Antonina Eriksson

Passenger car collision fatalities - with special emphasis on collisions with heavy vehicles

Between 1995 and 2004, 293 passenger car occupants died in collisions with other vehicles in northern Sweden (annual incidence: 3.3 per 100,000 inhabitants, 6.9 per 100,000 cars, or 4.8 per 10(9)km driven); half of these deaths involved heavy vehicles. The annual number of passenger car occupant deaths per 100,000 cars in car-truck/bus collisions has remained unchanged since the 1980s, but in car-car collisions it has decreased to one third of its former level. As crash objects, trucks and buses killed five times as many car occupants per truck/bus kilometer driven as did cars. The collisions were characterized by crashes in the oncoming vehicles lane, under icy, snowy, or wet conditions; crashes into heavy vehicles generally occurred in daylight, on workdays, in winter, and on 90 and 70 km/h two-lane roads. Head and chest injuries accounted for most of the fatal injuries. Multiple fatal injuries and critical and deadly head injuries characterized the deaths in collisions with heavy vehicles. An indication of suicide was present in 4% of the deaths; for those who crashed into trucks, this percentage was doubled. Among the driver victims, 4% had blood alcohol levels above the legal limit of 0.2g/L. Frontal collision risks might be reduced by a mid-barrier, by building less injurious fronts on trucks and buses, by efficient skid prevention, and by use of flexible speed limits varying with road and light conditions.

Gamma-aminobutyric acid-B (GABAB) binding sites in postmortem suicide brains

Gamma-aminobutyric acid-B (GABAB) binding sites labelled with [3H]GABA were determined in postmortem frontal cortex samples of 20 control subjects and 16 suicides. The suicide group was further subdivided according to the method of suicide and the existence of depressive symptoms prior to death. No significant differences in GABAB binding were found either between overall suicide and control groups or between the control group and the other subgroups (violent suicide, nonviolent suicide, nondepressed and depressed suicide victims). A significant increase in GABAB binding was observed in those individuals dying from carbon monoxide poisoning. It is concluded that although GABAB binding sites are not altered in our suicide group, a presynaptic dysfunction might account for the increased GABAB binding found in the carbon monoxide subgroup.

Collisions with passenger cars and moose, Sweden.

The number of collisions between motor vehicles and moose is increasing in many countries. Collisions with large, high animals such as moose cause typical rear- and downward deformation of the windshield pillars and front roof, most pronounced for small passenger cars; the injury risk increases with the deformation of the car. A strengthening of the windshield pillars and front roof and the use of antilacerative windshields would reduce the injury risk to car occupants.

Unnatural deaths in reindeer-herding Sami families in Sweden, 1961-2001

Objectives. Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population. To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families. Study design. The number of deaths from among a cohort of 7,482 members of reindeer-herding Sami families were retrieved from the National Board of Health and Welfare for the years 1961– 2001. Methods. An evaluation of the information from autopsy records at the National Board of Forensic Medicine, police reports, and available medical records identified 158 unnatural deaths. These were then analysed in detail. Results. Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an “outdoor lifestyle” and the working conditions were characterized by the use of off-road vehicles such as snowmobiles. Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims. Conclusions. The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.

Accidental deaths caused by electricity in Sweden, 1975-2000.

ABSTRACT: This study analyzes accidental fatalities caused by electricity—at work and during leisure time—to evaluate risk factors, the role of alcohol, and to identify possible preventive strategies. In Sweden, data on fatalities by electrocution from 1975 through 2000 were collected from the National Cause‐of‐Death Register. Additional cases were found in the archives of The Swedish National Electrical Safety Board. Suicides and deaths by lightning were excluded. Two hundred and eighty‐five deaths were found, including occupational (n=132), leisure time (n=151), and unknown (n=2). Most deaths were caused by aerial power lines, and the most common place for an electrical injury was a railway area or residential property. Postmortem blood from 20% (n=47) of the tested cases was found positive for alcohol, and these persons were killed mainly during leisure time. During the study period, the overall incidence of electricity‐related fatalities has decreased, in spite of increased use of electricity. This indicates that safety improvements have been successful.

Human fatalities caused by wasp and bee stings in Sweden

SummaryBee and wasp stings represent an uncommon cause of death. In a retrospective study of all fatalities due to venomous animals in Sweden during a 10-yearperiod, we found 19 fatalities due to wasps, 1 due to bees but none due to snake bite. This gives an annual incidence of 0.2 per million inhabitants. Most of the deceased were older than 50 years and had an underlying cardiovascular disease while previous severe reactions after insect stings were uncommon. The number of stings was not a factor of importance. Symptoms and death occurred within minutes after the sting. The autopsy findings were in most cases non-specific. Although uncommon, the possibility of a fatal insect sting should be considered in unwitnessed deaths occurring outdoors in summertime.ZusammenfassungStiche durch Bienen und Wespen stellen eine ungewöhnliche Todesursache dar. In einer Retrospektivstudie über sämtliche tödlich verlaufende Unglücksfälle durch giftige Tiere in Schweden über einen 10-Jahreszeitraum fanden wir 19 Todesfälle durch Wespen, einen durch Bienen, jedoch keinen durch Schlangenbiß. Dieses ergibt eine jährliche Häufigkeit von 0,2 auf eine Million Einwohner. Die meisten der Verstorbenen waren älter als 50 Jahre und hatten als Grundkrankheit eine Erkrankung des kardiovaskulären Systems, während vorhergehende schwere Reaktionen nach Insektenstichen ungewöhnlich waren. Die Zahl der Stiche war kein bedeutender Faktor. Die Symptome und der Tod traten innerhalb von Minuten nach dem Stich ein. Die Obduktionsbefunde waren in den meisten Fällen unspezifisch. Wenn dies auch ungewöhnlich ist, so sollte die Möglichkeit eines tödlichen Insektenstiches bei Todesfällen außerhalb des Hauses und in der Sommerzeit, welche sich unbeobachtet ereigneten, in Betracht gezogen werden.

Fatal snowmobile accidents in northern Sweden

The number of snowmobiles registered in Sweden has increased rapidly in recent years. At the same time, there has been a proportional increase in the number of snowmobile accidents. In the present study all the 36 fatal accidents reported in northern Sweden in the period 1 July 1973 to 1 July 1981 have been scrutinized. Most of the fatalities were men, two thirds of them between 20 and 40 years of age. Most of the accidents occurred at weekends and during holidays, especially in the spring, when the traffic is heaviest. About two thirds of the fatal accidents occurred at night. Drowning and lacerations of the thorax and the head were the most common causes of death. Twenty-four of the 30 drivers killed were found to have been driving under the influence of alcohol. This suggests that alcohol was a major contributing factor to the accidents. Retrospective analyses of police, social, and medical records revealed that a high proportion of the deceased were habitual excessive drinkers. Preventive measures designed to reduce alcohol consumption while driving snowmobiles seem to be needed.

Driver's Alcohol and Passenger's Death in Motor Vehicle Crashes

Objective. Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passengers view is not well known. This study (1) analyzes the relationship between passengers death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated. Method. The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests. Results. One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers. Conclusions. The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.

Violent deaths in small children in northern Sweden.

Abstract Objectives. To identify causes and trends of violent deaths among children younger than 4 years in a northern region. Study design. Retrospective analysis of medico-legal autopsy and police data. Methods. Data from all 72 deaths from “external causes” 1977–2004, in children < 4 years from the northern half of Sweden were analysed. Results. The death rate was 7.1 per 100,000 children and year during the first half of the study period, and 5.2 during the second half. Vehicle-and drowning-related deaths were halved. Fifteen were struck by motor vehicles (in 8 cases by heavy vehicles), 14 car occupants were killed in car crashes, 12 were killed by intentional violence inflicted by an adult, and 9 each were killed by (i) carbon monoxide/smoke inhalation, (ii) asphyxiation, or (iii) drowning. The boy:girl ratio was 1:1 in all groups, except in the groups “drowning” and “run over by motor vehicle”, where boys dominated. Conclusions. Medical professionals have a difficult but important task in identifying and taking action against child abuse and in promoting child safety especially in the traffic and home environments.

The costs of a bullet - inpatient costs of firearm injuries in South Africa

To the Editor: South Africa has a reputation for being a violent society, with non-natural causes of death estimated to account for up to 30% of all deaths. Among these, firearm injuries are a common cause of mortality. In addition, about 127 000 individuals are treated at South African state hospitals each year for non-fatal firearm injuries. A previous study examined the cost of treating serious abdominal gunshot wounds in a district hospital and showed that each bullet cost taxpayers the equivalent of US