxide Poisoning
PubMed: 38154312
DOI: 10.1016/j.legalmed.2023.102375 -
Sensors (Basel, Switzerland) Jan 2024Drowning poses a significant threat, resulting in unexpected injuries and fatalities. To promote water sports activities, it is crucial to develop surveillance systems... (Review)
Review
Drowning poses a significant threat, resulting in unexpected injuries and fatalities. To promote water sports activities, it is crucial to develop surveillance systems that enhance safety around pools and waterways. This paper presents an overview of recent advancements in drowning detection, with a specific focus on image processing and sensor-based methods. Furthermore, the potential of artificial intelligence (AI), machine learning algorithms (MLAs), and robotics technology in this field is explored. The review examines the technological challenges, benefits, and drawbacks associated with these approaches. The findings reveal that image processing and sensor-based technologies are the most effective approaches for drowning detection systems. However, the image-processing approach requires substantial resources and sophisticated MLAs, making it costly and complex to implement. Conversely, sensor-based approaches offer practical, cost-effective, and widely applicable solutions for drowning detection. These approaches involve data transmission from the swimmer's condition to the processing unit through sensing technology, utilising both wired and wireless communication channels. This paper explores the recent developments in drowning detection systems while considering costs, complexity, and practicality in selecting and implementing such systems. The assessment of various technological approaches contributes to ongoing efforts aimed at improving water safety and reducing the risks associated with drowning incidents.
Topics: Humans; Drowning; Water; Artificial Intelligence; Algorithms; Technology
PubMed: 38257424
DOI: 10.3390/s24020331 -
Accident; Analysis and Prevention Jan 2024Vision Zero involves the use of a systems approach to eliminate fatal and serious injuries from motor vehicle crashes by accommodating basic human limitations that lead...
Vision Zero involves the use of a systems approach to eliminate fatal and serious injuries from motor vehicle crashes by accommodating basic human limitations that lead to crashes through fundamental behavioral expectations, together with sound vehicle and road design. Alcohol-related crashes account for a significant proportion of motor vehicle crash death and injury and can be addressed in a safe road transport system. We look at near-term policy and program interventions that are known to motivate drivers to make safe drinking and driving decisions, and possibilities for using technology over the longer term to address risks resulting from driver impairment that is either inadvertent or willful high-risk behavior. From the Vision Zero perspective,"normal driving" refers to a situation where traffic and road users are operating as desired and planned. A driver in this normal driving envelope operates at a safe speed, wears a seat belt, focuses on the driving task, and is not impaired. A safe system accommodates human errors, mistakes, and misjudgments in the normal driving envelope. However, it may not be capable of compensating for deliberate violations and rule-breaking. A critical role of behavioral programs and policies is to motivate safe decisions by drivers and other road users and keep them in the normal driving envelope where they can be protected from unintentional errors by a safe system. While much progress has been made in developing and implementing impaired driving policies and programs, much potential remains in the their ability to motivate drivers to meet the fundamental expectations required in a safe system. Examples of behavioral programs and policies that have strong evidence of effectiveness but are underutilized in the U.S. include conducting periodic sobriety checkpoints, lowering the blood alcohol concentration limit for driving, and mandating the use of ignition interlock devices. While the specific interventions may differ, it is likely that the same situation of incomplete implementation of behavioral programs and policies - and consequent unrealized value to a comprehensive safe system - applies to many other nations. To reach the goal of zero deaths, a comprehensive Vision Zero program needs to address the problem of deliberate risk-taking, which can include driver impairment from alcohol or other causes and extend to dangerous and reckless driving. Advanced safety technologies offer a range of opportunities for this purpose. Cars available today and in the future will have a plethora of sensors that monitor circumstances inside and around the car. These systems can identify whether a driver is in their safe driving envelope and respond with interventions that are appropriate for the severity and nature of the risk. Interventions could range from those that are not perceivable to the driver, such as putting driver assist systems into active mode, to stronger steps such as limiting or preventing vehicle operation. Zero fatalities or serious injuries in motor vehicle crashes is possible with a systems approach that accommodates human errors and mistakes that occur with the normal driving envelope and incorporates effective responses to deliberate risk-taking outside of this envelope.
Topics: Humans; Accidents, Traffic; Blood Alcohol Content; Seat Belts; Automobiles; Causality; Automobile Driving
PubMed: 37924565
DOI: 10.1016/j.aap.2023.107344 -
EClinicalMedicine Jul 2023Drug overdose deaths in the USA have increased rapidly in the past 20 years, and understanding patterns and trends in mortality is essential to develop policy responses....
BACKGROUND
Drug overdose deaths in the USA have increased rapidly in the past 20 years, and understanding patterns and trends in mortality is essential to develop policy responses. This study aimed to determine whether cohort patterns in mortality due to drug overdose have changed in the past two decades and assess these patterns by race and sex.
METHODS
The national records of accidental drug overdose death were extracted from Centers for Disease Control and Prevention, National Center for Health Statistics Mortality Data for 2000-2020. Age-period-cohort analysis was performed to examine independent effects of age, period and birth cohort on accidental drug overdose mortality.
FINDINGS
The number of accidental drug overdose deaths increased by 622% between 2000 and 2020, and age-standardized mortality rates increased nearly four-fold in both men and women. Age-period-cohort decomposition found rapid increases in mortality since 2012 in men and women, with higher mortality risk in cohorts born after 1990. The fastest increase occurred in Black Americans since 2012, and Americans of all races born after 1975 had significantly higher mortality risk, with mortality risk increasing rapidly in more recent cohorts. The peak of mortality has shifted from the 40-59 age group to the 30-40 year age group in the past decade.
INTERPRETATION
The burden of drug overdose mortality has shifted to younger Americans, and a new generation of Americans are at significantly higher and rapidly increasing risk of overdose death. Urgent action is needed to prevent an entire generation of young people being consigned to decades of preventable mortality.
FUNDING
None.
PubMed: 37483548
DOI: 10.1016/j.eclinm.2023.102079 -
Pediatric Emergency Care Dec 2023Sudden unexplained death in childhood is a term that encompasses apparently natural deaths in children aged older than 1 year with no discernible cause despite a...
Sudden unexplained death in childhood is a term that encompasses apparently natural deaths in children aged older than 1 year with no discernible cause despite a thorough assessment. Definitive underlying causes vary but most cases remain largely unexplained. Research has furthered the view that sudden unexplained death in childhood is not an accident, but rather a sentinel medical event for which a thorough postmortem investigation is indicated. Emerging evidence in genetics, neurology, and neuropathology point to heterogeneous causes that in some cases share features of recognized diseases.
Topics: Child; Humans; Death, Sudden; Autopsy; Accidents; Cause of Death
PubMed: 38019718
DOI: 10.1097/PEC.0000000000003074 -
Pharmacotherapy Sep 2023Administration of vancomycin as a continuous infusion has been associated with reduced nephrotoxicity. Given limited published experience with continuous infusion... (Review)
Review
BACKGROUND
Administration of vancomycin as a continuous infusion has been associated with reduced nephrotoxicity. Given limited published experience with continuous infusion vancomycin in outpatient parenteral antimicrobial therapy (OPAT) programs, we reviewed outcomes from our center.
METHODS
This was a retrospective, single-center study of adult patients receiving vancomycin OPAT as continuous or intermittent infusion for an intended treatment duration of at least 7 days. The primary outcome was time to nephrotoxicity with continuous versus intermittent infusion vancomycin while on OPAT; additional outcomes included time to any vancomycin-associated adverse event, time to 60-day death or readmission, and time to 60-day emergency department encounter. Proportional hazards modeling was used to identify variables independently associated with outcomes, as well as assess the strength of association of continuous infusion with each outcome.
RESULTS
Four-hundred ninety-two patients were included: 118 treated with continuous and 374 with intermittent vancomycin infusion. Continuous infusion was not associated with lower rates of nephrotoxicity compared to intermittent infusion (adjusted hazard ratio (aHR) 0.72, 95% CI: 0.35-1.50). There were no advantages of continuous over intermittent infusion in the rates of any adverse event (aHR 0.93, 95% CI: 0.56-1.53), 60-day death or readmission (aHR 1.04, 95% CI: 0.68-1.61), or 60-day emergency department encounter (aHR 1.17, 95% CI: 0.68-1.99). Vancomycin area under the concentration-time curve (AUC) at discharge was the only modifiable factor identified that was independently associated with patient safety outcomes.
CONCLUSION
There was no appreciable benefit of continuous infusion vancomycin on outpatient safety outcomes. AUC-centered dosing approaches warrant further investigation as strategies to improve vancomycin safety in OPAT programs.
Topics: Adult; Humans; Vancomycin; Anti-Bacterial Agents; Outpatients; Retrospective Studies; Patient Safety; Anti-Infective Agents; Renal Insufficiency; Drug-Related Side Effects and Adverse Reactions
PubMed: 37248438
DOI: 10.1002/phar.2833 -
Journal of Pediatric Surgery May 2024Motor vehicle collisions (MVC) are the second leading cause of death in children and adolescents, but appropriate restraint use remains inadequate. Our previous work... (Review)
Review
PURPOSE
Motor vehicle collisions (MVC) are the second leading cause of death in children and adolescents, but appropriate restraint use remains inadequate. Our previous work shows that about half of pediatric MVC victims presenting to our trauma center were unrestrained. This study evaluates restraint use among children and adolescents who did not survive after MVC. We hypothesize that restraint use is even lower in this population than in pediatric MVC patients who reached our trauma center.
METHODS
We reviewed the local Medical Examiner's public records for fatal MVCs involving decedents <19 years old from 2010 to 2021. When restraint use was not documented, local Fire Rescue public records were cross-referenced. Patients were excluded if restraint use was still unknown. Age, demographics, and restraint use were compared using standard statistical methods.
RESULTS
Of 199 reviewed cases, 92 met selection criteria. Improper restraint use was documented in 72 patients (78%). Most decedents were White (72% versus 28% Black) and male (74%), with a median age of 17 years [15-18]. Improper restraint use was more common among Black (92% vs 73% White, p = 0.040) and male occupants (85% vs 58% female, p = 0.006). Improper restraint use was lower in the Hispanic population (73%) compared to non-Hispanic individuals (89%), but this difference was not statistically significant (p = 0.090).
CONCLUSION
Most pediatric patients who die from MVCs in our county are improperly restrained. While male and Black patients are especially high-risk, the overall dismal rates of restraint use in our pediatric population present an opportunity to improve injury prevention measures.
TYPE OF STUDY
Retrospective Comparative Study.
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Female; Humans; Male; Accidents, Traffic; Child Restraint Systems; Motor Vehicles; Retrospective Studies; Trauma Centers; Wounds and Injuries
PubMed: 38383176
DOI: 10.1016/j.jpedsurg.2024.01.029 -
The American Journal of Forensic... Jan 2024Agriculture encompasses a variety of activities that carry with them a variety of different risks. The unsafe use of vehicles, machinery, and tools as well as animal...
Agriculture encompasses a variety of activities that carry with them a variety of different risks. The unsafe use of vehicles, machinery, and tools as well as animal husbandry, working at heights, and exposure to chemical, biological, and weather events may result in the deaths of agricultural workers. Inexperienced operators and/or their inappropriate conduct may lead to avoidable fatalities. Forensic pathologists operating with the support of agricultural engineers or other professionals must evaluate the death scene, the case background and circumstances, the autopsy findings, and the toxicological data to establish the factors and dynamics responsible for such accidents and deaths.The aim of this review is to focus on the diagnostic approach required, by means of an interdisciplinary approach, to identify the cause of some typical agricultural fatalities, to confirm that death was accidental, and to help exclude the possibility of homicide or suicide.
PubMed: 38261551
DOI: 10.1097/PAF.0000000000000909 -
Journal of Safety Research Dec 2023Motorcycle accidents cause millions of deaths and injuries globally. It is estimated that billions of dollars would be saved in the United States alone if safety... (Review)
Review
INTRODUCTION
Motorcycle accidents cause millions of deaths and injuries globally. It is estimated that billions of dollars would be saved in the United States alone if safety equipment, such as helmets and eye protection, was ubiquitously worn. Legislation concerning eye protection specifically is understudied and poorly characterized.
METHOD
We reviewed all motorcycle-related safety equipment laws in all 50 states of the United States for information regarding eye protection. We graded the rigor of each statute using our six-category Eye Safety Metric and performed a comparative analysis of statutes across all jurisdictions.
RESULTS
Fourteen states did not have any statutes regarding eye protection. Among states that did, 23 states had weak statutes (0-2 points), 20 states had moderately stringent statutes (3-4 points), and 7 states had strong statutes (5-6 points). States in western United States tended to have less strict eye protection laws. Twenty-six states had eye protection exemptions for windshields, which are a poor form of eye protection. Six states that had universal helmet laws had no laws requiring eye protection.
CONCLUSIONS
We characterized eye protection legislation across the country and found great diversity in the stringency of laws across all jurisdictions. Despite only two states lacking helmet laws, we found that 14 states lacked eye protection laws. These findings from our Eye Safety Metric can be used as a springboard for future research, which can be used to determine the need for and significance of eye safety legislation for motorcyclists and to inform legislative decision-making.
PRACTICAL APPLICATIONS
With this research, we hope to further the understanding of legislation regarding eye protection for motorcyclists and help policymakers identify states that need improved eye safety standards.
Topics: United States; Humans; Accidents, Traffic; Motorcycles; Protective Devices; Head Protective Devices; Craniocerebral Trauma
PubMed: 38081713
DOI: 10.1016/j.jsr.2023.08.012