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Acta Psychiatrica Scandinavica Dec 2023Suicidal thoughts and behaviours (STB) are a common reason for presentation to emergency departments and general hospitals. A meta-analysis of the strength of clinical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Suicidal thoughts and behaviours (STB) are a common reason for presentation to emergency departments and general hospitals. A meta-analysis of the strength of clinical risk factors for subsequent suicide might aid understanding of suicidal behaviour and help suicide prevention.
METHODS
We conducted a meta-analysis of cohort and controlled studies on clinical risk factors and later suicide among people presenting to emergency departments and general hospitals with STB. Data were extracted from papers meeting inclusion criteria, published in Medline, PsycINFO, and Embase between 1 January 1960 and 10 October 2022 using papers located with the search terms ((suicide*).m_titl AND (emergency* OR accident and emergency OR casualty OR general hospital OR toxicology service).mp) or were indexed in PubMed and had titles located with the search terms (suicide* OR self-harm OR self-harm OR self-injury OR self-injury OR self-poisoning OR self-poisoning OR overdose OR para-suicide OR parasuicide [title/abstract]) AND (Emergency department OR emergency room OR Casualty OR general hospital OR toxicology OR accident and emergency [all fields]). Data about the association between clinical risk factors and suicide extracted from three or more studies were included in a random-effects meta-analysis of the odds of later death by suicide. The study was registered in PROSPERO and conducted according to MOOSE and PRISMA guidelines.
RESULTS
Seventy-five studies reported on 741,624 people, of which 19,649 died by suicide (2.65%). Male sex (odds ratio (OR) = 1.99) and age (OR = 2.01) were the most consistently reported risk factors. The strongest associations with subsequent death by suicide related to violent self-harm methods at the hospital presentation, including: unspecified violent method (OR = 4.97), any violent method (OR = 4.57) and the specific violent methods of drowning (OR = 4.32), hanging (OR = 4.26), and use of firearms (OR = 10.08). Patients categorised as higher risk using suicide prediction scales or any other method that combined risk factors had moderately increased odds of suicide (OR = 2.58). Younger age, Black and Hispanic ethnicity, overdose, a diagnosis of adjustment disorder, and the absence of any psychiatric diagnosis were protective against suicide.
CONCLUSIONS
Most risk factors for suicide among people who have presented with STB are not strongly associated with later suicide. The strongest risk factors relate to self-harm methods. In the absence of clear indicators of future suicide, all people presenting with suicidality warrant a thorough assessment of their needs, and further research is needed before we can meaningfully categorise people with STB according to suicide risk.
Topics: Humans; Male; Suicidal Ideation; Hospitals, General; Suicide; Self-Injurious Behavior; Risk Factors; Drug Overdose; Emergency Service, Hospital
PubMed: 37904016
DOI: 10.1111/acps.13620 -
Injury Epidemiology Dec 2023Drowning is a major public health issue internationally. In August 2022, a report was released by members of the Central Texas Drowning Prevention Action Team that...
Drowning is a major public health issue internationally. In August 2022, a report was released by members of the Central Texas Drowning Prevention Action Team that provided data on drowning fatalities in Texas between 2006 and 2020 and offered recommendations for drowning prevention actions. The information in the Texas drowning report is an important contribution to the field of injury prevention. The aim of this editorial is to allow the information in the report to be available to a wider audience and potentially used as a model for other states.
PubMed: 38087381
DOI: 10.1186/s40621-023-00480-3 -
Forensic Science, Medicine, and... Feb 2024Grigori Yefimovich Rasputin, a confidant of Tsar Nicholas and his wife, was murdered by Prince Yussupov and his co-conspirators in the cellar of the prince's Moika...
Grigori Yefimovich Rasputin, a confidant of Tsar Nicholas and his wife, was murdered by Prince Yussupov and his co-conspirators in the cellar of the prince's Moika Palace in St Petersburg, Russia, on the evening of December 30th, 1916 (December 17th in the Russian calendar). The narrative of his death is largely based on Prince Yussupov's published memoirs and has Rasputin being poisoned with cyanide, shot, bludgeoned, and finally drowned. A review of the available forensic material, however, shows a photograph with a contact gunshot wound to Rasputin's forehead. This would indicate that he was dead prior to being dropped into the Little Nevka River. His distaste for sweet foods and the absence of poison at autopsy would also suggest that the story of cyanide toxicity was fabricated. Yussupov's description of Purishkevich firing at Rasputin from a distance as he ran across the courtyard in an attempt to escape would also not be consistent with the post mortem photograph. The simplest version of the events would be that Rasputin was executed by a contact gunshot wound to the forehead when he visited the Yussupov Palace. While it appears that the events of that fateful evening have been embellished, it is certainly not uncommon for perpetrators of homicides to provide histories that are later shown to be at odds with the truth. Re-evaluation of historic cases may provide compelling evidence for alternative interpretations to the popular historic record.
PubMed: 38386172
DOI: 10.1007/s12024-024-00793-9 -
International Journal of Legal Medicine May 2024Finding a dead body in water raises an issue concerning determining the cause of death as drowning because of the complex pathophysiology of drowning. In addition, the...
Oxidative stress and NF-KB/iNOS inflammatory pathway as innovative biomarkers for diagnosis of drowning and differentiating it from postmortem submersion in both fresh and saltwater in rats.
BACKGROUND
Finding a dead body in water raises an issue concerning determining the cause of death as drowning because of the complex pathophysiology of drowning. In addition, the corpse may be submersed postmortem.
OBJECTIVE
Evaluate the role of oxidative stress markers and NF-KB/iNOS inflammatory pathway as diagnostic biomarkers in drowning and whether they could differentiate freshwater from saltwater drowning.
METHODS
This study included forty-five adult male albino rats classified into five groups: control group (C), Freshwater-drowned group (FD), Freshwater postmortem submersion group (FPS), saltwater-drowned group (SD), and saltwater postmortem submersion group (SPS). After the autopsy, the rats' lungs in each group were prepared for histological, immunohistochemical (caspase 3, TNF-α, NF-kB, COX-2 & iNOS), biochemical studies; MDA, NOx, SOD, GSH, VCAM-1, COX-2; and RT-PCR for the relative quantification of NF-kB and iNOS genes expression.
RESULTS
Lung oxidative markers were significantly affected in drowned groups than in postmortem submersion groups. Inflammatory pathway markers were also significantly increased in the drowned groups, with concern that all markers were significantly affected more in saltwater than in freshwater drowned group.
CONCLUSIONS
It is concluded that the tested markers can be used accurately in diagnosing drowning and differentiating it from postmortem submersion with a better understanding of the mechanism of death in drowning as both mechanisms, inflammatory and oxidative stress, were revealed and involved.
PubMed: 38801418
DOI: 10.1007/s00414-024-03249-5 -
Health Promotion Journal of Australia :... Nov 2023
PubMed: 38009891
DOI: 10.1002/hpja.830 -
BMC Public Health Aug 2023Co-ordinated, evidence-based policy and programmatic efforts are needed to respond to complex drowning prevention problems. Comprehensive, current, and robust data are...
BACKGROUND
Co-ordinated, evidence-based policy and programmatic efforts are needed to respond to complex drowning prevention problems. Comprehensive, current, and robust data are vital for agenda setting, burden and risk factor identification, intervention design and evaluation, as well as setting policy. We aim to record methods used in, and identify impacts of, the development of a national fatal drowning database (NFDD) in Australia, including lessons learned across research, policy, and practice.
METHODS
We employ a case study method using process mapping and document review to explore the evolution, drivers and impacts of the NFDD. We analyse methodological approaches including those relating to data definitions, drowning case collection, and management, as well as tracking the various outputs of the NFDD. We describe a development timeline that presents impact of drowning prevention policy, and research agendas on database development, and research investments more specifically.
RESULTS
Our study identified that the collected variables grew 20-fold from 2002 to 2022, reaching 259 variables, and 5,692 unique cases of fatal drowning. The NFDD employs data triangulation methodology, combining keyword and targeted searches of coronial files, media report monitoring, and organisational data provision. Database development is influenced by the Australia Water Safety Strategy, policymaker and practitioner-initiated research agendas, and identification of knowledge gaps. We identified numerous outputs spanning publications, media, intervention development, and legislative submissions.
CONCLUSION
A comprehensive and robust NFDD informed by policymaker and practitioner input can enhance surveillance, policy, and intervention development for drowning prevention. Employing mixed data collection and validation methods can supplement weaknesses in official data sources. There is a need for the NFDD to continue to evolve in its application while maintaining rigorous case identification and data quality assurance processes. Despite significant investment, the outputs and influence on drowning prevention practice in Australia has been extremely valuable and contributed to sizeable reductions in Australia's fatal drowning rate.
Topics: Humans; Drowning; Australia; Risk Factors; Databases, Factual; Data Collection
PubMed: 37550757
DOI: 10.1186/s12889-023-16392-2 -
Diving and Hyperbaric Medicine Sep 2023This study investigated snorkelling and breath-hold diving deaths in Australia from 2014-2018 and compared these to those from 2001-2013 to identify ongoing problems and...
INTRODUCTION
This study investigated snorkelling and breath-hold diving deaths in Australia from 2014-2018 and compared these to those from 2001-2013 to identify ongoing problems and assess the effectiveness of countermeasures.
METHODS
Media reports and the National Coronial Information System were searched to identify snorkelling/breath-hold diving deaths for 2014-2018, inclusive. Data were extracted from witness and police reports, medical histories, and autopsies. An Excel® database was created and a chain of events analysis conducted. Comparisons were made with the earlier report.
RESULTS
Ninety-one fatalities (78 males, 13 females, median age 48 years [range 16-80]) were identified with one third likely doing some breath-hold diving. Fifty-two of 77 with known body mass index were overweight or obese. Approximately two thirds were inexperienced snorkellers and 64 were alone. Fifty-one were tourists. Planning shortcomings, such as solo diving and diving in adverse conditions, as well as pre-existing health conditions and inexperience predisposed to many incidents. Primary drowning was the likely disabling condition in 39% of cases with drowning recorded as the cause of death (COD) in two thirds. Cardiac events were the likely disabling conditions in 31% although recorded as the COD in 21% of cases.
CONCLUSIONS
Increasing age, obesity and associated cardiac disease have become increasingly prevalent in snorkelling deaths and there is a need for improved health surveillance and risk management. Closer supervision of inexperienced snorkellers is indicated. Apnoeic hypoxia from extended breath-holding and poor supervision remain a problem. The increased risk of harvesting seafood in areas frequented by large marine predators needs to be appreciated and managed appropriately.
Topics: Female; Male; Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Diving; Australia; Drowning; Breath Holding; Autopsy
PubMed: 37718294
DOI: 10.28920/dhm53.3.210-217 -
Social Psychiatry and Psychiatric... Feb 2024To measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007-2019 and identify risk factors for these methods of self-harm.
PURPOSE
To measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007-2019 and identify risk factors for these methods of self-harm.
METHOD
Data on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning.
RESULTS
The age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15-24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72-3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16-1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17-1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58-1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41-2.99).
CONCLUSION
The incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.
Topics: Male; Adolescent; Young Adult; Humans; Suicide; Ireland; Drowning; Self-Injurious Behavior; Risk Factors; Hospitals; Registries
PubMed: 37525008
DOI: 10.1007/s00127-023-02525-w -
MMWR. Morbidity and Mortality Weekly... May 2024Drowning is the cause of approximately 4,000 U.S. deaths each year and disproportionately affects some age, racial, and ethnic groups. Infrastructure disruptions during...
INTRODUCTION
Drowning is the cause of approximately 4,000 U.S. deaths each year and disproportionately affects some age, racial, and ethnic groups. Infrastructure disruptions during the COVID-19 pandemic, including limited access to supervised swimming settings, might have affected drowning rates and risk. Data on factors that contribute to drowning risk are limited. To assess the potential impact of the pandemic on drowning death rates, pre- and post-COVID-19 pandemic rates were compared.
METHODS
National Vital Statistics System data were used to compare unintentional drowning death rates in 2019 (pre-COVID-19 pandemic onset) with those in 2020, 2021, and 2022 (post-pandemic onset) by age, sex, and race and ethnicity. National probability-based online panel survey (National Center for Health Statistics Rapid Surveys System) data from October-November 2023 were used to describe adults' self-reported swimming skill, swimming lesson participation, and exposure to recreational water.
RESULTS
Unintentional drowning death rates were significantly higher during 2020, 2021, and 2022 compared with those in 2019. In all years, rates were highest among children aged 1-4 years; significant increases occurred in most age groups. The highest drowning rates were among non-Hispanic American Indian or Alaska Native and non-Hispanic Black or African American persons. Approximately one half (54.7%) of U.S. adults reported never having taken a swimming lesson. Swimming skill and swimming lesson participation differed by age, sex, and race and ethnicity.
CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE
Recent increases in drowning rates, including those among populations already at high risk, have increased the urgency of implementing prevention strategies. Basic swimming and water safety skills training can reduce the risk for drowning. Addressing social and structural barriers that limit access to this training might reduce drowning deaths and inequities. The U.S. National Water Safety Action Plan provides recommendations and tools for communities and organizations to enhance basic swimming and water safety skills training.
Topics: Humans; Drowning; Swimming; United States; Male; Adult; Female; Young Adult; Child, Preschool; Adolescent; Child; Middle Aged; Infant; COVID-19; Aged; Self Report; Recreation
PubMed: 38781109
DOI: 10.15585/mmwr.mm7320e1 -
Critical Reviews in Food Science and... 2024Roasting is an essential process in cocoa industry involving high temperatures that causes several physicochemical and microstructural changes in cocoa beans that ensure... (Review)
Review
Roasting is an essential process in cocoa industry involving high temperatures that causes several physicochemical and microstructural changes in cocoa beans that ensure their quality and further processability. The versatility in roasting temperatures (100 - 150 °C) has attracted the attention of researchers toward the exploration of the effects of different roasting conditions on the color, proximal composition, cocoa butter quality, concentration of thermolabile compounds, formation of odor-active volatile organic compounds, generation of melanoidins, production of thermal processes contaminants in cocoa nibs, among others. Some researchers have drowned in exploring new roasting parameters (e.g., the concentration of water steam in the roasting chamber), whilst others have adapted novel heat-transfer techniques to cocoa nibs (e.g., fluidized bed roasting and microwaves). A detailed investigation of the physicochemical phenomena occurring under different cocoa roasting scenarios is lacking. Therefore, this review provides a comprehensive analysis of the state of art of cocoa roasting, identifies weak and mistaken points, presents research gaps, and gives recommendations to be considered for future cocoa studies.
Topics: Cacao; Hot Temperature; Volatile Organic Compounds; Cooking; Color; Food Quality; Polymers; Seeds; Odorants; Microwaves; Dietary Fats
PubMed: 36382628
DOI: 10.1080/10408398.2022.2141191