Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine. In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II). We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively.  In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention.

Ertrinken ist bei Kindern nach Autounfällen die zweithäufigste nicht-natürliche Todesursache. Die Zahl der Fälle von Beinahe-Ertrinken wird auf etwa das Vierfache geschätzt. Im Rahmen dieser Promotionsarbeit wurden, an der Universitätsklinik für Kinder und Jugendliche Leipzig behandelte, Ertrinkungsunfälle mittels selbstgestalteten Fragebogen retrospektiv analysiert. Hiermit sollten mögliche Gemeinsamkeiten gefunden werden, um eventuelle Prädiktoren für Behandlung und Outcome zu definieren. Die Hälfte der Kinder verunglückte an künstlich angelegten Gewässern wie Pools und Gartenteichen. Die mediane Submersionszeit betrug 2 Minuten. Eine Submersionszeit von unter 1 Minute korrelierte mit einem guten und von über 10 Minuten mit einem schlechten Outcome. Eine Glasgow Coma Scale (GCS) von 3 (n=15) sowie lichtstarre Pupillen (n=14) waren mit einem letalen Ausgang oder dem Zurückbleiben neurologischer Defizite assoziiert. Eine negative Prognose ergab sich bei schwer azidotischen pH-Werten mit einem niedrigen Base Excess, hohen Glukose- sowie Laktatwerten. 6 Patienten verstarben innerhalb der ersten 24 Stunden, 6 weitere im stationären Verlauf. 5 Kinder behielten neurologische Folgeschäden zurück, 27 konnten gesund entlassen werden. Unsere Ergebnisse konnten andere Studien zum Thema Ertrinkungsunfälle bestätigen, und ergaben das höchste Risiko für Jungen im Alter zwischen 1 und 3 Jahren, die alleine im Garten spielen. Die Prognose ist von den jeweiligen Unfallumständen abhängig, Submersionszeit und initiale Reanimationspflichtigkeit haben jedoch einen besonderen Einfluss. Die Erstversorgung am Unfallort ist ausschlaggebend für den Ausgang der Fälle. Schulungen von Eltern und Betreuern zu Prävention und Erster Hilfe bei Ertrinkungsunfällen könnten dazu beitragen Unfälle zu verhindern.

Esta é a primeira descrição específica de casos de afogamento, em uma área nãolitorânea no Brasil, realizada na região de Ribeirão Preto, Estado de São Paulo. É uma região cujos padrões sociais são comparáveis aos de países desenvolvidos. Um total de 89 casos foi analisado. Esses casos ocorreram entre 2001 e 2004, com coeficiente de mortalidade de 2,44 casos por 100.000 habitantes por ano. Foi delineado o padrão de afogamentos fatais avaliando-se os parâmetros de idade, sexo e sazonalidade. O perfil predominantemente observado foi o de homens brancos, em idade economicamente produtiva (15 a 59 anos), acidentalmente afogados em rios e represas de áreas rurais, de ocorrência durante o verão e o outono. O estudo dessas fatalidades pode permitir o desenvolvimento de programas de prevenção de afogamento em áreas não-litorâneas e não-turísticas no Brasil e em outros lugares do mundo. / This is the first specific description of drowning cases in a non-coastal area of Brazil, in the locality of Ribeirão Preto, State of São Paulo—a region with standards of living comparable to those in developed countries. A total of 89 cases were analyzed. These cases occurred between 2001 and 2004, at a rate of 2.44 cases per 100,000 habitants per year. The pattern of drowning fatalities in relation to parameters of age, sex, seazonality is discussed. The predominant profile observed was that of the Caucasian male of economically productive age (15 to 59 years), accidentally drowned in rivers and dams in rural areas during the summer and autumn. Observation of the pattern of fatalities may permit the development of a program of prevention of drowning in non-coastal, non-tourist areas in Brazil and elsewhere.

Esta é a primeira descrição específica de casos de afogamento, em uma área nãolitorânea no Brasil, realizada na região de Ribeirão Preto, Estado de São Paulo. É uma região cujos padrões sociais são comparáveis aos de países desenvolvidos. Um total de 89 casos foi analisado. Esses casos ocorreram entre 2001 e 2004, com coeficiente de mortalidade de 2,44 casos por 100.000 habitantes por ano. Foi delineado o padrão de afogamentos fatais avaliando-se os parâmetros de idade, sexo e sazonalidade. O perfil predominantemente observado foi o de homens brancos, em idade economicamente produtiva (15 a 59 anos), acidentalmente afogados em rios e represas de áreas rurais, de ocorrência durante o verão e o outono. O estudo dessas fatalidades pode permitir o desenvolvimento de programas de prevenção de afogamento em áreas não-litorâneas e não-turísticas no Brasil e em outros lugares do mundo. / This is the first specific description of drowning cases in a non-coastal area of Brazil, in the locality of Ribeirão Preto, State of São Paulo—a region with standards of living comparable to those in developed countries. A total of 89 cases were analyzed. These cases occurred between 2001 and 2004, at a rate of 2.44 cases per 100,000 habitants per year. The pattern of drowning fatalities in relation to parameters of age, sex, seazonality is discussed. The predominant profile observed was that of the Caucasian male of economically productive age (15 to 59 years), accidentally drowned in rivers and dams in rural areas during the summer and autumn. Observation of the pattern of fatalities may permit the development of a program of prevention of drowning in non-coastal, non-tourist areas in Brazil and elsewhere.

Having the same parents repeatedly complete questionnaires over time, the current community based study investigated beliefs relevant to supervision, drowning risk, and water safety for children aged two through five enrolled in swim lessons. Results revealed that many parents value swimming lessons for young children and view supervision as an important prevention approach. Water safety beliefs and accuracy in judging children’s swim abilities improved over lessons, but time in lessons was related to endorsing poorer supervision of children near water. Having experienced a “close call” for drowning was found to make parents more aware of drowning risk and the importance of close supervision. Results highlight the need for parent education that targets beliefs about water safety and supervision during lessons, and also suggest that a close call for drowning may act as a “teachable moment” for parents and be an appropriate time to implement such interventions.

Thesis (M.D.)--University of Pennsylvania, 1808. / Microform version available in the Readex Early American Imprints series.

Title: Evaluation of the number drowned people in the Czech Republic in the years 1998-2018 Objective: Evaluation of the number of drowned people in the Czech Republic, depending on age, sex and cause of drowning in the years 1998-2018. Methods: Search of available resources. Collecting data from the Czech Statistical Office and information portals. Results: The group 50-64 years of age in the terms of drowning is the most risky age group. The age group 10-14 years is the least risky. The ratio of all drowned men and women is 2,7:1. The most common cause of drowning is unspecified drowning. In many cases, it is not possible to determine the cause of the drowning. Keywords: Drowning, International Classification of Diseases and Related Health Problems, Water Rescue Service, Accidental drowning and submersion

Os recursos empregados para identificação humana variam desde antropologia física até o estudo dos ácidos nucléicos. Exemplos recentes como o Tsunami, na Tailândia e o Katrina, em Nova Orleans reforçam a necessidade de domínio de técnicas de extração do DNA no processo de identificação de corpos esqueletizados ou em estado de decomposição avançado que estiveram sob influência de ambiente aquoso. Neste sentido, o objetivo deste trabalho foi conhecer a casuística de situações que envolvam casos de afogamento, através dos registros do Instituto Médico-Legal Nina Rodrigues na cidade de Salvador - Bahia, além de, verificar o potencial de recuperação do DNA obtido de dentes humanos, imersos na água doce e salgada, por 1 mês. Foram utilizados 40 dentes sendo o DNA extraído pelo método orgânico e amplificado por PCR utilizando a amelogenina como iniciador. A eletroforese ocorreu inicialmente em gel de agarose e posteriormente em gel de poliacrilamida. Em seguida, foram selecionadas 10 amostras para amplificação através do sistema Powerplex® 16 System, sendo a eletroforese realizada em seqüenciador automático. No levantamento, observou-se 346 óbitos por afogamento, a maioria destes na água salgada (51,73%), predominando vítimas do sexo masculino (86,13%), na faixa etária de 18-35 anos (37,94%). Os cirurgiõesdentistas atuaram na identificação de 14,74% das vítimas. A recuperação do DNA foi possível em 37,5% das amostras (45% provenientes de dentes imersos em água doce e 30% em água salgada). A análise em gel de poliacrilamida de 27 amostras (15 dentes e 12 de células da mucosa oral) provenientes de 12 participantes, que tiveram amplificação positiva no gel de agarose, possibilitou a identificação correta do sexo em 83,3% dos casos (10 indivíduos). Entretanto, foi visualizada a perda de alelos em amostras de dois participantes, prejudicando a determinação do sexo. No Powerplex® foi possível a obtenção de pelo menos uma região do DNA em todas as amostras, mesmo naquelas que tiveram amplificação negativa no gel de agarose. Desta forma, a exposição dos dentes à água interferiu diretamente na recuperação do DNA. A investigação do sexo pela amelogenina mostrou-se efetiva, mas como toda técnica necessita de uma interpretação criteriosa dos resultados. Além disso, o sistema multiplex permitiu a obtenção de resultados mais fidedignos em função do seu alto poder discriminativo. O presente estudo proporcionou a obtenção de conhecimentos técnicos e científicos sobre o emprego da biologia molecular na investigação do sexo, demonstrando que apesar de ser uma técnica extremamente sensível às condições ambientais e outros fatores, trata-se de um método eficiente nos processos de identificação humana. Entretanto, a análise de DNA, mesmo sendo uma poderosa ferramenta, não é condição sine qua non em estudos forenses, devendo ser considerada dentro de um conjunto de variadas evidências. / The resources used for human identification vary since physical anthropology until nucleic acid study. Recent examples as the Tsunami, in Thailand and the Katrina, in New Orleans strengthen the necessity of domain of DNA extraction techniques in the skeleton bodies identification process in advanced decomposition state that had been under watery environment influence. In this direction, the objective of this work was to know the casuistry of situations that involve drowning cases, through the registers of Nina Rodrigues Forensic Medicine Institute in Salvador city - Bahia, beyond, to verify the recovery potential of DNA in human teeth immersed in the water for 1 month. 40 teeth had been used, being the DNA extracted for the organic method and amplified by PCR using the amelogenin as initiator. The electrophoresis occurred initially in agarose gel and later in polyacrylamide gel. After that, 10 samples was select for amplification through the Powerplex® 16 System, being the electrophoresis carried in the automated sequence data. In the survey, was observed 346 deaths for drowning, the majority of these in the saline water (51,73%), predominating victims of the masculine sex (86,13%), with age between 18-35 years (37,94%). The surgeon-dentists had acted in the identification of 14,74% of the victims. The DNA recovery was possible in 37,5% of the samples (45% comimg teeth immersed in fresh water and 30% in saline water). The analysis in polyacrylamide gel of 27 samples (15 teeth and 12 of oral mucous cells) proceeding from 12 participants, who had positive amplification in the agarose gel, made possible the correct sex identification in 83,3% of the cases (10 individuals). However, the allelic loss in samples of two participants was visualized, harming the sex determination. In the Powerplex® it was possible obtaining at least one region of the DNA in all the samples, exactly in that they had negative amplification in the agarose gel. Of this form, the exposition of teeth to the water intervened directly with the DNA recuperation. The sex identification by amelogenin revealed effective, but as all technique needs one sensible interpretation of the results. Moreover, the multiplex system allowed the obtaining of trustworther results in function of your high discriminate power. The present study provided the obtaining of technician and scientific knowledge about use of molecular biology in the sex investigation, demonstrating that although to be one extremely sensible technique to the ambient conditions and other factors, is one efficient method in the human identification processes. However, the DNA analysis, exactly being one powerful tool, is not indispensable condition in forensic studies, having to be considered inside of one set of varied evidences.

Made available in DSpace on 2017-07-10T16:17:00Z (GMT). No. of bitstreams: 1 Antonio Schinda.pdf: 3823696 bytes, checksum: 8d3d64f0f05d2ce88fa8c193906bfa2e (MD5) Previous issue date: 2013-12-16 / Drowning is a difficult problem to solve. Every year there are many deaths in the state of Paraná, the majority in isolated places. How can we reduce the number of drownings in the state of Parana? Where and how are the deaths by drowning occurring? What are the preventive measures that could be used as public policies for prevention? The main objective of the research was to analyze the drowning epidemiology in Paraná State to improve the understanding on this subject and also classify the problem of drowning deaths in liquid environment as one of the part of the social problem; it was also considered that social policies are actions from the State. Accordingly, therefore, the drowning epidemiology was treated and understood as a matter of public policy. As primary source, the occurrence records system from the Fire Department of Paraná (SISBM) was used to analyze the incidents of aquatic search, along with the analysis of the database about drowning used in the Unified Health System (SUS) called (DATASUS) in the period of 2008-2012, supplemented with official documents and reports, research reports, articles, books and the annals of the events. The research was divided as follows: in Section I a brief introduction was made on the origin of the subject of the research that was reported and the research problem; Section II approached the social and environmental characteristics of the drowning epidemiology and discussed some of the State and public policies; in Section III, the diagnoses was presented, social and environmental characteristics of the drowning epidemiology in Paraná using reports from DATASUL and SISBM; Section IV brought the data analysis, discussions, and final closing remarks / O afogamento é um problema de difícil solução. Todos os anos ocorrem muitas mortes no estado do Paraná, sendo a maioria em locais isolados. Como podemos reduzir o número de afogamentos da localidade? Onde e como estão ocorrendo as mortes por afogamento? Quais as medidas preventivas que poderiam ser usadas como políticas públicas de prevenção? O objetivo principal do trabalho é analisar a epidemiologia do afogamento no estado do Paraná para melhorar a compreensão deste tema. Também vamos classificar a questão de mortes por afogamento em meio líquido como uma das partes do problema social, considerando que as políticas sociais são ações do Estado. Deste modo, portanto, a epidemiologia do afogamento é tratada e compreendida como uma questão de políticas públicas. Utiliza-se como fonte primária o sistema de registros de ocorrências do Corpo de Bombeiros do Paraná (SISBM), por meio da análise das ocorrências de busca aquática, bem com da análise do banco de dados sobre afogamento utilizado no Sistema Único de Saúde (SUS), denominado DATASUS, no período de 2008 2012, complementados com os documentos e relatórios oficiais, relatos de pesquisa, artigos, livros e anais de eventos. O trabalho está dividido da seguinte forma: no capítulo I foi feita uma rápida introdução da pesquisa onde foi relatado sobre a origem da temática de estudo e a problemática; o capítulo II trata das características sociais e ambientais da epidemiologia do afogamento, bem como discute um pouco o Estado e políticas públicas; no capítulo III foram apresentados o diagnóstico, as características sociais e ambientais da epidemiologia do afogamento no estado do Paraná utilizando os relatórios do DATASUS e do SISBM; o capítulo IV trouxe a análise dos dados, discussão e as considerações finais

<p>Because of the difficulties in concluding whether a person has drowned or not, information that could be relevant for postmortal diagnosis of drowning was studied. With postmortal CT images lung volume, mean attenuation, anterior-posterior difference, lung density profile and amount of water within the lungs were investigated.</p><p>The report also evaluates three examples of software that calculates lung volume from postmortal CT images: Siemens’ Syngo Pulmo CT, Siemens‘ Volume Evaluation and GE Medical Systems’ Volume Viewer. The method used at autopsy was also studied. The repeatability and validity were tested and sources of errors identified.</p><p>Repeatability and validity for the three tested types of software were acceptable, while the method used at autopsy had to be improved. The study also showed that lung volume related to length, anterior-posterior difference and lung density profile seemed to vary between drowned and other deceased. These measures might conclude whether a person has drowned.</p>