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International Journal of Environmental... Feb 2022A ligature mark is a common injury in cases of hanging or strangulation. Estimation of age and vitality of the ligature mark can be crucial for differentiating... (Review)
Review
BACKGROUND
A ligature mark is a common injury in cases of hanging or strangulation. Estimation of age and vitality of the ligature mark can be crucial for differentiating antemortem and postmortem wounds and to distinguish between simulated suicidal hanging or accidental strangulation to conceal a crime and not simulated events. The immunohistochemistry has been recommended by several Authors as a reliable tool to determine whether an injury was sustained during life or not. Unfortunately, no general agreement on the immunohistochemical markers to be used has been found among the scientific community. The aim of the study was to detect the type and function of the immunohistochemical markers useful in the assessment of the vitality and age of the ligature marks for routine diagnostics.
METHODS
Papers available on Pubmed, Scopus, and Web of Science were reviewed according to the PRISMA statement.
RESULTS
Only eight papers satisfied all the following inclusion criteria: full texts in English dealing with human ligature marks and immunohistochemistry published on impacted or indexed scientific journals.
CONCLUSIONS
The assessment of the vitality of a ligature mark is still a challenging topic in forensic science. Under ideal conditions and in compliance with autopsy protocols, the diagnosis of death by hanging or strangulation on fresh bodies can be better supported by autopsy findings other than a ligature mark. The validation of immunohistochemical markers on large series could be of help in doubtful cases and differential diagnoses.
Topics: Asphyxia; Autopsy; Humans; Skin; Suicide
PubMed: 35206225
DOI: 10.3390/ijerph19042035 -
BMJ Open Mar 2014Motor vehicle accidents associated with commercial driving are an important cause of occupational death and impact public safety. (Review)
Review
BACKGROUND
Motor vehicle accidents associated with commercial driving are an important cause of occupational death and impact public safety.
OBJECTIVES
We summarise the evidence regarding the type, prevalence and impact of medical conditions discovered during health assessment of commercial drivers.
EVIDENCE REVIEW
We conducted a systematic review of multiple electronic databases and made a manual search for relevant studies that enrolled commercial drivers in any country and reported the outcomes of health assessment carried out in the context of commercial driving through November 2012. Data were extracted by a pair of independent reviewers and synthesised using a metanarrative approach.
RESULTS
We identified 32 studies of moderate methodological quality enrolling 151 644 commercial drivers (98% men). The prevalence of multiple health conditions was high (sleep disorders 19%, diabetes 33%, hypertension 23% and obesity 45%). Some conditions, such as sleep disorders and obesity, were linked to increased risk of crashes. Evidence on several other highly relevant medical conditions was lacking. Cost-effectiveness data were sparse.
CONCLUSIONS
Several medical conditions are highly prevalent in commercial drivers and can be associated with increased risk of crashes, thus providing a rationale for health assessment of commercial drivers.
Topics: Accidents, Traffic; Automobile Driving; Chronic Disease; Commerce; Diabetes Mellitus; Female; Health Status; Humans; Hypertension; Male; Obesity; Physical Fitness; Safety; Sleep Wake Disorders
PubMed: 24604478
DOI: 10.1136/bmjopen-2013-003434 -
Journal of Opioid Management 2016In response to persistent public health concerns regarding prescription opioids, many states and healthcare systems have implemented legislation and policies intended to... (Review)
Review
OBJECTIVE
In response to persistent public health concerns regarding prescription opioids, many states and healthcare systems have implemented legislation and policies intended to regulate or guide opioid prescribing. The overall impact of these policies is still uncertain. The aim of this systematic review was to examine the existing evidence of provider-level and patient-level outcomes preimplementation and postimplementation of policies and legislation constructed to impact provider prescribing practices around opioid analgesics.
DESIGN
A systematic search of MEDLINE, EMBASE, the Web of Science, and the Cochrane Database of Systematic Reviews was conducted to identify studies evaluating the impact of opioid prescribing policies on provider-level and patient-level outcomes. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Eleven studies were included in the review. A meta-analysis was not possible due to between-study heterogeneity. Six of the studies assessed state-level policies, and five were at the level of the healthcare system or hospital. Studies showed temporal associations between policy implementation and reductions in opioid prescribing, as well as opioid-related overdoses. Results were mixed regarding the impact of policies on misuse. The majority of the studies were judged to be of low quality based on the GRADE criteria.
CONCLUSIONS
There is low to moderate quality evidence suggesting that the presence of opioid prescribing policy will reduce the amount and strength of opioid prescribed. The presence of these policies may impact the number of overdoses, but there is no clear evidence to suggest that it reduces opioid misuse.
Topics: Analgesics, Opioid; Cause of Death; Drug Overdose; Drug Prescriptions; Health Policy; Humans; Inappropriate Prescribing; Models, Organizational; Opioid-Related Disorders; Patient Safety; Policy Making; Practice Patterns, Physicians'; Prescription Drug Misuse; Regional Health Planning; Risk Assessment; Risk Factors; State Government; State Health Plans
PubMed: 27194195
DOI: 10.5055/jom.2016.0322 -
Bulletin of Emergency and Trauma Oct 2020This study aims to review systematically the association of social determinants of health (SDH) and road traffic deaths (RTD) within scientific literature. (Review)
Review
OBJECTIVE
This study aims to review systematically the association of social determinants of health (SDH) and road traffic deaths (RTD) within scientific literature.
METHODS
A search strategy was designed and run in EMBASE, PubMed via MEDLINE, Scopus, Web of Science, and Cochrane library. Through title, abstract, and full-text screening, all English original papers (except ecological studies) which studied social determinants of health and fatal injuries were included. Papers which studied association between RTD and the education, income, rural settlement, and marital status were evaluated and the related data was extracted from the full-texts.
RESULTS
Eleven articles out of 7,897 primary results were selected to be included in the study. Among eight papers studied education, seven confirmed a negative association between years of schooling and RTD. Two out of three articles reported no association between income leveland RTD. Among three papers studied rural settlement, two approved a positive relationship between this determinant and RTD. Both articles studied marital status, confirmed an association between this determinant and RTD.
CONCLUSION
A few papers studied association of social determinants of health (SDH) and RTD. There was an inverse relationship between education and RTD. The evidence for such an association between income, rural settlement, and marital state was scarce. Further investigations are recommended through original research.
PubMed: 33426135
DOI: 10.30476/beat.2020.86574 -
American Journal of Preventive Medicine Aug 2022The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate alcohol-attributable fractions. Updated alcohol-attributable fractions can contribute to improved estimates of the public health impact of excessive alcohol use.
METHODS
Peer-reviewed and gray literature for 1995-2019 on 15 causes of fatal nontraffic injuries in the U.S., Canada, or Mexico were systematically reviewed, and state data systems were queried for available estimates of fatalities with recorded blood alcohol concentration levels and proportions of decedents with blood alcohol concentrations ≥0.10 g/dL by cause of injury. For each injury cause, alcohol-attributable fractions across studies were synthesized by meta-analysis of single proportions using generalized linear mixed models.
RESULTS
In total, 60 published studies and 40 additional population-level data points from 6 state data systems were included. The meta-analyzed alcohol-attributable fractions by cause of injury are as follows: air-space transport (0.03), aspiration (0.24), child maltreatment (0.09), drowning (0.31), fall injuries (0.37), fire injuries (0.34), firearm injuries (0.24), homicide (0.29), hypothermia (0.29), motor vehicle nontraffic crashes (0.42), occupational and machine injuries (0.08), other road vehicle crashes (railroad trespasser injuries) (0.63), poisoning (not alcohol) (0.20), suicide (0.21), and water transport (0.27), yielding an overall median alcohol-attributable fraction of 0.27.
DISCUSSION
Excessive alcohol use is associated with substantial proportions of violent and nonviolent injury deaths. These findings can improve the data used for estimating alcohol-attributable injury deaths and inform the planning and implementation of evidence-based strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to prevent them.
Topics: Accidents, Traffic; Alcohol Drinking; Blood Alcohol Content; Cause of Death; Child; Ethanol; Firearms; Humans; Wounds and Injuries; Wounds, Gunshot
PubMed: 35581102
DOI: 10.1016/j.amepre.2022.03.025 -
Annali Di Igiene : Medicina Preventiva... 2014The prevention of road traffic accidents should be considered a serious public health concern, since they are the eighth leading cause of death globally and the main... (Review)
Review
BACKGROUND
The prevention of road traffic accidents should be considered a serious public health concern, since they are the eighth leading cause of death globally and the main cause of death for young people aged 15-29. Evidences from many countries show that successes in preventing road traffic injuries can be achieved through concerted efforts at national level. The aim of our study was to assess the effectiveness of two interventions to prevent road traffic accidents: the introduction of graduated driver licensing (GDL) and the interventions to improve pedestrian and cyclist visibility.
METHODS
Our search started with a scoping review on the interventions to prevent road traffic accidents to allow the development of a logical framework of traffic accidents. Specific and answerable questions formulated according to PICO scheme and combinations of keywords were used to perform a systematic search in the following databases: Pubmed, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Evidence, Transport Research International Documentation (TRID) and Google. References of selected papers were searched. Only systematic reviews and meta-analyses were eligible. No temporal limits or linguistic filters were applied.
RESULTS
160 systematic reviews and meta-analyses were found for the question of the introduction of GDL program and 188 on the improvement of visibility in cyclists and pedestrians. After selection, four papers were included in qualitative synthesis for each question. All included studies underwent quality evaluation. GDL programs seem to be effective in reducing crash rates among young drivers, in particular in 16 year-old. Programs with more restrictions seem also to reduce fatal events. To improve visibility of pedestrians and cyclists, street lighting has been suggested as an intervention able to improve driver's visual capabilities and ability to detect roadway hazards and to prevent car crashes. Visibility aids (fluorescent materials, lamps, flashing lights and retroreflective materials) have the potential to increase visibility and enable drivers to detect pedestrians and cyclists earlier.
CONCLUSIONS
The two interventions seem to be effective, but further examinations are needed to measure long-term effects. It is necessary to provide feasible studies in local context to estimate the impact of introduction of GDL programs or of some of their components and to improve interventions to increase visibility of pedestrians and cyclists.
Topics: Accidents, Traffic; Automobile Driving; Bicycling; Humans; Walking
PubMed: 24452185
DOI: 10.7416/ai.2014.1959 -
BMJ Open Jun 2017To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone.
DESIGN AND SETTING
Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting. Searches for eligible studies published between 1 January 1995 and 31 December 2016 (inclusive) were conducted in PubMed, the Cochrane Library and EMBASE without any language constraints. Searches were conducted in January 2017, screening and data extraction were conducted by two independent reviewers, and study quality was assessed using a modified Jadad scale.
INTERVENTIONS
Capnography monitoring relative to visual assessment and pulse oximetry alone.
PRIMARY AND SECONDARY OUTCOME MEASURES
Predefined endpoints of interest were desaturation/hypoxaemia (the primary endpoint), apnoea, aspiration, bradycardia, hypotension, premature procedure termination, respiratory failure, use of assisted/bag-mask ventilation and death during PSA.
RESULTS
The literature search identified 1006 unique articles, of which 13 were ultimately included in the meta-analysis. Addition of capnography to visual assessment and pulse oximetry was associated with a significant reduction in mild (risk ratio (RR) 0.77, 95% CI 0.67 to 0.89) and severe (RR 0.59, 95% CI 0.43 to 0.81) desaturation, as well as in the use of assisted ventilation (OR 0.47, 95% CI 0.23 to 0.95). No significant differences in other endpoints were identified.
CONCLUSIONS
Meta-analysis of 13 RCTs published between 2006 and 2016 showed a reduction in respiratory compromise (from respiratory insufficiency to failure) during PSA with the inclusion of capnography monitoring. In particular, use of capnography was associated with less mild and severe oxygen desaturation, which may have helped to avoid the need for assisted ventilation.
Topics: Bradycardia; Capnography; Conscious Sedation; Deep Sedation; Humans; Monitoring, Physiologic; Oximetry; Patient Safety; Randomized Controlled Trials as Topic; Respiration, Artificial; Respiratory Insufficiency
PubMed: 28667196
DOI: 10.1136/bmjopen-2016-013402 -
Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review.Indian Journal of Community Medicine :... 2023Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood... (Review)
Review
Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children.
PubMed: 37970167
DOI: 10.4103/ijcm.ijcm_887_22 -
Risk assessment of road traffic accidents related to sleepiness during driving: a systematic review.Eastern Mediterranean Health Journal =... Sep 2022Injuries due to accidental crash are the 8th leading cause of death worldwide. Sleepiness results in disrupted neurological function and is a major risk factor for road... (Review)
Review
BACKGROUND
Injuries due to accidental crash are the 8th leading cause of death worldwide. Sleepiness results in disrupted neurological function and is a major risk factor for road traffic accidents.
AIMS
This systematic review assessed the relationship between sleepiness during driving and road traffic accidents.
METHODS
A systematic review was conducted using online databases such as Wiley Online Library, JSTOR, Medline, and PubMed. Full-text, English language articles published between May 2000 and November 2020 were retrieved. Road traffic accident was set as the outcome of interest and sleepiness during driving as the exposure. The review included studies containing adjusted risk estimates (95% confidence interval). Ten cross-sectional studies (N = 55,945), 5 case-control studies (N = 3821), and 2 cohort studies (N =16,875) were included.
RESULTS
Over 50% of the participants in the different studies experienced sleep deprivation ranging from 3.5% to 67.3%. Abe et al. reported the highest (58%) frequency of sleepiness during driving in their cross-sectional study in Japan, and Nabi et al. reported the lowest (1.1%) in their cohort study in France.
CONCLUSION
Sleepiness and sleep deprivation were related to road traffic accidents; and sleep deprivation was the main contributor to drowsiness while driving.
Topics: Accidents, Traffic; Automobile Driving; Cohort Studies; Cross-Sectional Studies; Humans; Risk Assessment; Risk Factors; Sleep Deprivation; Sleepiness
PubMed: 36205209
DOI: 10.26719/emhj.22.055 -
Journal of the American Medical... Mar 2017To systematically review studies reporting problems with information technology (IT) in health care and their effects on care delivery and patient outcomes. (Review)
Review
OBJECTIVE
To systematically review studies reporting problems with information technology (IT) in health care and their effects on care delivery and patient outcomes.
MATERIALS AND METHODS
We searched bibliographic databases including Scopus, PubMed, and Science Citation Index Expanded from January 2004 to December 2015 for studies reporting problems with IT and their effects. A framework called the information value chain, which connects technology use to final outcome, was used to assess how IT problems affect user interaction, information receipt, decision-making, care processes, and patient outcomes. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS
Of the 34 studies identified, the majority ( n = 14, 41%) were analyses of incidents reported from 6 countries. There were 7 descriptive studies, 9 ethnographic studies, and 4 case reports. The types of IT problems were similar to those described in earlier classifications of safety problems associated with health IT. The frequency, scale, and severity of IT problems were not adequately captured within these studies. Use errors and poor user interfaces interfered with the receipt of information and led to errors of commission when making decisions. Clinical errors involving medications were well characterized. Issues with system functionality, including poor user interfaces and fragmented displays, delayed care delivery. Issues with system access, system configuration, and software updates also delayed care. In 18 studies (53%), IT problems were linked to patient harm and death. Near-miss events were reported in 10 studies (29%).
DISCUSSION AND CONCLUSION
The research evidence describing problems with health IT remains largely qualitative, and many opportunities remain to systematically study and quantify risks and benefits with regard to patient safety. The information value chain, when used in conjunction with existing classifications for health IT safety problems, can enhance measurement and should facilitate identification of the most significant risks to patient safety.
Topics: Delivery of Health Care; Humans; Medical Errors; Medical Informatics; Patient Safety; Treatment Outcome
PubMed: 28011595
DOI: 10.1093/jamia/ocw154