Perfil de las víctimas mortales por intoxicaciones agudas en Costa Rica del 2012 al 2021 asociadas al consumo de sustancias psicoactivas y drogas de abuso: etanol, metanol, benzodiacepinas, anfetaminas, heroína, cocaína y mixto / Profile of fatalities due to acute intoxications in Costa Rica from 2012 to 2021 associated with the consumption of psychoactive substances and drugs of abuse: ethanol, methanol, benzodiazepines, amphetamines, heroin, cocaine and mixed

Resumen Introducción: La mortalidad por intoxicaciones agudas de sustancias psicoactivas representa un problema de salud pública, especialmente en personas jóvenes. El objetivo del estudio fue crear un perfil de las víctimas mortales por intoxicación aguda en Costa Rica entre los años 2012 y 2021 asociado al consumo de sustancias psicoactivas y drogas de abuso. Materiales y métodos: Se recopilaron datos de Sección de Patología Forense del Departamento de Medicina Legal en Costa Rica, con los cuales se realizó una revisión de las víctimas mortales por intoxicaciones agudas a partir del 1 de enero de 2012 hasta el 31 de diciembre de 2021. La revisión incluyó las siguientes variables: variables epidemiológicas: sexo, edad, nacionalidad, ocupación, estado civil, provincia, consumo frecuente asociado, manera de muerte, tipo de sustancia y lugar de intoxicación. Resultados: De los 456 casos de muertes asociados a intoxicaciones agudas por etanol, metanol, benzodiacepinas, anfetaminas, heroína, cocaína y mixtas; reportados entre el 1 de enero de 2012 y el 31 de diciembre de 2021: el año que más casos reportó fue 2020; 82% de las víctimas fueron hombres y 18% mujeres; las principales edades de las personas reportadas abarcan entre 41 y 60 años. 80% de las personas eran costarricenses; San José fue la provincia con mayor número de casos de intoxicación letal, siendo el domicilio el sitio más frecuente. 14% de las víctimas eran desempleadas; 77% de las personas presentaban algún trastorno de la adicción o consumo frecuente de alguna de las sustancias estudiadas. La mayoría de muertes fueron de manera accidental. Conclusiones: El perfil predominante de las víctimas fue: masculino, entre 41 y 60 años, costarricense, de estado civil indeterminado o soltero, desempleado, que muere de manera accidental, en su domicilio, por intoxicación aguda con alcohol o mixta (alcohol y cocaína).

Abstract Introduction. Mortality from acute poisoning of psychoactive substances represents a public health problem, especially in young adults. The purpose of the study was to create a profile of fatalities due to acute poisoning in Costa Rica between 2012 and 2021 associated with the consumption of psychoactive substances and drugs of abuse. Materials and methods. Data were collected from the Forensic Pathology Section of the Legal Medicine Department in Costa Rica, then a review of fatalities due to acute poisoning was carried out from January 1, 2012 to December 31, 2021. The review included the following epidemiological variables: sex, age, nationality, occupation, marital status, province, consumption associated, manner of death, type of substance, and place of intoxication. Results. Out of the 456 reported cases of deaths associated with acute intoxication with ethanol, methanol, benzodiazepines, amphetamines, heroin, cocaine, and mixed substances between January 1, 2012, and December 31, 2021: the year with the highest number of cases reported was 2020; 82% of the victims were male, and 18% were female; the main age group of reported victims ranged from 41 to 60 years old. 80% of the victims were Costa Rican, and San Jose was the province with the highest number of lethal intoxication cases, with the home being the most frequent site. 14% of the victims were unemployed, and 77% of the individuals had some addiction disorder or frequent consumption of one of the studied substances. The majority of deaths were accidental. Conclusion. The main profile of the victims was male, between 41 and 60 years old, Costa Rican, of indeterminate or single marital status, unemployed, who died accidentally, at home, due to acute intoxication with alcohol or a mixture of substances (alcohol and cocaine).

Trend of work-related injuries in the Philippines from 2010-2020

INTRODUCTION@# Although Occupational Health and Safety (OSH) has been introduced as early as 1971, the protection of workers remained insufficient globally as 360 million occupational accidents occurred annually. In the Philippines, the incidence rate of occupational injury is 4.27 percent which indicates that there are around 4 cases of occupational injuries with workdays lost per 100 workers.@*OBJECTIVE@#The study aims to determine the trend of work-related injuries using hospital data entries from 2010-2020, and factors that contribute to work-related injuries and worker fatalities in the Philippines. @*METHODS@#The work-related data from the Department of Health’s Online National Electronic Injury Surveillance System (ONEISS) from 2010 to 2020 was processed and analyzed in the study using exploratory data analysis presented as table and graphs, and logistic regression and phi-coefficient analysis for statistical inference. The relationships between patient fatality, type of injury sustained, and external factors for occupational injuries and fatalities were analyzed. @*RESULTS@# A total of 72,897 (6.6%) work-related injuries and worker fatalities were analyzed in this study. The reports of occupational injuries and fatalities increased and peaked in 2019 and declined by 2020. Phi coefficient determined that all injuries sustained were significantly associated with work-related activities. Phi coefficient showed that all types of injuries were significantly associated with patient fatality. The external causes that were found to be significantly associated with patient fatality using phi coefficient were contact with sharp objects, exposure to forces of nature, fall, and transport and vehicular crash. Fall was significantly associated with patient fatality while also increasing its odds (OR=2.57, 95% CI: 1.76 – 3.75), and increased odds for multiple injuries (OR=2.30, 95% CI: 2.17 – 2.45), abrasion (OR=2.10, 95% CI: 1.97 – 2.24), and fracture (OR=9.66, 95% CI: 8.92 – 10.46). Transport/vehicular crash was significantly associated with increased patient fatality (OR=2.94, 95% CI: 2.22 – 3.88), multiple injuries (OR=6.77, 95% CI: 6.48 – 7.07), abrasion (OR=12.87, 95% CI: 12.34), and fracture (OR=4.12, 95% CI: 3.82 – 3.45).@*CONCLUSION@#The study determined the relationship between work-related injuries, patient fatalities, types of injuries, and external causes of injuries based on the ONEISS data from 2010 to 2020. It is recommended that the study results be used in evaluating work-related accidents and in conducting comprehensive health assessments.

Incidence Of Firearm-Related Deaths And Epidemiology In Klang Valley, Malaysia From 2006 To 2016: A Retrospective Study

@#Death due to firearm is more common in countries with higher gun ownership such as United States of America compared to countries with restrictive gun ownership such as European countries and Malaysia. However, the increasing number of shooting cases in Malaysia recently should not be overlooked. This study was carried out to investigate the incidence of firearm-related deaths and epidemiology in Klang Valley for 11-year period. The demographic data on the incidence of firearm-related deaths from 2006 to 2016 was collected retrospectively from four government hospitals in Klang Valley. 204 cases of firearm-related deaths were reported with irregular trend of the incidence throughout the 11-year period. The results revealed that most victims were male, aged between 30 to 34 years old and Malaysian citizen. Firearms fatalities were higher among Malaysian specifically Indian, as compared to non-Malaysian. Most firearms fatalities were homicides and took place during late night between 12.00 am to 5.59 am. The highest cause of death was head injury due to gunshot wound. It is hoped that this study will raise awareness to Malaysian citizen regarding firearm-related cases and to develop strategies to overcome the issue of gun violence in Malaysia with appropriate authorities.

Occupational accidents footprint: new concept linked to chain of custody in sustainable forest management / Huella de la accidentalidad laboral: nuevo concepto asociado a la cadena de custodia en manejo forestal sustentable

The study, due to inconveniences in previous methods, proposes the new concept of "occupational accidents footprint", and its implementation and traceability in the chain of custody (CoC) related with sustainable forest management (SFM), through specially elaborated labor accident indicators. Data from primary sources related to fatal cases, accidents with temporary disabilities and lost time on forest operations accidents of 24 countries, plus production associated to those works, was compiled; and then, processed to get results in terms of fatal cases/million m3, total work accidents/million m3 and total lost time/million m3. Results show that is feasible to apply the concept of occupational accidents footprint to measure aggregated value to forest products certification of the CoC. In Production vs Fatality the cleanest occupational accidents footprint in the forests belongs to Germany, Belgium, Finland and Australia; for Production vs Accidents the best behaviors are for Sweden, USA, New Zealand and Belgium; while in Production vs Lost Time Finland, Belgium and Austria are leaders. Due to the convenience to make evident the labor accidents impact on forest products aggregated value, it is proposed the implementation of new safety indicators associated to the occupational accidents footprint, in order to be useful in the certification of CoC in SFM.

El estudio, debido a inconveniencias en métodos previos, propone el nuevo concepto de "huella de accidentalidad laboral", y su implementación y trazabilidad en la cadena de custodia (CdC) en manejo forestal sustentable (MFS), mediante indicadores de accidentalidad ocupacional especiales. Se recolectaron datos de fuentes primarias sobre casos fatales, accidentes con incapacidades temporales y tiempo perdido en siniestros ocurridos en operaciones forestales de 24 países, más producción asociadas a dichas faenas, siendo éstos procesados para obtener resultados de casos fatales/millón m3, cantidad accidentes/millón m3 y tiempo perdido/millón m3. Los resultados evidencian la factibilidad de aplicar el concepto de huella de accidentalidad laboral para medir agregación de valor a productos forestales en la CdC. En Producción vs Fatalidad la huella de accidentalidad laboral más limpia en bosques corresponde a Alemania, Bélgica, Finlandia y Australia; para Producción vs Accidentes los mejores comportamiento son de Suecia, EE.UU., Nueva Zelandia y Bélgica; mientras que en Producción vs Tiempo Perdido se destacan Finlandia, Bélgica y Austria. Siendo conveniente transparentar en los productos forestales el impacto de los accidentes del trabajo en su agregación de valor, se propone establecer indicadores asociados a la huella de accidentalidad laboral útiles en la certificación de la CdC en MFS.

The sinking of the MV Doña Paz - A critique on maritime disaster preparedness in the Philippines: Policy implications

OBJECTIVE: To discuss the various factors contributory to maritime disaster preparedness in the Philippines, in the context of the sinking of the MV Dona Paz and formulate recommendations to address these factors. METHOD: Review of the state of maritime preparedness in the pre-disaster setting and the post-disaster response following the sinking of the MV Dona Paz by the government and responsible agencies. A scrutiny of the state of preparedness of concerned agencies and subsequent response to the disaster was conducted with the objective of formulating recommendations which may lead to prevention and mitigate loss of lives. RESULTS: Multiple factors accounted for the occurrence of this tragedy. These factors include an inherent risk due to the geography of shipping industry and its labor force. Economic conditions prevent both the industry and government agencies from upgrading vessels and communications equipment. Lack of enforcement of existing regulations allows vessels to sail overloaded and at times manned by less-than-qualified crew. Delayed response and deficient post-disaster medical response may have led to a disproportionately high mortality. CONCLUSIONS: The systems inadequacies of the Philippine maritime disaster response mechanism are highlighted by the Dona Paz tragedy. Many of the factors contributing to the disproportionately high incidence of maritime disasters in the Philippines and the resulting loss of limb may be preventable. Recommendations on regulation and enforcement, disaster preparedness, search and rescue, and medical response are discussed.

The sinking of the MV Doña Paz - A critique on maritime disaster preparedness in the Philippines: An analysis of the event

OBJECTIVE: To discuss the various factors contributory to the fatalities that resulted from the sinking of the MV Dona Paz. METHODS: Review of the pre-disaster, disaster and post-disaster events surrounding the sinking of the MV Dona Paz, as well as the subsequent response by the government and responsible agencies to the disaster. RESULTS: The Sinking of the MV Dona Paz, along with the loss of more than 4,000 precious lives, is but a footnote in the long litany of misfortunes plaguing the Philippine maritime industry. A closer look into the events and circumstances leading to this tragedy demonstrates a confluence of equipment and system inadequacy on one hand and human error and lack of preparedness on the other. CONCLUSION: Multiple factors account for the occurence of this tragedy, along with other maritime disaster incidents dotting the long maritime history of the Philippines. A cursory analysis of these factors may lead to recommendations that can prevent similar occurrences in the future and mitigate damage to property and loss of life. The policy implications of these findings are discussed in a subsequent paper.

Analysis of railway fatalities in central India.

A two year retrospective study of railway related fatal cases has been carried out in the Department of Forensic Medicine & Toxicology, Indira Gandhi Government Medical College, Nagpur. Railway fatality cases were stand for 5.99% (Total 173) of all autopsies (n=2888) conducted during the period of January 2001 to December 2002. The fatalities were predominantly seen in the males. Male to female ratio was 8.62:1. The maximum numbers of victims were in the age group of 20-49 years (n= 120 cases, 69.34%). Majority of victims died on the spot (96.53%). Maximum number of railway fatalities were accidental (91.32 %) followed by the suicidal (8.68 %) in nature, whereas none of the homicidal railway fatalities noted. Crush injuries were found mostly over lower limbs followed by the upper limb then over the face and head. Maximum victims (84.38 %) died due to hemorrhage and shock following injuries to the vital organs.

Traumatic asphyxial deaths due to an uncontrolled crowd at railway station: Two case reports.

Deaths in stampede accidents are not new in India. Majority of causalities occurred as a result of traumatic asphyxia in such cases. Traumatic asphyxia is a rare syndrome first described over 150 years ago by Olivier. It is caused by sudden compressive chest trauma and is associated with craniocervical cyanosis, facial edema and petechiae, sub-conjunctival hemorrhage, and neurological symptoms. Although minor incidents of jostling are common at railway stations, but deaths occurring consequent to stampede by an uncontrollable crowd is not very common. A stampede occurred at New Delhi railway station which results in death of two persons and injuring many. The autopsy findings along with circumstantial evidence, results in arriving of conclusion that these deaths occurs as a consequence of traumatic asphyxia. Various clinical features of this condition are described in the literature, a brief review of which is given in this article. In the conclusion few preventive measures are also suggested so that in future such tragedies can be averted.

Aluminium phosphide fatalities: A 24 years experience.

A 24 years autopsy study (1982-2006) of acute poisoning deaths owing to aluminium phosphide from a tertiary care hospital of Northern India (Postgraduate Institute of Medical Education and Research, Chandigarh revealed that mortality due to acute poisoning constitued 12.6% of the total unnatural fatalities and out of which 51.3% were because of this fumigant insecticide. The first victim reported in 1982 and its proportion, which was 20% in years 1982 to 86, increased to 73% between the years 1994-98 and then decreased to 49% of the total acute poisoning fatalities in 2002-06. Peak incidence was observed in the age group of 21-25 years (31%) and least in the age group of beyond 65 years (3%). The proportion of suicidal deaths increased from 20% to 54% between these periods. Sales workers / businessmen (15%), office workers (10.7%) followed by student (10.4%), among the males and domestic workers (23%), students (10.4%) in females were the main victims of suicidal poisoning. 53% male victims were married where as 59.4% female victims were unmarried. 52.4% were from the urban areas.

Epidemiology of poisoning fatalities in Manipal.

A twelve year retrospective review of poisoning fatalities was undertaken in the tertiary care referral hospital of Kasturba Medical College, Manipal, South India. Of the 1917 cases of forensic autopsies conducted, 372 cases (79.4%) were due to poisoning deaths. There was an increasing trend observed in the number of poisoning deaths from the period 1993-94 to 1999-2000, followed by a declining trend during 2003-04. Ninety two percent of the fatalities were due to self-poisoning, with 77% due to pesticide consumption. Majority of the cases occurred in the rural areas during winter season. Many of the decedents were men (73.1%) in their 3rd decade of life. Suggestions are being offered on the basis of this study for the control of pesticide poisoning.