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Traffic and drowning incidents with emphasis on the presence of alcohol and drugs
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
2014 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine.

In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II).

We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively. 

In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention. 

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet , 2014. , s. 62
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1662
Nyckelord [en]
Traffic incidents, drivers, passenger, drowning, alochol, pharmaceuptical, illicit drugs, suicidal drowning, mental disorder
Nationell ämneskategori
Rättsmedicin
Forskningsämne
rättsmedicin
Identifikatorer
URN: urn:nbn:se:umu:diva-91526ISBN: 978-91-7601-095-2 (tryckt)OAI: oai:DiVA.org:umu-91526DiVA, id: diva2:736895
Disputation
2014-09-19, Hörsal D, Unod T9, Norrlands Universitetssjukhus, Umeå, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2014-08-29 Skapad: 2014-08-11 Senast uppdaterad: 2018-06-07Bibliografiskt granskad
Delarbeten
1. Driver's alcohol and passenger's death in motor vehicle crashes
Öppna denna publikation i ny flik eller fönster >>Driver's alcohol and passenger's death in motor vehicle crashes
2006 (Engelska)Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 7, nr 3, s. 219-223Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's 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.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2006
Nyckelord
Accidents; Traffic/*mortality, Adolescent, Adult, Age Distribution, Aged, Aged; 80 and over, Alcohol Drinking/*mortality, Alcoholic Intoxication/*mortality, Breath Tests, Central Nervous System Depressants/*analysis, Child, Child; Preschool, Ethanol/*analysis, Female, Humans, Infant, Infant; Newborn, Male, Middle Aged, Sweden/epidemiology
Nationell ämneskategori
Rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-12801 (URN)10.1080/15389580600727846 (DOI)16990235 (PubMedID)
Tillgänglig från: 2008-01-08 Skapad: 2008-01-08 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
2. Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden
Öppna denna publikation i ny flik eller fönster >>Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden
2009 (Engelska)Ingår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 41, nr 1, s. 129-136Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.

Ort, förlag, år, upplaga, sidor
Elsevier, 2009
Nyckelord
Driver; Alcohol; Drugs; Road traffic; Injury
Nationell ämneskategori
Rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-22359 (URN)10.1016/j.aap.2008.10.002 (DOI)19114147 (PubMedID)
Tillgänglig från: 2009-05-06 Skapad: 2009-05-06 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
3. Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-2009
Öppna denna publikation i ny flik eller fönster >>Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-2009
2013 (Engelska)Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, s. 216-Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.

Methods: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.

Results: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (<= 18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688/4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.

Conclusion: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2013
Nyckelord
Alcohol, Drowning, Illicit drugs, Pharmaceutical drugs, Suicide
Nationell ämneskategori
Beroendelära Rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-70348 (URN)10.1186/1471-2458-13-216 (DOI)000317115800002 ()23497055 (PubMedID)
Tillgänglig från: 2013-06-27 Skapad: 2013-05-14 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
4. Suicidal drowning deaths in Northern Sweden 1992-2009
Öppna denna publikation i ny flik eller fönster >>Suicidal drowning deaths in Northern Sweden 1992-2009
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-91519 (URN)
Anmärkning

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Tillgänglig från: 2014-08-11 Skapad: 2014-08-11 Senast uppdaterad: 2018-06-07Bibliografiskt granskad

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