Search

Background: Cervical injuries are important complications of near-hanging, which is defined as self-injury by hanging if the patient survives at admission. Previous studies have reported that complicated cervical injuries due to near-hanging are uncommon. The primary aim of this study was to evaluate whether cervical imaging can be safely omitted for near-hanging patients who are alert and have no abnormal neck symptoms or signs., Methods: This was a retrospective observational study to investigate the prevalence of cervical injuries among hospitalized near-hanging patients between April 2014 and June 2023. The primary outcome was the prevalence of any complicated cervical injuries, which included laryngeal fractures, laryngeal deviations, spinal cord injuries, cervical spine fractures, and blunt cerebrovascular injuries. The primary aim of this study was to determine the primary outcome among near-hanging patients with normal levels of consciousness and no abnormal neck symptoms or signs., Results: During the study period, a total of 63 near-hanging patients were hospitalized. Of these, 11 patients (18%) with normal levels of consciousness and no neck symptoms or signs at admission were included. The median age of the patients was 37 years (IQR 27 to 53); 5 (45%) were women, and none had cardiac arrest at the scene. For the primary outcome, no complicated cervical injuries (0%; 95% CI, 0% to 27%) occurred among the small number of near-hanging patients who had normal levels of consciousness and no abnormal neck symptoms or signs at admission., Conclusions: There were no cases of complicated cervical injuries among near-hanging patients with normal levels of consciousness and no abnormal neck symptoms or signs. Further prospective multicenter studies are warranted to investigate whether cervical imaging can be safely omitted in assessments of these patients., Competing Interests: Declaration of competing interest None of authors have financial relationships with any organizations that might have an interest in this work or other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Early identification of non-fatal strangulation in the context of intimate partner violence (IPV) is crucial due to its severe physical and psychological consequences for the individual experiencing it. This study investigates the under-reported and underestimated burden of IPV-related non-fatal strangulation by analysing assault-related injuries leading to anoxia and neck injuries., Methods: An IRB-exempt, retrospective review of prospectively collected data were performed using the National Electronic Injury Surveillance System All Injury Programme data from 2005 to 2019 for all assaults resulting in anoxia and neck injuries. The type and mechanism of assault injuries resulting in anoxia (excluding drowning, poisoning and aspiration), anatomical location of assault-related neck injuries and neck injury diagnosis by morphology, were analysed using statistical methods accounting for the weighted stratified nature of the data., Results: Out of a total of 24 493 518 assault-related injuries, 11.6% (N=2 842 862) resulted from IPV (defined as perpetrators being spouses/partners). Among 22 764 cases of assault-related anoxia, IPV accounted for 40.4%. Inhalation and suffocation were the dominant mechanisms (60.8%) of anoxia, with IPV contributing to 41.9% of such cases. Neck injuries represented only 3.0% of all assault-related injuries, with IPV accounting for 21% of all neck injuries and 31.9% of neck contusions., Conclusions: The study reveals a significant burden of IPV-related anoxia and neck injuries, highlighting the importance of recognising IPV-related strangulation. Comprehensive screening for IPV should be conducted in patients with unexplained neck injuries, and all IPV patients should be screened for strangulation events., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Survival of critically buried avalanche victims is directly dependent on the patency of the airway and the victims' ability to breathe. While guidelines and avalanche research have consistently emphasized on the importance of airway patency, there is a notable lack of evidence regarding its prevalence., Objective: The aim of this review is to provide insight into the prevalence of airway patency and air pocket in critically buried avalanche victims., Methods: A scoping review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline extension for scoping reviews. MEDLINE and Cochrane databases, as well as additional manual searching was performed to identify literature reporting data on airway patency and the presence of an air pocket in critically buried avalanche victims. After eliminating duplicates, we screened abstracts and main texts to identify eligible studies., Results: Of 4,109 studies identified 154 were eligible for further screening. Twenty-four publications and three additional data sources with a total number of 566 cases were included in this review. The proportion of short-term (< 35 min) to long-term burial (≥ 35 min) in the analysed studies was 19% and 66%, respectively. The burial duration remained unknown in 12% of cases. The prevalence of airway patency in critically buried avalanche victims was 41% while that of airway obstruction was 12%, with an overall rate of reporting as low as 50%. An air pocket was present in 19% of cases, absent in 46% and unknown in 35% of the cases., Conclusion: The present study found that in critically buried avalanche victims patent airways were more than three times more prevalent than obstructed, with the airway status reported only in half of the cases. This high rate of airway patency supports the ongoing development and the effectiveness of avalanche rescue systems which oppose asphyxiation in critically buried avalanche victims. Further effort should be done to improve the documentation of airway patency and the presence of an air pocket in avalanche victims and to identify factors affecting the rate of airway obstruction., (© 2024. The Author(s).)

Introduction: The characteristics of ski- and snowboard-related fatalities at Japanese ski resorts remain unknown. We aimed to analyze the characteristics of this in the current study., Methods: Using the Ski Resort Injury Report data for the 13-y period between the 2011-12 and 2022-23 seasons, we described the characteristics of fatal accidents due to exogenous causes., Results: Eighty-four subjects (48 skiers and 36 snowboarders) were analyzed. Males accounted for 73 cases of all 84 fatalities (86.9%), including 44 skiers (91.7%) and 29 snowboarders (80.6%). Skiers aged ≥50 y and snowboarders aged 20-35 y had the highest number of fatal accidents (32 and 18 cases, respectively). Regarding location, 26 fatal accidents occurred on slopes, and 58 occurred out of slopes (skiers, 11 and 37 cases; snowboarders, 15 and 21 cases, respectively). Among skiers, head and neck trauma accounted for the cause of death in 13 cases (27.1%) and asphyxiation in 11 cases (22.9%). Among snowboarders, head and neck trauma accounted for the cause of death in 14 cases (38.9%) and asphyxiation in 14 cases (38.9%)., Conclusions: Males, particularly those aged ≥50 among skiers and 20-35 among snowboarders, should be wary of the potential for injuries to the head, neck, and airway when skiing or snowboarding. In this study, traumatic deaths from crashing into trees and asphyxiation from deep snow immersion accidents accounted for approximately half of fatal ski accidents in Japan.

Background: Birth asphyxia is the main cause of neonatal mortality and morbidity worldwide. Some studies indicate intimate partner violence during pregnancy is a risk factor for birth asphyxia. In Ethiopia, intimate partner violence during pregnancy is reported to be high. Despite this high prevalence, there is a lack of data about the association of birth asphyxia and intimate partner violence. The aim of this study was to assess the prevalence of intimate partner violence during pregnancy and its associated factors with birth asphyxia in health facilities in the Tigray region of northern Ethiopia., Methods: This was an institutional-based cross-sectional study conducted at select health facilities in the Tigray region of Ethiopia. Random sampling technique was employed to select health facilities and systematic sampling was used to select 648 study participants. Data was entered by using Epi info version 3.5.1 and was analyzed using SPSS version 20. Bivariate and multivariate analysis was done to assess the association between exposure to intimate partner violence during pregnancy and birth asphyxia after adjusting for possible confounders., Results: The prevalence of intimate partner violence during pregnancy was 47(7.3%). Eighty two (12.7%) babies were delivered with birth asphyxia. Intimate partner violence during pregnancy had a significant association with birth asphyxia, AOR (95% CI) = 4.4(2-9.8). In addition to this, other factors that were associated with birth asphyxia include place of residence [ AOR (95% CI) = 2.7(1.55-4.8)], age > 19 [AOR (95% CI) = 2.9(1.29-6.5)], age 20-35 [AOR (95% CI) = 3.1(1.06-9.3)], gestational age < 37 weeks [AOR(95% CI) = 7.2(3.5-14.8)] and low birth weight [AOR(95% CI) = 3.9(2.1-7.3)]., Conclusions: The prevalence of birth asphyxia in this study is high and is further increased by intimate partner violence during pregnancy. Health care providers and policy makers should take measures aimed at preventing intimate partner violence during pregnancy to reduce harm to the mother and adverse birth outcomes., (© 2024. The Author(s).)

Since the early 2000 s the practice of free-range egg production has increased in developed countries, partly driven by consumer perception that free-range housing is better for hen welfare. While poultry in free-range systems have more behavioural opportunities compared with poultry in caged systems, free-range systems are associated with greater frequencies of infectious disease, predation and 'smothering', a condition where birds pile on top of one another with death occurring due to suffocation. Although the frequency of smothering deaths in Australian free-range layer poultry is anecdotally high, there is a lack of empirical evidence quantifying smothering cause-specific mortality rates and identifying factors that place birds at higher risk of death from smothering. This was a prospective cohort study of poultry flocks managed by three commercial free-range layer organisations in Eastern Australia. Flocks were enrolled into the study from 1 January 2019 to 29 March 2021 and were followed until the end of lay or until the end of the study on 31 March 2022, whichever occurred first. Throughout the follow-up period flock managers provided production details for each flock and details of smothering events using custom-designed logbooks.A total of 84 flocks were enrolled in the study: 32 from Organisation 1, 35 from Organisation 2 and 17 from Organisation 3. The number of birds per flock ranged from 16,000 to 45,000. The total mortality rate was 1131 deaths per 10,000 bird-years. Smothering mortality rate across the three organisations was 183 (minimum 133, maximum 223) deaths per 10,000 bird-years at risk. Smothering accounted for around 16% (minimum 9%, maximum 22%) of all deaths.We identified no distinctive temporal pattern in daily smothering risk as a function of either the number of days since placement or calendar date. The locations of smothering events in sheds and in the outdoor range were not consistent, with relatively large numbers of smothering events occurring in specific locations for some sheds but not others. To the best of our knowledge, this study is the largest prospective study of smothering mortality in commercial free-range layer flocks conducted to date. Estimates of smothering incidence rate and how that varies within and between flocks and organisations over time provides a critically important benchmark for further investigations into this substantial area of productivity loss., Competing Interests: Declaration of Competing Interest None of the authors has any financial or personal relationships that could inappropriately influence or bias the content of this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The suicide rate among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Veterans increased from 2001 to 2020. Identifying regions where suicide rates are elevated and increasing among AANHPI Veterans would inform targeted prevention efforts for members of this cohort. We conducted a population-based retrospective cohort study of 377,833 AANHPI Veterans to examine suicide rates and methods (2005-2019) by United States (US) region and over time (2005-2009, 2010-2014, 2015-2019), using US Veteran Eligibility Trends and Statistics and Joint DoD/VA Mortality Data Repository data. AANHPI Veterans across most regions experienced increases in suicide rates from the earliest to latest period; however, patterns differed by region. Age-adjusted suicide rates increased across all three periods among those in the Northeast and West, but increased, then declined in the Midwest and South. In 2015-2019, the age-adjusted suicide rate among AANHPI Veterans was highest in the Northeast (42.0 per 100,000) and lowest in the West (27.5). However, the highest percentages of AANHPI Veteran suicide deaths in 2005-2019 occurred in the West (39.5%) and South (34.7%), with lower percentages in the Midwest (15.0%) and Northeast (10.8%). Across regions, those ages 18-34 had the highest suicide rates. Firearms were the most frequently used suicide method across regions (44.4%-60.2%), except the Northeast (35.2%), where suffocation was more common (38.3%). Results suggest particular needs for suicide prevention efforts among AANHPI Veterans in the Northeast and to ensure that lethal means safety initiatives for AANHPI Veterans encompass both firearms and suffocation, with some variations in emphasis across regions., Competing Interests: Declaration of Competing Interest Authors were employed by the Department of Veterans Affairs (VA) during the initial analysis and writing of this manuscript. Authors have received funding from the VA Office of Mental Health and Suicide Prevention (Monteith, Schneider, Miller, Gaeddert, Holliday, Spark, Brenner, Hoffmire), VA Health Services Research and Development (Monteith, Schneider, Miller, Gaeddert, Holliday, Spark, Brenner, Hoffmire), VA Rehabilitation Research and Development (Brenner), VA Office of Rural Health (Schneider, Brenner, Spark), VA National Center on Homelessness among Veterans (Holliday, Monteith, Brenner), VA National Center for Patient Safety (Monteith, Hoffmire), VA Office of Women’s Health (Monteith), VA Office of Health Equity (Holliday, Monteith), the National Institutes of Health (Brenner, Holliday, Hoffmire), the Department of Defense (Monteith, Holliday, Brenner, Hoffmire), the American Psychological Association (Monteith), and the State of Colorado (Brenner, Hoffmire). In her current employment with Westat, Dr. Spark has also received funding from the CDC and SAMHSA. Dr. Brenner also reports editorial remuneration from Wolters Kluwer, royalties from the American Psychological Association and Oxford University Press, and consults with sports leagues via her university affiliation., (Published by Elsevier B.V.)

Background: We sought to define the incidence and outcomes of pediatric hanging and strangulation injuries to inform best practices for trauma triage and management., Methods: A retrospective review was conducted that included all patients who presented after hanging or strangulation to a Level I Pediatric Trauma Center from 2011 through 2021. Patient demographics, injury characteristics, and clinical outcomes were collected. All imaging modalities of the head and neck were reviewed to determine if a bony fracture or vascular injury was present., Results: Over the 11-year study period, 128 patients met inclusion criteria. The median age of the cohort was 13 years [IQR: 8.5-15], most patients were male (60.9%), and the median GCS was 11 [3, 15]. There were 96 cases (75%) that were intentional injuries. 76 patients (59.4%) received imaging in the form of plain radiographs, CT, or MRI of the neck and cervical spine. No fractures were identified and there were 0 clinically significant cervical spine injuries. CT angiograms of the neck identified no cerebral vascular injuries. Mortality was high (32%), and 25% of patients with nonaccidental injuries had a documented prior suicide attempt., Conclusion: We identified no cervical spine fractures and no blunt cerebral vascular injuries after a hanging or strangulation in over 10 years at a Level 1 Pediatric Trauma Center. Use of CT and CT angiography of the neck and cervical spine should be minimized in this patient population without high clinical index of suspicion and/or significant mechanism., Level of Evidence: IV., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Globally, 45% of under-five children death occurs during the neonatal period and about 25% of all neonatal deaths are caused by birth asphyxia. In Ethiopia, in 2015, it was the first cause of neonatal deaths followed by prematurity and sepsis. The study aims to assess prevalence of Birth asphyxia and associated factors., Methods: Institution-based cross-sectional study was conducted among neonates admitted to Neonatal intensive care unit of Hawassa University Specialized comprehensive hospital from December 1 to December 30, 2020. Systematic random sampling technique was employed to select samples. Logistic regression analysis using Statistical Package for Social sciences version 24was employed., Results: The prevalence of neonatal asphyxia in this study was17.9%. Prolonged labor [AOR (Adjusted odds ration) = 2.909; (95% CI (Confidence Interval): 1.184 - 7.151)], presence of meconium [AOR= 2.137; 95% CI 1.028 - 4.683)], premature rapture of membrane [AOR = 2.459; 95% CI: 1.021 - 6.076)] and complication during labor [AOR= 3.351; 95% CI: 2.142-5.871))], were factors associated with neonatal asphyxia., Conclusion and Recommendations: Nearly two in every ten newborns faced perinatal asphyxia in the study area. Early identification of high-risk women, intervening on delay in referral, and early and vigorous management of abnormal labor and complicated labor is essential to halt the problem., Competing Interests: The authors declare that they have no competing interests., (© 2023 Demisse M et al.)

Background/objective: The number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment. This study provides a review of the available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations., Results: Causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing the chances of critical burial, the most determining risk factor. However, there is a scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education and risk compensation., Conclusions: Avalanche airbags seem to be an important tool in reducing mortality in the backcountry expeditions. However, more research and standardized data collection are needed to fill the knowledge gap, and mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels; and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia and trauma., (© International Society of Travel Medicine 2022. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Injury is the most common cause of preventable morbidity and death among children under five. This study aimed to describe the epidemiological characteristics of injury-related mortality rates in children under five and to provide evidence for future preventive strategies. Data were obtained from the Under Five Child Mortality Surveillance System in Hunan Province, China, 2015-2020. Injury-related mortality rates with 95% confidence intervals (CI) were calculated by year, residence, gender, age, and major injury subtype (drowning, suffocation, traffic injuries, falls, and poisoning). And crude odds ratios (ORs) were calculated to examine the association of epidemiological characteristics with injury-related deaths. The Under Five Child Mortality Surveillance System registered 4,286,087 live births, and a total of 22,686 under-five deaths occurred, including 7586 (which accounted for 33.44% of all under-five deaths) injury-related deaths. The injury-related under-five mortality rate was 1.77‰ (95% CI 1.73-1.81). Injury-related deaths were mainly attributed to drowning (2962 cases, 39.05%), suffocation (2300 cases, 30.32%), traffic injuries (1200 cases, 15.82%), falls (627 cases, 8.27%), and poisoning (156 cases, 2.06%). The mortality rates due to drowning, suffocation, traffic injuries, falls, and poisoning were 0.69‰ (95% CI 0.67,0.72), 0.54‰ (95% CI 0.51,0.56), 0.28‰ (95% CI 0.26,0.30), 0.15‰ (95% CI 0.13,0.16), and 0.04‰ (95% CI 0.03,0.04), respectively. From 2015 and 2020, the injury-related mortality rates were 1.78‰, 1.77‰, 1.60‰, 1.78‰, 1.80‰, and 1.98‰, respectively, and showed an upward trend (χ 2 trend  = 7.08, P = 0.01). The injury-related mortality rates were lower in children aged 0-11 months than in those aged 12-59 months (0.52‰ vs. 1.25‰, OR = 0.41, 95% CI 0.39-0.44), lower in urban than rural areas (1.57‰ vs. 1.88‰, OR = 0.84, 95% CI 0.80-0.88), and higher in males than females (2.05‰ vs . 1.45‰, OR = 1.42, 95% CI 1.35-1.49). The number of injury-related deaths decreased with children's age. Injury-related deaths happened more frequently in cold weather (around February). Almost half (49.79%) of injury-related deaths occurred at home. Most (69.01%) children did not receive treatment after suffering an injury until they died, and most (60.98%) injury-related deaths did not receive treatment because it was too late to get to the hospital. The injury-related mortality rate was relatively high, and we have described its epidemiological characteristics. Several mechanisms have been proposed to explain these phenomena. Our study is of great significance for under-five child injury intervention programs to reduce injury-related deaths., (© 2023. The Author(s).)

To investigate the associations between low birth weight (LBW) and perinatal asphyxia by a hospital-based study. The participants of this study were mothers who gave birth at our hospital in 2018. They were divided into case group and control group according to their children's asphyxia status. The bivariable and multivariable logistics regression were used to identify maternal and newborn factors with perinatal asphyxia. A total of 150 participants were enrolled in this study, including 50 participants in the case group and 100 participants in the control groups. The bivariate logistic regression analysis showed the significant relationship of LBW, the mother's age which was less than 20 years, and the gestational age with perinatal asphyxia (P < .05). The multivariate analysis was shown that LBW, male newborns, mothers who had preeclampsia/eclampsia, or mothers who were primipara or whose gestational age more than 37 weeks had higher risks of perinatal asphyxia (P < .05). However, there were no significant relationships of the age of mother or history of antenatal care with perinatal asphyxia. LBW of infants contributes to the higher risk of perinatal asphyxia., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Aims: The U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+., Methods: Data came from the 2017-2019 National Violent Death Reporting System (NVDRS; N = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use., Results: In all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women "other" methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45-64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45-64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes., Implications: The findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Choi, Marti and Choi.)

Introduction: Geographic and urbanization differences in female suicide trends across the U.S. necessitates suicide prevention efforts on the basis of geographic variations. The purpose of this study was to assess female suicide rates by mechanism within Census divisions and by urbanicity to help inform geographically tailored approaches for suicide prevention strategies., Methods: Data from 2004 to 2018 were obtained from the National Vital Statistics System (analyzed in 2021). Annual counts of female suicides were tabulated for firearm, suffocation, and drug poisoning and stratified by the U.S. Census division and urbanicity. Age-adjusted rates were calculated to describe female suicide incidence by geographic areas and urbanicity. Data were analyzed annually and by 5-year timeframes. Trends in annual female suicide rates by mechanism for 3 urbanization levels were identified using Joinpoint Regression. Annual percent change estimates were calculated for age-adjusted female suicide rates between 2004 and 2018., Results: Female suicide rates by mechanism were not homogeneous within Census divisions or by urbanization levels. Suicide rates by mechanism across Census divisions within the same urbanization level varied (range=3.38-11.15 [per 100,000 person per year]). From 2014 to 2018 in large metropolitan areas in the northern divisions, rates for suffocation were higher than for firearms and drug poisoning. During the same period, in all urbanization levels in southern divisions, rates for firearms were higher than for suffocation and drug poisoning., Conclusions: Female suicide mechanisms vary by urbanization level, and this variation differs by region. These results could inform female suicide prevention strategies on the basis of mechanism, urbanization, and geographic region., (Published by Elsevier Inc.)

COVID-19 pandemic has affected all age groups globally including pregnant women and their neonates. The aim of the study was to understand outcomes in neonates of mothers with COVID-19 during the first and second waves of COVID-19 pandemic. A retrospective analysis of 2524 neonates born to SARS-CoV-2-infected mothers was conducted during the first wave (n = 1782) and second wave (n = 742) of the COVID-19 pandemic at five study sites of the PregCovid registry in Maharashtra, India. A significant difference was noted in preterm birth, which was higher in the second wave (15.0%, 111/742) compared to the first wave (7.8%, 139/1782) (P < 0.001). The proportion of neonates requiring NICU admission was significantly higher in the second wave (19.0%, 141/742) as compared to that in the first wave (14.8%, 264/1782) (P < 0.05). On comparing regional differences, significantly higher neonatal complications were reported from Mumbai metropolitan region (P < 0.05). During the second wave of COVID-19, birth asphyxia and prematurity were 3.8- and 2.1-fold higher respectively (P < 0.001). Neonatal resuscitation at birth was significantly higher in second wave (3.4%, 25/742 vs 1.8%, 32/1782) (P < 0.05). The prevalence of SARS-CoV-2 infection in neonates was comparable (4.2% vs 4.6%) with no significant difference between the two waves., Conclusion: Higher incidence of adverse outcomes in neonates born to SARS-CoV-2-infected mothers in the second wave of COVID-19 as compared to the first wave., Trial Registration: PregCovid study is registered with the Clinical Trial Registry of India (CTRI/2020/05/025423, Registered on 28/05/2020)., What Is Known: • The second wave of COVID-19 was more lethal to pregnant women than the first wave. Newborns are at risk of developing complications., What Is New: • Birth asphyxia, prematurity, and neonatal resuscitation at birth were significantly higher in the second wave as compared to those in the first wave of the COVID-19 pandemic in India., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Birth asphyxia is a leading cause of neonatal deaths, which accounts for about 31.6% of all neonatal deaths in Ethiopia. Despite its being one of the important causes of morbidity and mortality in newborns, its determinants were not investigated according to local context. So, this study was aimed at investigating the determinants of asphyxia at Illu Aba Bor zone public health facilities. An institution-based case-control study was employed. A pre-tested, structured and adapted interviewer administered questionnaire for mothers of newborn interviews and a data extraction tool for chart review were used. The collected data were entered into Epi-data version 3.1 and exported to SPSS version 24 for further analysis. A binary logistic regression was employed, and variables with a p-value < 0.25 were taken to a multi-variable logistic regression. Finally, a Bonferroni correction was used and variables with a p-value < 0.0038 at 95% CI were declared statistically significant. A total of 308 (103 cases vs 205 controls) mothers of newborns were interviewed, yielding a response rate of 100%. The mean age (SD) of mothers for the cases and the controls were (25.97 ± 4.47) and (25.52 ± 4.17) respectively. Prolonged duration of labor [AOR 4.12; 95% CI 1.78, 9.50], non-cephalic fetal presentation [AOR 4.35; 95% CI 1.77, 10.67], being preterm [AOR 5.77; l95% CI 2.62, 12.69] and low birth weight [AOR 4.43; (95% CI 1.94, 10.13) were found to be the determinants of birth asphyxia. Prolonged duration of labor, non-cephalic presentation, prim parous, preterm, and low birth weight were the independent determinants of birth asphyxia. Hence, improving the utilization of parthograph during labor and interventions focusing on this area should give priority to reducing the risk of morbidity and mortality., (© 2022. The Author(s).)

In recent decades, despite significant advances in medicine and perinatal care, asphyxia remains a serious condition, leading to significant mortality and morbidity. The incidence of severe perinatal asphyxia varies from 1 to 3 per 1000 live births, in developed countries 5-10 per 1000 or more in developing countries, and is the third most common cause of neonatal death (23%) after preterm birth (28%) and severe infection (26%). Neonatal asphyxia is often accompanied by multiple organ failure, mainly involving the kidneys, brain, and heart. Asphyxia results in significant tissue hypoperfusion and reduced oxygen supply, which can cause neurological damage and damage to cochlear hair cells. Under our supervision were 35 (n=30) newborns who were in the neonatal intensive care unit of the Perinatal Center of the Khorezm region in the period from 2018 to 2019. Of these, 22 (I (main) group n=22), who were in the neonatal pathology department, had signs of perinatal CNS damage; The comparison group included 13 newborns (n=13), with Apgar scores >7 in the first minute. There is a clear correlation between the degree of hearing impairment in infants and the degree of pathology of the CNS. However, the degree of impairment of the auditory analyzer increased in parallel with the degree of asphyxia and severity (P≤0,05).

Aim: To determine the epidemiological characteristics, temporal trends and survival outcomes of OHCAs precipitated by chemical asphyxiation., Methods: We conducted a retrospective cohort analysis of OHCAs attended by paramedics in Queensland, Australia between 2011 and 2020. Patients were classified into two groups depending on the asphyxiating agent involved; simple (argon, carbon dioxide, helium, liquified petroleum gas, nitrogen) and systemic (carbon monoxide, cyanides, hydrogen sulfide, methemoglobin-inducing substances, smoke inhalation). Incidence rates, characteristics and outcomes were described for the entire cohort and independently for each group, with the groups then compared. Temporal trends of asphyxiant utilisation were also described., Results: During the study period, 50,669 OHCAs were attended, with 551 (1.1%) attributable to chemical asphyxiation. The incidence rate was 1.1 per 100,000 population with no significant temporal changes. Suspected suicide was the primary cause of exposure (-95.8%), with systemic asphyixants the dominant agent reported in comparison to simple agents (66.4% vs 33.6%). Over the 10-year period, events precipitated by carbon monoxide decreased by 26.2% (p for trend < 0.001), helium remained unchanged (p for trend = 0.302) and incidents involving nitrogen increased by 28.7% (p for trend < 0.001). Overall, 14.2% (78/551) of the study cohort received a resuscitation attempt by paramedics with 6.4% of these incidents witnessed and 2.6% involving patients presenting in a shockable rhythm. Survival rates were low, with 6.4% surviving the index event, and 1.3% surviving to hospital discharge with a normal neurocognitive function., Conclusion: OHCA precipitated by chemical asphyxiation is relatively infrequent and associated with poor survival outcomes., (Crown Copyright © 2022. Published by Elsevier B.V. All rights reserved.)

Background: Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns., Methods: This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05., Results: Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia., Conclusion: In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors., (© 2022 Yoseph Merkeb Alamneh, et al.)

Objective: The purpose of this study was to review the evaluation of strangulation victims assessed by a sexual assault nurse examiner (SANE) service. The primary objective was to produce observational results on documented injury frequency and secondarily to explore advanced imaging use, outcomes, signs/symptoms, and documentation., Methods: This was a retrospective analysis of a cohort of 130 consecutive strangled patients over a 42-month period evaluated by a SANE consult service in a metropolitan area. A single investigator extracted medical records for demographics, history, imaging, injuries, disposition, and both presence and documentation of a number of signs/symptoms. A second investigator independently extracted greater than 30% of the total charts with universal agreement. Data were analyzed with descriptive statistics., Results: Patients were primarily female (129:1) and their age averaged 30.6 years. Time from event to presentation varied. There were no major brain or neck injuries detected (0%; 95 confidence interval, 0-2.31), and all patients were discharged in stable condition. Imaging was used in 23 patients (17.7%). Certain signs and symptoms were more common than others, and documentation frequency of signs and symptoms varied., Conclusion: In this retrospective cohort of 130 consecutive nonfatally strangled awake patients seen as SANE consults in a single emergency department, there were no major injuries documented. The most common signs or symptoms were neck pain, neck markings, and loss of consciousness. Imaging was used in 17.7% of the patients. Presence or absence of neck pain, neck markings, and altered mental status were most consistently documented. Seizure, subcutaneous emphysema, and carotid bruit were least consistently documented., (Copyright © 2022 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Objective: Non-fatal strangulation assessment is challenging for clinicians as clear guidelines for evaluation are limited. The prevalence of non-fatal strangulation events, clinical findings, frequency of injury on computed tomography angiogram (CTA) and outcomes across two trauma centres will be used to improve this assessment process., Methods: This is a retrospective observational study of adult presentations during 2-year period to two major-trauma referral hospitals and subsequent 12 months to identify delayed vascular injury. Patients included using standardised search terms. Demographic data, clinical findings, radiological reports and outcomes were included for review., Results: A total of 425 patients were included for analysis. Self-inflicted injury comprised 62.1%, with domestic violence (28.5%) and assault (9.4%) the remainder. Manual strangulation events 36.7% of overall presentations and 63.3% following ligature strangulation (ligature strangulation, incomplete and complete hanging). On examination soft signs present in 133 (31.2%) cases, commonly neck tenderness in isolation. No hard signs suggesting vascular damage. Vascular injury was demonstrated in three cases (0.7% of the total cohort and 1.5% of CTA scans completed), and all occurred in ligature strangulation events as a result of hanging. No patients had delayed vascular injury in the 12-month period post-initial presentation., Conclusions: In non-fatal strangulation presentations, the majority have subtle signs of neck injury on examination with inconsistent documentation of findings. Low rate of vascular injury overall (0.7%), and entirely in hanging events. No longer-term vascular sequalae identified. Improving documentation focusing on hypoxic insult and evidence of airway trauma is warranted, rather than a reliance on computed tomography imaging to delineate a traumatic event in non-fatal strangulation., (© 2021 Australasian College for Emergency Medicine.)

Introduction: Perinatal asphyxia continues to be a significant clinical concern around the world as the consequences can be devastating. World Health Organization data indicates perinatal asphyxia is encountered amongst 6-10 newborns per 1000 live full-term birth, and the figures are higher for low and middle-income countries. Nevertheless, studies on the prevalence of asphyxia and the extent of the problem in poorly resourced southern Ethiopian regions are limited. This study aimed to determine the magnitude of perinatal asphyxia and its associated factors., Methods: A retrospective cross-sectional study design was used from March to April 2020. Data was collected from charts of neonates who were admitted to NICU from January 2016 to December 31, 2019., Result: The review of 311 neonates' medical records revealed that 41.2% of the neonates experienced perinatal asphyxia. Preeclampsia during pregnancy (AOR = 6.2, 95%CI:3.1-12.3), antepartum hemorrhage (AOR = 4.5, 95%CI:2.3-8.6), gestational diabetes mellitus (AOR = 4.2, 95%CI:1.9-9.2), premature rupture of membrane (AOR = 2.5, 95%CI:1.33-4.7) fetal distress (AOR = 3,95%CI:1.3-7.0) and meconium-stained amniotic fluid (AOR = 7.7, 95%CI: 3.1-19.3) were the associated factors., Conclusion: Substantial percentages of neonates encounter perinatal asphyxia, causing significant morbidity and mortality. Focus on early identification and timely treatment of perinatal asphyxia in hospitals should, therefore, be given priority., Competing Interests: The authors have declared that no competing interests exist.

Objective: To describe characteristics of strangulation, and associated medical care, documentation, and injuries of women after nonfatal intimate partner strangulation (NF-IPS) who present for care to a community-based emergency department (ED) with an associated intimate partner violence (IPV) advocacy program between 2008 and 2016., Setting, Design, and Participants: A retrospective review of 345 female ED patients' medical records who sought care at a community hospital ED following a physical assault including strangulation by an intimate partner was conducted. Demographics, characteristics related to reported signs and symptoms, injuries, and subsequent imaging, diagnoses, and discharge information were abstracted., Results: Commonly reported symptoms were neck pain (67.2%) and headache (45.8%), with fewer patients reporting more severe symptoms such as loss of consciousness (22.6%), dysphagia (25.0%), or dysphonia (26.7%). Rates of patients disclosing strangulation to the entire multidisciplinary team and dedicated neck imaging appeared to improve between 2008 and 2014. Among the 45 patients with noted head and neck findings, 2 patients were found to have an internal carotid artery dissection, 2 patients were found to have strokes, and 1 patient was found to have an intracranial hemorrhage., Conclusions: Survivors of NF-IPS may present to community-based hospitals, and existing imaging guidelines can support clinicians in identifying serious internal injury such as carotid artery dissection and stroke. Further research is needed to better discern symptoms previously attributed to psychological trauma from poststrangulation brain injury. This study contributes to the growing literature on NF-IPS with data specific to community-based ED visits., Competing Interests: All authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Non-fatal strangulation is a dangerous mechanism of injury among survivors of intimate partner violence and sexual assault, with inadequate evidence to guide investigation in the emergency department (ED). The primary objective is to identify the proportion of intimate partner violence and sexual assault where non-fatal strangulation occurs, and to describe the sequelae of injuries., Methods: Health records review of patients treated at the Sexual Assault and Partner Abuse Care Program (SAPACP) and/or Trauma Program at a tertiary level hospital between January 2015 and December 2018. Eligible patients were greater than 16 years old, seen by the SAPACP or trauma team for intimate partner violence and sexual assault, and had a non-fatal strangulation injury. Data were abstracted from the standardized assessment completed by the SAPACP nurse. Descriptive statistics were used., Results: We identified 209 eligible cases of non-fatal strangulation, among 1791 patient presentations to the SAPACP. Median patient age was 27 years, and 97.6% were female. Computed tomography (CT) of the head was obtained in 22.5%, and CT angiography (CTA) of the head and neck in 6.2% of cases. Eleven significant injuries were identified. Two cases of vascular abnormalities: internal carotid artery indentation with possible intramural hematoma and possible internal carotid artery dissection. Other injuries included delayed bilateral subdural hematomas, a depressed skull fracture, and six nasal fractures., Conclusion: We found over 10% prevalence of non-fatal strangulation in survivors of intimate partner violence and sexual assault. There was a low rate of clinically important injury on the index ED visit secondary to non-fatal strangulation. Severe injury was primarily secondary to concomitant trauma, and utilization of CTA in this cohort was low. Increased awareness is needed among ED physicians regarding the need to consider CTA head and neck., (© 2021. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

Background: This retrospective study aimed to determine the epidemiological features of deaths caused by unintentional suffocation among infants in China., Methods: The data used in this study were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS) from October 1, 2015, to September 30, 2016. A total of 377 children under 1 year of age who died from unintentional suffocation were included in the survey. Primary caregivers were interviewed individually using the Unintentional Suffocation Mortality among Children under 5 Questionnaire. EpiData was used to establish the database, and the results were analysed using SPSS 22.0., Results: Most (85.9%) unintentional infant suffocations occurred in rural areas, and 67.5% occurred in infants 0 to 3 months old. Among the primary caregivers of the infants, most (82.7%) had a junior middle school education or below, and 83.1% of them lacked unintentional suffocation first aid skills. Of the 377 unintentional suffocated-infant deaths, the causes of death were accidental suffocation and strangulation in bed (ASSB) (193, 51.2%), inhalation suffocation (154, 40.8%), other unintentional suffocation (6, 1.6%), and unknown (24, 6.4%). Among the infant deaths due to ASSB, overlaying (88.6%) was the most frequently reported circumstance. A total of 93.8% of cases reported occurred during co-sleeping/bed sharing with parents, and in 72.8% of the cases, the infants were covered with the same quilt as their parents. In our study, most inhalation suffocation deaths (88.3%) involved liquid food (such as breast milk and formula milk). A total of 80.5% of infant deaths reportedly occurred after eating; in 28.2% of those cases, the infants were held upright and patted by their caregivers, and 57.2% of them were laid down to sleep immediately after eating., Conclusions: To reduce the occurrence of unintentional suffocation, local government should strengthen knowledge and awareness of unintentional suffocation prevention and safety among parents and caregivers. Additionally, health care providers should educate parents and caregivers about safety issues of unintentional suffocation, and relevant policies should be introduced to provide environments and activities that reduce the risk of suffocation, such as promoting the Safe to Sleep Campaign. It is important to enhance the focus on infant unintentional suffocation as a health issue., (© 2021. The Author(s).)

Background: Hangings are an infrequent wounding mechanism among patients arriving alive to hospital but are frequently encountered by the Coroner's Office. It is unclear if classically described hanging injuries, such as the Hangman's fracture, are common among contemporary hangings patients who typically do not suspend from height. This study was undertaken to define patient and injury characteristics after hangings causing death., Methods: All patients presenting to the Los Angeles County Medical Examiner/Coroner's Office (January 2016 - May 2020) who died by hanging were included. Demographics, psychiatric history, hanging details, autopsy type, and sustained injuries were collected. Data variables were summarized with descriptive statistics and the diagnostic yield of a ligature mark in the diagnosis/exclusion of cervical injuries was calculated., Results: Over the study, 1,401 patients died by hanging. Patients underwent external exam alone (n = 1,282, 92%), traditional neck autopsy (n = 114, 8%), or traditional neck autopsy plus postmortem computed tomography scan (n = 5, <1%). Home was the most frequent hanging setting (n = 1,028, 73%) followed by public spaces (n = 80, 6%) and jail (n = 28, 2%). The manner of death was almost exclusively suicide (n = 1,395, >99%) and psychiatric disease was common (n = 968, 69%). Of the patients undergoing traditional autopsy, most had a ligature mark (n = 109, 92%) and only 9 (8%) had a cervical injury (hyoid fractures, n = 6, 5%; thyroid cartilage fractures, n = 4, 3%). None had a vertebral fracture/dislocation. Sensitivity, specificity, positive predictive value, and negative predictive value of a ligature mark were 100%, 5%, 8%, and 100%., Conclusions: Hangings are a frequent cause of death in Los Angeles County. Patients typically have a psychiatric history and die almost exclusively from suicide. Hangings commonly occur at home, in public places, and in jail. Injuries were exceedingly rare and no patient sustained a Hangman's fracture, which may be related to the lack of significant suspension with modern hangings., (Copyright © 2021. Published by Elsevier Inc.)

Introduction: Perinatal asphyxia is one of the main causes of morbidity and mortality in newborns. It generates high costs, both social and economic, and presents modifiable risk factors. Objective: To determine the biological and psychosocial factors and risk behaviors associated with the development of perinatal asphyxia (Sarnat II-III) in newborns from low socioeconomic status in a tier III university hospital in the city of Cali, Colombia. Materials and Methods: With a case and control design, 216 patients were studied (54 cases/162 controls) (1 case/3 matched controls). The cases were defined as newborns with modified or severe perinatal asphyxia (Sarnat II-III) between 2012 and 2014, with gestational age ≥ 36 weeks, with neurological signs not attributable to other causes, multiorgan compromise, advanced reanimation, and presence of a sentinel event. For the analysis, conditional logistic regression models were developed to evaluate association (OR), considering that the cases and controls had been paired by the birth and gestational age variables. Results: The final model showed that, from the group of biological variables, meconium amniotic fluid was identified as a risk factor (OR 15.28, 95%CI 2.78-83.94). Induction of labor lowered the risk of perinatal asphyxia by 97% (OR 0.03, 95%CI 0.01-0.21), and monitoring of fetal heart rate was associated with lower odds by 99% (OR 0.01, 95%CI 0.00-0.31) of developing perinatal asphyxia in the newborn. Regarding social variables, the lack of social support was identified as a risk factor for the development of perinatal asphyxia (OR 6.44, 95%CI 1.16-35.66); in contrast, secondary education lowered the odds of developing perinatal asphyxia by 85% when compared with pregnant women who only had primary school education (OR 0.15, 95%CI 0.03-0.77). Conclusion: Assessment of biological and psychosocial factors and social support is important in pregnant women to determine the risk of developing perinatal asphyxia in a low-income population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Torres-Muñoz, Fonseca-Perez and Laurent.)

Background: Piling, a behaviour where hens crowd together, is referred to as smothering if mortalities result. Smothering is a considerable concern for the egg industry, yet is vastly understudied., Methods: During an outbreak of recurrent smothering, continuous video footage captured a commercial, free-range flock over 35 days. We describe the piling behaviour observed and potential associations with productivity and flock health indicators., Results: Forty-eight piles were filmed, with a maximum density of 187.93 birds/m 2 and up to 1204 birds in one pile. Piling occurred in the same house location on 33 of 34 observation days, the first evidence of regularity in piling behaviour. Despite extreme bird densities, we did not find associations between piling extremity and productivity but did find associations with water:feed ratio and temperature range., Conclusion: This study describes the most extreme level of piling reported in literature and offers new insights into this problem behaviour and its consequences., (© 2021 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Hanging by the neck is the leading method of suicide globally. The epidemiological risk factors for suicidal hanging can contribute to construct a socioeconomic and demographic profile of hanging victims. These profiles can then be used to identify individuals at the highest risk for committing suicide by hanging for referral to a suicide prevention program. The aim of this study was to describe the socioeconomic and demographic profiles of hanging victims in Bloemfontein, South Africa. A retrospective descriptive study was performed using data from the Bloemfontein Forensic Mortuary, for the period 1 January 2008 to 31 December 2015. In total, 9085 autopsies were performed during the study period; 355 (3.9%) were hanging victims. The median age of the victims was 31.4 (range 11-78) years, with 138 (38.9%) cases being 21-30 years of age. Three hundred and twenty-three (91.0%) of the victims were male, 227 (63.9%) were single, 201 (56.6%) were unemployed, and 129 (36.3%) completed their high school education. The most common location where the hanging occurred was at home. Single, unemployed males 21-40 years of age were found to have the highest risk for committing suicide by hanging. The group at the lowest risk were married and employed individuals older than 60 years, who had a tertiary education. We report the first socioeconomic and demographic profiles of individuals who commit suicide by hanging in central South Africa, emphasizing the need for a National Suicide Prevention Program via a multidisciplinary team approach.

Study Purpose: Out-of-hospital cardiac arrests (OHCA) in the young population have only been examined in a limited number of regional studies. Hence, we sought to describe OHCA characteristics and predictors of survival to hospital discharge for the young Irish population., Study Design: An observational analysis of the national Irish OHCA register for all OHCAs aged ≤35 years between January 2012 and December 2017 was performed. The young population was categorised into three age groups: ≤1 year, 1-15 years and 16-35 years. Multivariable logistic regression was used to determine the independent predictors of survival to hospital discharge., Results: A total of 1295 OHCAs aged ≤35 years (26.9% female, median age 25 (IQR 17-31)) had resuscitation attempted. OHCAs in those aged ≥16 years (n=1005) were more likely to happen outside the home (38.5% vs 22.8%, p<0.001) and be of non-medical aetiology (59% vs 27.6%, p<0.001) compared with those aged <16 years (n=290). Asphyxiation, trauma and drug overdoses accounted for over 90% of the non-medical OHCAs for those 16-35 years. Overall survival to hospital discharge for the cohort was 5.1%; survival was non-significantly higher for those aged 16-35 years compared with those aged 1-15 years (6.0%, vs 2.8% p=0.93). Independent predictors of survival to hospital discharge included bystander witnessed OHCA, a shockable initial rhythm and a bystander defibrillation attempt., Conclusions: The high prevalence of non-medical OHCAs and the OHCA location need to be considered when developing OHCA care pathways and preventative strategies to reduce the burden of OHCAs in the young population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Nonfatal intimate partner strangulation poses significant acute and long-term morbidity risks and also heightens women's risk for future femicide. The lifetime prevalence of nonfatal intimate partner strangulation has been estimated to be approximately 10%, or 11 million women, in the general United States population. Given the potential for significant health risks and serious consequences of strangulation, this study adds to the limited literature by estimating prevalence and describing the associated characteristics of strangulation-related visits among United States ED visits by adult women after intimate partner violence., Methods: Prevalence estimation as well as simple and multivariable logistic regression analyses were completed using data from the Nationwide Emergency Department Sample spanning the years 2006 to 2014., Results: The prevalence of strangulation codes was estimated at 1.2% of all intimate partner violence visits. Adjusting for visits, hospital characteristics, and visit year, higher odds of strangulation were noted in younger women, metropolitan hospitals, level I/II trauma centers, and non-Northeast regions. Increases in strangulation events among intimate partner violence-related visits in recent years were also observed., Discussion: A relatively low prevalence may reflect an underestimate of true nonfatal intimate partner strangulation visits owing to coding or a very low rate of ED visits for this issue. Higher odds of strangulation among intimate partner violence visits by women in more recent years may be due to increased recognition and documentation by frontline clinicians and coding teams. Continued research is needed to further inform clinical, postcare, and social policy efforts., (Copyright © 2021 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: There is growing awareness internationally around the prevalence and dangerousness of non-fatal strangulation (NFS). The aim of this study was to: (i) identify the prevalence of NFS in patients presenting to the Saint Mary's Sexual Assault Referral Centre (SARC), Manchester, UK for an acute forensic medical examination (FME) after a report of rape or sexual assault, (ii) explore the characteristics of patients reporting NFS compared to those who did not and (iii) explore the prevalence of various symptoms and signs associated with NFS., Method: Data from case files of all patients attending in a three year period, January 1, 2017 to December 31, 2019, were analysed. There was not any age or gender related exclusion criteria. In the NFS cases the Saint Mary's SARC NFS pro-forma used as part of the contemporaneous medical notes was also reviewed., Results: A total of 2196 adults (≥18 years old) attended Saint Mary's SARC for an acute FME during the three year study period. This comprised 1994 (90.7%) non-NFS cases and 204 (9.28%) NFS cases. The prevalence of NFS was 18.9% where the alleged perpetrator was a partner or ex-partner. For NFS cases, 96.6% (n = 197) of the patients were female and the alleged perpetrator was male in 98% (n = 200) of the NFS cases. 40% of the NFS cases had been strangled in their own homes and in 33% of cases children lived in that home. In 27% (n = 55) of the NFS cases the patient said that the alleged perpetrator had also strangled them on a previous occasion. 46.6% had an injury to the neck or above attributable to the NFS. 15.7% (n = 32) of the NFS cases reported loss of consciousness, 8.8% (n = 18) were incontinent of urine and 2% (n = 4) incontinent of faeces as a result of the NFS. Over a third of the patients (36.6%) thought that they were going to die during the NFS., Conclusion: The study shows that NFS in sexual assault is a gendered crime, with most victims female and most assailants male. NFS is prevalent and this prevalence increases where the alleged perpetrator is a partner or ex-partner. Many are assaulted in their own homes, homes frequently shared with children. Visible NFS injuries are not the norm yet fear of death is not uncommon. Over 1 in 6 (15.7%) reported loss of consciousness suggesting that they were victims of a near lethal assault. That 27% had previously been a victim of NFS by the same alleged perpetrator indicates that there are considerable numbers potentially living in fear and at risk. Awareness of the risk of NFS, and an enhanced response to it, is required by those looking after victims and all those in the criminal justice system., (Copyright © 2021 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Objective: Few studies have addressed the unintentional suffocation of infants in China. This study is to assess the mortality rate of unintentional suffocation among infants and the differences across age groups, gender, rural versus urban locations and related healthcare services., Design: A cross-sectional study on unintentional suffocation death of infants under 1 year of age in Hunan Province from 2009 to 2018., Setting: Hunan Province, with a population of 74 million, has an area of 210 000 square kilometres and 123 counties/districts., Participants: The total data of 4109 unintentional suffocation deaths of infants in Hunan Province from 2009 to 2018 was collected, including 2331 boys, 1766 girls, 12 infants of unknown gender, 2906 rural children and 1203 urban children., Main Outcome Measure: The unintentional suffocation mortality rate of infants is defined as the number of unintentional suffocation deaths of children under 1 year of age per 100 000 live births in the same year., Results: The infant mortality rate showed a downward trend from 2009 to 2018. Infant unintentional suffocation death decreased first and then fluctuated. The proportion of unintentional suffocation death to infant death showed an upward trend in fluctuation. Boys and rural children had higher mortality rates than those of girls and urban children. A total of 43.5% of the deaths occurred in winter. Forty-eight per cent of the unintentional suffocations were infants between 1 and 4 months of age. A total of 46.4% of the deaths occurred at home, and 71.6% were not treated; approximately 81.8% of the untreated cases were mainly due to a lack of time to get to the hospital. A total of 65.2% of the deaths were diagnosed postmortem., Conclusion: The mortality rate of unintentional suffocation among infants in Hunan Province should attract the attention of the population, and measures should be taken according to epidemiological investigations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We aimed to examine the impact of a daily pro-inflammatory diet during pregnancy on intrapartum fetal acidemia using a large birth cohort study in Japan. We used data on singleton pregnancies in the Japan Environment and Children's Study (JECS) involving births from 2011 to 2014 through vaginal delivery to calculate the maternal dietary inflammatory index (DII). Participants were categorized according to DII quintiles. A multiple logistic regression model was used to estimate the risk of a pro-inflammatory diet on fetal umbilical artery pH. In total, 56,490 participants were eligible for this study. Multiple regression analysis showed that nulliparous women who had undergone vaginal delivery and were consuming a pro-inflammatory diet had an increased risk of pH < 7.10 (adjusted odds ratio [aOR]: 1.64, 95% confidence interval [CI]: 1.12-2.39). Among these women, the risk of pH < 7.10 was not affected by the duration of labor (aOR: 1.64, 95% CI: 1.11-2.42). In conclusion, following a pro-inflammatory diet during pregnancy is a risk factor for fetal acidosis among nulliparous women undergoing vaginal delivery. A high DII diet during pregnancy may modify the intrapartum fetal heart rate pattern via intrauterine inflammation.

Objective: To characterize the epidemiology of unintentional asphyxias in Mexico from 1999 to 2017., Method: Secondary analysis of vital registries, three national health surveys and information from the safety inspection program of the Ministry of Health in Mexico were used to characterize fatal and non-fatal drownings (ICD-10: W65-W74) and other asphyxias including suffocation, chocking and strangulation (ICD-10: W75-W84), and to estimate the level of exposure to different risk factors within households and daycares., Results: 100,834 deaths were registered, 44.66% were drowning and 77.17% male. Drownings mainly affect children and adolescents, occur in April, July and August, on Sundays, during the afternoon. Other asphyxias affect children and the elderly more frequently, occur mainly from December to February, on Sundays and from 4 to 6h. According to ENSANut-2012, 53,065 individuals experience a non-fatal asphyxia per year, 26.21% of them with permanent consequences in their health and wellbeing. Important risks of unintentional asphyxias are present in 38% of daycares and 80% of households analyzed., Conclusions: Unintentional asphyxias are a major public health problem that needs to be urgently attended to achieve the Sustainable Development Goals, in particular the 3.2. Evidence presented in this work constitutes an input to inform and orient efforts directed to tackle this problem., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

National injury hospitalization statistics are essential for understanding the burden and pattern of injuries. This paper used the Discharge Abstract Database to analyse injury hospitalizations in Canada (excluding Quebec) for fiscal year 2018/19. The results show that unintentional injuries were the eighth leading cause of hospitalization compared to all other diseases and conditions. For unintentional injury-related hospitalizations, in rank order, the leading causes were falls, suffocation, motor vehicle traffic crashes, poisonings, struck by/against, and fire/hot object/smoke. However, the rankings were different across age groups., Competing Interests: All authors declare no conflicts of interest.

Background: To investigate the occurrence frequency, changing trends, and epidemiological distribution of unintentional suffocation in children under 5 years old., Methods: The data were collected from the Maternal and Child Health Surveillance system from 2009 to 2018. The cause of death was classified by ICD-10. Data on unintentional suffocation death were calculated according to the characteristics of the population, time, space, cause of death and medical treatment, and constituent ratio were calculated., Results: The mortality rate of children under 5 years old showed a downward trend, but the mortality of unintentional suffocation initially decreased and then increased. The death rate of unintentional suffocation in children less than 1-year-old was much higher than that in children aged 1 to 4 years old. The death rate of unintentional suffocation was higher in boys than in girls, and the rate was higher for rural children than for urban children. The number of low-weight and pre-term infants in the group under 1-year-old was significantly higher than that in the group of 1-4 years old. Children under 1-year-old are more likely to die at home than children aged 1 to 4 years old, and a higher proportion of younger children did not receive treatment. More than 80% of children under the age of 5 go untreated because it was too late to go to the hospital., Conclusion: For areas and populations with a high incidence of unintentional suffocation, we suggest that priorities should include prevention, the development of a safe environment, strengthened prevention, the development of safety habits, and the popularization of first aid knowledge.

Objectives: Assault by strangulation has the potential for severe brain injury or death. The objectives of this study were to describe the profile of individuals who had strangulation-related emergency department (ED) or acute care visits, and to explore 1-year readmission outcomes among survivors., Methods: A population-based retrospective cohort study was conducted using health administrative data in Ontario, Canada. Adults aged 15 years and older who were seen in the ED or acute care with assault by strangulation between fiscal years 2002/2003 and 2016/2017 were included in the study. Bivariate analyses were conducted to compare the patient profile and subsequent readmissions within 1 year of discharge, stratified by sex., Results: A total of 586 patients were included in the study. The majority of these patients were seen in the ED (93%), predominantly female (70%), aged ≤ 39 years (68%), and of lower income quintiles of ≤ 3 (73%). Of the 579 patients who survived the initial admission, 52% had subsequent ED readmission and 21% had acute care readmission within 1 year. In sex-stratified analyses, a higher proportion of females were between 20 to 39 years (58.7% vs. 44.1%, p = 0.001), discharged home (88% vs. 81%, p < 0.001), and had ED readmission within 1 year of discharge (56% vs. 17%, p = 0.002). Males had comparatively higher 1-year acute care readmissions., Conclusion: The study shows high readmissions with sex differences among individuals with an assault by strangulation, suggesting sex-specific approach to health care practices to support the needs of this vulnerable population, thus reducing health system inefficiencies.

Objective: To review domestic and family violence (DFV) and non-lethal strangulation (NLS) presentations to an ED with 24-h social work., Methods: Retrospective cohort study of 12 months of DFV presentations comparing demographics, perpetrator relationship, social work review, injuries and NLS incidence and assessment., Results: Women represent 90% of DFV presentations. In 26% of DFV presentations NLS was identified, with 47.5% clinically assessed appropriately. Social work did not review 34% of DFV presentations, 64% due to no referral., Conclusions: Social work referral for DFV is regularly missed despite 24-h access. Assessment of NLS in ED requires improvement and standardised national guidelines., (© 2020 Australasian College for Emergency Medicine.)

Purpose: To identify factors for choking in psychiatric wards that can be easily screened., Design and Methods: Data were collected from patients admitted to the acute phase psychiatric wards who were assessed for swallowing function by dentists. We defined 47 and 102 patients of choking in the high- and low-risk groups, respectively., Findings: Through multivariate analysis, we identified basal metabolic index and two Drug-induced Extra-pyramidal Symptoms Scale items, bradykinesia and tremor, as independent choking factors., Practice Implications: Choking risk is related to patient tolerability rather than to the absolute severity of psychiatric symptoms or psychotropic dose., (© 2020 Wiley Periodicals, Inc.)

Background: Unintentional injury, a leading cause of morbidity among adolescents, may also be a risk factor for deliberate self-harm. To inform clinical and public health prevention efforts in adolescent populations, we examined whether distinct subtypes of unintentional injury were differentially associated with deliberate self-harm., Methods: Statewide, all-payer, individually linkable administrative data on adolescent patients presenting to any California emergency department (ED) in 2010 (n = 490,071) were used to investigate longitudinal associations between subtypes of unintentional injury and deliberate self-harm. Adolescents aged 10-19 years presenting with unintentional drug poisoning, other poisoning, fall, suffocation, or cutting/piercing injuries formed the exposure groups; adolescents presenting with unintentional strike injuries formed the primary referent group. Study patients were followed back in time (2006-2009) to compare the groups' odds of a prior ED visit for deliberate self-harm, as well as forwards in time (2010-2015) to compare their risks of subsequent self-harm., Results: Unintentional drug-poisoning injury was strongly associated with increased likelihood of ED visits for deliberate self-harm, assessed both retrospectively (adjusted OR = 4.52; 95% confidence interval [CI] = 3.08, 6.64) and prospectively (adjusted RR = 3.74; 95% CI = 3.03, 4.60). Positive associations with odds of prior self-harm and/or risk of subsequent self-harm were also observed for patients with unintentional non-drug poisoning, suffocation, and cutting/piercing injuries., Conclusions: Certain subtypes of unintentional injury, particularly drug poisoning, are strongly associated with risk for deliberate self-harm among adolescents, a finding with implications for targeting clinical assessment and intervention in emergency department settings. More research is needed to understand the mechanisms underlying these associations., Competing Interests: Declaration of competing interest The authors report no potential conflicts of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Hanging is a common form of self-harm, and emergency care physicians will not infrequently be called upon to manage a survivor.Despite the relative frequency of the injury, there is a paucity of literature on the topic and the spectrum and incidence of associated injuries are poorly described., Objectives: To review experience with management of victims of hanging at a major trauma centre in South Africa., Methods: All patients treated by the Pietermaritzburg Metropolitan Trauma Service following a hanging incident between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry. Basic demographics were recorded, and the management and outcome of each patient were noted., Results: During the 6-year period under review, a total of 154 patients were seen following a hanging incident. The mean age was 29.4 years. There were 24 females (15.6%) and 130 males (84.4%). The vast majority (n=150; 97.5%) had attempted suicide, and only 4 hangings (2.5%) were accidental. A total of 92 patients (60.9%) had consumed alcohol prior to the incident. There were 23 patients with a Glasgow Coma Score (GCS) &lt;9 (severe traumatic brain injury (TBI)), 14 with a GCS of 9 - 12 (moderate TBI) and 117 with a GCS &gt;12 (mild TBI). A total of 7 patients (4.5%) required intensive care unit admission, and 25 (16.2%) required intubation. The following extracranial injuries were documented on computed tomography scans: hyoid bone fractures (n=2), cervical spine fracture (n=10), mandible fracture (n=4) and oesophageal injury (n=1). Intracranial pathology was evident on 27.0% of scans, with the most common finding being global cerebral ischaemia. The mortality rate was 2.5% (4/154)., Conclusions: Hanging is a common mechanism of self-harm. It is associated with significant injuries and mortality. The acute management of hanging should focus on airway protection followed by detailed imaging of the head and neck. Further work must attempt to include mortuary data on hanging.

Objectives: To describe infant deaths where a u-shaped pillow was under or around an infant and to describe cases classified as Explained Suffocation., Methods: We examined demographics and circumstances of 141 infant deaths during 2004-2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment., Results: Most infants were < 6 months old (92%), male (58%), non-Hispanic White (53%), and of the nine explained suffocation deaths, four occurred when the u-shaped pillow obstructed the infant's airway; five occurred when the infant rolled off the pillow and their airway was obstructed by another object., Conclusions for Practice: Although infrequent, infant deaths with u-shaped pillows have occurred. Health care providers may include discussion of the importance of caregivers following infant product packaging precautions and warning labels for commonly used consumer products, such as u-shaped pillows in their advice to caregivers.

Objective: Compare mothers' reports of injuries for infants and toddlers sleeping with crib-bumpers/mesh-liners/no-barriers and reasons for these sleep environment choices., Methods: A cross-sectional survey of mothers subscribing to a parenting magazine and using crib bumpers (n = 224), mesh liners (n = 262), and no barriers (n = 842). Analyses of four possible injuries (face-covered, climb-out/fall, slat-entrapment, hit-head) including multivariate logistic regression adjusted for missing data/demographics and Chi squared analyses of reasons for mothers' choices., Results: Maternal reports of finding infants/toddlers with face covered had 3.5 times higher adjusted odds (aOR) for crib bumper versus mesh liner use. Breathing difficulties and wedgings were reported for infants/toddlers using crib bumpers but not mesh liners. Climb-outs/falls showed no significant difference in aORs for crib bumpers versus no-barriers and mesh liners versus no barriers. Reports of slat-entrapment were less likely for mothers using crib bumpers and mesh liners than using no barrier (aOR = .28 and .32). Reports of hit-heads were less likely for crib bumpers vs no barrier (aOR = .38) with no significant difference between mesh liners versus no barrier use. Mothers using crib bumpers and mesh liners felt their choice prevented slat-entrapment (89%, 91%); 93.5% of crib bumper users felt their choice prevented hit-heads. Significantly more mesh liner than crib bumper users chose them because "There is no suffocation risk" (64.1% vs. 40.6%), while 83.6% of no-barrier users chose them because "I was concerned about suffocation risk.", Conclusions for Practice: Mothers appeared to be more concerned about preventing minor risks than suffocation. Understanding reasons for mothers' use of barriers/no-barriers is important in tailoring counseling for mothers with infants/toddlers.

Background: The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh., Methods: We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)., Findings: In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04-5.38, p < .001 and in phase 2: 15.20 CI: 6.36-36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother's education, husband's education, and fetal sex., Conclusion: The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh., Trial Registration: ClinicalTrials.gov NCT03509103., Competing Interests: The authors have declared that no competing interests exist.

The absence of studies that investigate the causes and risk factors of nonfatal occupational injury in Tunisia inhibits the development of effective preventive strategies. The objective of this study was to identify the causes and risk factors of nonfatal occupational injury in the private sector in Tunisia. We used retrospective data derived from the occupational injury reporting forms submitted to the Caisse Nationale d'Assurance Maladie. A sample of 42,293 workers in the private sector for 2014 contains information on sociodemographic variables. Multivariable Poisson regression was used to investigate the association of cause-specific injury with demographic variables. The leading causes of nonfatal occupational injury were "falls" (employee fall and falling objects; 36%) and "struck by objects" (23%). Male employees were at higher risk of "exposure to extreme temperatures" (PR = 12 [7-45]), "asphyxia and poisoning" (PR = 4 [2.4-12]), "transport and handling" (PR = 2.4 [1.9-5]), "falling objects" (PR = 2.3 [1.4-3.7]), and "employee fall" (PR = 1.2 [1.1-1.5]). Although, rural areas were at higher risk to "asphyxia and poisoning" (PR = 3.6 [1.1-11.4]), "transport and handling" (PR = 2.5 [1.3-5.4]), and "burns" (PR = 1.3 [1.1-3]). It is important that effective interventions be developed to minimize the impact of falls and "struck by objects." The most vulnerable categories to occupational injury are less educated men, rural residents aged between 15 years and 24 years, and elderly employees (55 years and over). Thus, our findings can contribute to the planning of prevention intervention programs that should expand to the most vulnerable categories.

Non-fatal strangulation (NFS) can be a cause of severe injury. However, the prevalence and rates of injuries from NFS are unknown, as few victims present to medical attention after strangulation. As up to 40% of fatal strangulations have no external signs, and the majority of surviving victims have few or minor injuries, finding those people severely injured remains challenging. The majority of the evidence regarding NFS is largely based on case reports and case series with no robust studies estimating rates of injuries or the best investigation tools. The injuries that are reported make clear that strangulation is a potentially lethal form of injury that should not be ignored in those presenting having been strangled, or in those presenting with neurological symptoms, including strokes, seizures and vascular abnormalities. The safety implications of strangulation are also important as it can be a prelude to homicide. A search of the literature was carried out with the following terms: Nonfatal strangulation (10), Nonfatal strangulation (17), 'Strangulation injuries' (19), 'Manual strangulation' (92) - laboratory testing eliminated, and 'choking game'. The PubMed database was used first, followed by the collections of Monash University and the Strangulation Institute (as some articles were too old to find electronically). This article summarises the injuries that can occur following strangulation and discusses the quality of the evidence thus far., (© 2019 Australasian College for Emergency Medicine.)

Introduction: Understanding patterns of avalanche fatalities can aid prevention and rescue strategies. In 2007, we published a report reviewing avalanche deaths in Utah between the 1989-1990 and 2005-2006 winter seasons. In the current report, we discuss Utah avalanche fatalities from the 2006-2007 to 2017-2018 seasons., Methods: Avalanche fatality data were obtained from the Utah Avalanche Center and Utah State Office of the Medical Examiner. Autopsy reports were reviewed to determine demographic information, type of autopsy (external vs internal), injuries, and cause of death., Results: Thirty-two avalanche deaths occurred in Utah during the study period. The mean (±SD) age of victims was 32±13 (8-54) y. Thirty victims (94%) were male and 2 (6%) were female. Seventy-two percent of deaths were from asphyxiation, 19% from trauma alone, and 9% from a combination of asphyxiation and trauma. Snowmobilers accounted for the largest percentage of avalanche fatalities (15 victims; 47%) during the 2007-2018 period., Conclusions: Asphyxia continues to be the most prevalent killer in avalanche burial. Patterns of ongoing avalanche deaths continue to suggest that rapid recovery and techniques that prolong survival while buried may decrease fatality rates. Trauma is a significant factor in many avalanche fatalities. Education and technologies focused on reducing traumatic injuries such as improved education in techniques for avalanche risk avoidance and/or use of avalanche airbags may further decrease fatality rates. Snowmobilers represent an increasing percentage of Utah avalanche deaths and now make up the majority of victims; increased education targeting this demographic in the basics of avalanche rescue gear and avalanche rescue may also reduce fatalities., (Copyright © 2019 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Background: Unintentional suffocation is the leading cause of injury death among infants <1 year old in the United States, with 82% being attributable to accidental suffocation and strangulation in bed. Understanding the circumstances surrounding these deaths may inform prevention strategies., Methods: We analyzed data from the population-based Sudden Unexpected Infant Death Case Registry from 2011 to 2014. Cases categorized as explained suffocation with unsafe sleep factors (suffocation), per the Centers for Disease Control and Prevention's Sudden Unexpected Infant Death Case Registry classification system, were included and assigned a mechanism of obstruction, including soft bedding, overlay, or wedging. We calculated frequencies and percentages of suffocation deaths by mechanism and selected demographic and sleep-environment characteristics., Results: Fourteen percent of sudden unexpected infant death cases were classified as suffocation; these cases were most frequently attributed to soft bedding (69%), followed by overlay (19%) and wedging (12%). Median age at death in months varied by mechanism: 3 for soft bedding, 2 for overlay, and 6 for wedging. Soft-bedding deaths occurred most often in an adult bed (49%), in a prone position (82%), and with a blanket (or blankets) obstructing the airway (34%). Overlay deaths occurred most often in an adult bed (71%), and infants were overlaid by the mother (47%). Wedging deaths occurred most often when the infant became entrapped between a mattress and a wall (48%)., Conclusions: Safe sleep environments can reduce infant suffocation deaths. Increased knowledge about the characteristics of suffocation deaths can help inform prevention strategies by targeting highest-risk groups., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

According to the World Health Organization's World Report, approx. 950,000 children and young people < 18 years old die from an injury each year, and unintentional injury deaths account for a large portion of these cases. Here we used medico-legal documents to epidemiologically analyze the cases of unintentional injury deaths among children < 5 years old in Okayama Prefecture, Japan from 2001 to 2015. Age, sex, manner/cause of death, and various circumstances of the incident were investigated. There were 73 unintentional injury deaths during the study period. Drowning (n=29), suffocation (n=24), and transport accidents (n=13) were the major categories of unintentional injury deaths. Twenty-two cases (30.1%) were autopsied. Differences in the characteristics of the unintentional injury deaths by age were observed. Information which cannot be obtained from Vital Statistics was available from medico-legal documents, and detailed characteristics of unintentional injury deaths among children < 5 years old were elucidated. Investigating medico-legal information is one of the meaningful measures for the prevention of unintentional injury deaths among children in Japan., Competing Interests: No potential conflict of interest relevant to this article was reported.