Thomas Wakley and the medical coronership--occupational death and the judicial process.
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Accidents, Occupational↗
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The Werther effect after television films: new evidence for an old hypothesis.
In this study it was possible to prove the Werther effect in suicides after watching fictional models for the first time. A twice-broadcast (1981, 1982) six-episode weekly serial showing the railway suicide of a 19-year-old male student provided a quasi-experimental ABABA design to investigate differential effects of suicide imitation. Imitation effects were most clearly observable in the groups whose age and sex were closet to those of the model. Over extended periods (up to 70 days after the first episode), the number of railway suicides increased most sharply among 15- to 19-year-old males (up to 175%); the effect steadily decreased in the older age groups, so that no effect was observable for males over 40 years and females over 30 years. Also, the imitation effects remained detectable for longer periods in the groups closest in age to the model. The increases observed after the first and second broadcast for males aged less than 30 years closely corresponded with the respective audience figures for the two showings.
Adolescent↗
Railway suicide: the psychological effects on drivers.
People have jumped (or fallen) in front of trains on the London Underground system in increasing numbers throughout the twentieth century. During the past decade there have been about 100 such incidents each year, of which around 90 would involve the train driver witnessing his train strike the person on the track. Most are suicides or attempts at suicide. They represent major unexpected and violent events in the lives of the train drivers and it might be expected that some of them would respond by developing a post-traumatic stress reaction of the type identified by Horowitz (1976) or other adverse psychological reactions or both. The research reported in this paper was designed to characterize the range of responses of drivers to the experiences of killing or injuring members of the public during the course of their daily work. It was found that 16.3% of the drivers involved in incidents did develop post-traumatic stress disorder and that other diagnoses, e.g. depression and phobic states, were present in 39.5% of drivers when interviewed one month after the incident.
Adult↗
Psychiatric aspects of railway fatalities.
National statistics for railway fatalities in England and Wales show a reduction of train crashes and a fluctuating level of deaths, of which an increasing proportion is from suicide. A closer examination of a two-year sample from the South of England revealed a large proportion of probable suicides and a small proportion of pure accidents. The remainder appeared to have medical, mainly psychiatric, contributions to their death, of which alcohol was an important factor in single young men. Rail suicides appear to be younger, the men less often married, the women more often married, and both sexes less often widowed than other suicides. They included more cases of major psychosis and neurosis, but fewer and less severe alcoholics. Characteristic patterns of this method of suicide are described with examples. Hypotheses to explain the choice of method suggest that it is not related to either volume of traffic, or residence in a rail-dense area or in an area with a high suicide rate, or the proximity of a psychiatric hospital.
Accidents↗
Mite fauna of dust from passenger trains in Glasgow.
The mite fauna of dust from cloth-covered seats of four passenger trains and bedding from a British Rail linen store in Glasgow was investigated; 22 samples containing 4488 mg of dust from a total surface area of 5.5 m2 were taken. Sixteen samples were positive for mites and 33 specimens belonging to 10 species were found. The most common species were Dermatophagoides pteronyssinus (Trouessart), Glycyphagus domesticus (De Geer), G. destructor (Schrank) and Euroglyphus maynei (Cooreman). The species composition bore considerable resemblance to that of house dust (although the density of mites was far lower) and the mites have probably been transported from homes via clothing and pets. Only five intact specimens, which may have been alive at the time of sampling, were found. The dust from trains consisted mostly of particles of soot. Very few skin scales, the food source of house dust mites, were detected. The small numbers of intact mites found and the absence of an identifiable food source make it unlikely that permanent populations of mites survive in upholstered seats on trains.
Animals↗
Effects on local emergency departments of large-scale urban chemical fire with hazardous materials spill.
INTRODUCTION: On 18 July 2001, a train hauling hazardous materials, including hydrochloric acid, hydrofluoric acid, and acetic acid, derailed in the city of Baltimore, Maryland, resulting in a fire that burned under a downtown street for five days. Firefighters were stymied in their efforts to extinguish the fire, and the city was subjected to thick smoke for several days. OBJECTIVES: To determine whether an urban chemical fire with a hazardous materials spill resulted in a detectable public health impact, and to demographically describe the at-risk population for potential smoke and chemical exposure. METHODS: The United States Centers for Disease Control and Prevention (CDC) was consulted about possible side effects from chemical exposure. Total numbers of emergency department (ED) patients and admissions from 15:00 hours (h), 15 July 2001 to 15:00 h, 21 July 2001 were collected from five local hospitals. Patient encounters citing specified chief complaints from 15:00 h, 15 July to 15:00 h, 18 July (pre-accident) were compared with the period from 15:00 h, July 18 to 15:00 h, 21 July (post-accident). Data were analyzed using Fisher's exact test. The United States Census Bureau's Topologically Integrated Geographic Encoding and Referencing (TIGER) digital database of geographic features and ArcView Geographic Information Systems (GIS) were used to create maps of Baltimore and to identify populations at-risk using attribute census data. RESULTS: There were 62,808 people residing in the immediate, affected area. The mean of the values for age was 33.7 +/- 3.2 years (standard deviation; range = 16 yrs) with 49% (30,927) males and 51% (31,881) females. A total of 2,922 ED patient encounters were screened. Chief complaints included shortness of breath, pre-event = 109 vs. post-event = 148; chest complaints = 90 vs. 113; burns and/or skin irritation = 45 vs. 42; eye irritation 26 vs. 34; throat irritation = 33 vs. 27; and smoke exposure = 0 vs. 15. There was a statistically significant increase (p < 0.05) for shortness of breath and smoke exposure-related complaints. No statistically significant increase in numbers of admitted patients with these complaints was found. CONCLUSIONS: In the setting of a large-scale urban chemical fire, local EDs can expect a significant increase in the number of patients presenting to EDs with shortness of breath and/or smoke inhalation. Most do not require in-patient hospitalization. Careful assessment of impact on local EDs should be considered in future city-accident planning. Some official warnings were widely misinterpreted or ignored. Public education on potential hazards and disaster preparedness targeted to populations at-risk should receive a high priority. Geographic information systems (GIS) may serve as useful tools for identifying demographics of populations at-risk for disaster planning and responses.
Adolescent↗
KAMEDO report no. 79: train accident in Germany, 1998.
A train traveling at 200 kilometers per hour carrying 300 passengers crashed into a bridge. At leaset 85 doctors and 1889 persons were involved in the emergency response. A total of 101 persons were killed, 108 were injured, and 87 were transported to a hospital (27 by helicopter; 60 by land ambulance). Eighty percent of the severely injured were trasported to a hosptial within two hours of the crash. Coordination of the activities of the hoards of responders was an issue, as was the lack of a formal organization to provide psychosocial support. Preparedness plans should include management of the dead and for the provision of psychosocial support.
Accidents↗
The emergency medical response to the Cantara hazardous materials incident.
On 14 July 1991, at 2150 h, a train derailment occurred near the Cantara rail curve about six miles above Dunsmuir in Northern California. The derailment spilled approximately 19,000 gallons of metam-sodium into the Sacramento River. When mixed with water, metam-sodium degrades to methylisothiocyanate (MITC) and other gases. The contaminated river water passed the town of Dunsmuir and other occupied areas exposing residents to MITC gas. From 15 July to 20 July (five days), a total of 360 people underwent triage. The majority of patients displayed minor exposure symptoms that did not require hospital care. Mercy Mt. Shasta Hospital, a small rural hospital close to Dunsmuir, received the majority of patients. As of 29 July, 15 days after the incident, Mercy Mt. Shasta Hospital had seen 244 exposed patients in its emergency department, and had admitted five. Three had symptoms that could have been spill-related. Three Regional Poison Control Centers provided medical toxicology advice. Medical management of the emergency medical services (EMS) response to the event was piecemeal and weak. There did not appear to be a medical operations component at local Emergency Operations Centers (EOC). Most health care personnel interviewed complained about inadequate information about the substance and the situation. Local fire service mutual-aid agreements to obtain additional fire service and ambulance personnel worked well. It is important to emphasize that everyone who believed they had been exposed to the chemical underwent triage and received appropriate acute medical care.
California↗
Lessons in emergency evacuation from the Miamisburg train derailment.
Hazardous materials incidents result from the release of materials considered to be harmful or potentially harmful to human beings or the environment. This article describes a train derailment and subsequent hazardous materials release with the evacuation of approximately 50,000 citizens. The hazardous materials release took five days to control and resulted in 561 patient visits to local emergency departments for symptoms related to chemical exposure. The evacuation and emergency medical operations are described and serve as a model for developing community emergency preparedness plans and managing victims involved in hazardous materials incidents.
Accidents↗
Subway particles are more genotoxic than street particles and induce oxidative stress in cultured human lung cells.
Epidemiological studies have shown an association between airborne particles and a wide range of adverse health effects. The mechanisms behind these effects include oxidative stress and inflammation. Even though traffic gives rise to high levels of particles in the urban air, people are exposed to even higher levels in the subway. However, there is a lack of knowledge regarding how particles from different urban subenvironments differ in toxicity. The main aim of the present study was to compare the ability of particles from a subway station and a nearby very busy urban street, respectively, to damage DNA and to induce oxidative stress. Cultured human lung cells (A549) were exposed to particles, DNA damage was analyzed using single cell gel electrophoresis (the comet assay), and the ability to induce oxidative stress was measured as 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) formation in lung cell DNA. We found that the subway particles were approximately eight times more genotoxic and four times more likely to cause oxidative stress in the lung cells. When the particles, water extracts from the particles, or particles treated with the metal chelator deferoxamine mesylate were incubated with 2'-deoxyguanosine (dG) and 8-oxodG was analyzed, we found that the oxidative capacity of the subway particles was due to redox active solid metals. Furthermore, analysis of the atomic composition showed that the subway particles to a dominating degree (atomic %) consisted of iron, mainly in the form of magnetite (Fe3O4). By using electron microscopy, the interaction between the particles and the lung cells was shown. The in vitro reactivity of the subway particles in combination with the high particle levels in subway systems give cause of concern due to the high number of people that are exposed to subway particles on a daily basis. To what extent the subway particles cause health effects in humans needs to be further evaluated.
8-Hydroxy-2'-Deoxyguanosine↗
Contamination of passenger trains with Dermatophagoides (Acari: Pyroglyphidae) mite antigen in Japan.
Passenger trains were surveyed for contamination with Dermatophagoides farinae Hughes and Dermatophagoides pteronyssinus (Trouesart) mites in Japan. A total of 492 dust samples were collected from upholstered seats in six commuter trains, one long-distance express train and three night trains in October, 1996 and January, April, and July, 1997. Mite antigen levels contained in fine dust fractions of these samples were measured by an enzyme-linked immunosorbent assay. Most samples obtained from commuter trains showed relatively high mite antigen levels of > 10 microgm(-2) (corresponding to > 100 mites). Express and night trains showed lower antigen levels per square meter, but higher mite antigen levels per gram of fine dust than commuter trains, indicating relatively high mite antigen densities. Seasonal comparisons indicated that commuter trains showed the highest mean antigen level per square meter in winter (January), whereas the highest antigen level per gram of fine dust was observed in summer (July) in express and night trains.
Animals↗
Railway suicide: who is responsible?
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Cause of Death↗
Rail commuting duration and passenger stress.
Over 100 million Americans commute to work every weekday. Little is known, however, about how this aspect of work, which may indeed be the most stressful aspect of the job for some, affects human health and well-being. The authors studied a sample of 208 male and female suburban rail commuters who took the train to Manhattan, New York. The greater the duration of the commute, the larger the magnitude of salivary cortisol elevations in reference to resting baseline levels, the less the commuter's persistence on a task at the end of the commute, and the greater the levels of perceived stress. These effects were not moderated by gender. Commuting stress is an important and largely overlooked aspect of environmental health.
Adult↗
Health costs associated with the mining, transport and combustion of coal in the steam-electric industry.
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Accident Prevention↗
Childhood leukaemia and non-Hodgkin's lymphoma in relation to proximity to railways.
We investigated whether living close to railway lines is a risk factor for childhood leukaemia and non-Hodgkin's lymphoma in electoral wards in England and Wales, 1966-1987. The national rail network, 1966-1987, was digitised and the numbers of cases in each ward were related to two measures of environmental exposure to railways: a proximity and a density function, contributions to these functions being weighted by the frequency of use and time in use of each stretch of railway. Poisson regression was used to derive rate ratios in relation to these measures of exposure to railways, both unadjusted and adjusted for population mixing. We found no association between risk of leukaemia and railway proximity (unadjusted rate ratio for trend from the lowest to the median value=1.006, 95% CI: 0.998 - 1.013, P=0.14) and a very small association with railway density, of marginal statistical significance (rate ratio for trend=1.001, 95% CI: 1.000 - 1.003, P=0.05). This effect depended on two deprived, urban wards with high railway density and high population mixing and became nonsignificant (P=0.09) after allowing for population mixing. The very weak association between railway density and risk of childhood leukaemia is likely to be a consequence of the association between population mixing and proximity to railways in very deprived, urban wards.
Child↗
Acting at a disaster site: experiences expressed by Swedish nurses.
In a previous study the knowledge and views of nursing students on how they thought nurses, both in their professional role and as private persons, should act at a disaster site were evaluated. In the present study the practical functional role and experiences of nurses (n = 16) in two major disaster situations (one 'load and go' and one 'stay and play' type of emergency situation) were assessed from personal interviews along a standardized questionnaire. Nurses more routinely involved in emergency care and nurses with no or limited previous practical experience of disaster nursing were included in the study. Leadership-type actions, i.e. a systematic way of attempting to survey and to comprehend the situation, what has happened, and how many injured there may be at the site of the accident, were reported by most of the experienced nurses, while inexperienced nurses were involved mainly in the immediate care of injured according to directions given by more experienced members of the emergency team. Readiness for action, reflected by having a feeling of being prepared for work at the disaster site, was experienced more often by nurses with considerable previous experience of disaster nursing than by nurses with limited experience. Negative experiences, such as feelings of being insufficient, of unreality, mental strain, and problems in understanding the organization, were commonly mentioned by the inexperienced nurses. The present study stresses the importance, for all types of nurses, of more systematic training in disaster nursing.
Adult↗
The effect of an irregular shift system on sleepiness at work in train drivers and railway traffic controllers.
Sleepiness and fatigue are frequent problems in railway transportation with occasional monotony and irregular shift schedules. This study aimed at (1) studying the prevalence of severe sleepiness in shifts and (2) examining which shift and sleep-related factors were associated with the occurrence of severe sleepiness in an irregular shift system. A total of 126 randomly selected male train drivers (Tdrs) and 104 railway traffic controllers (Tcos) were investigated using questionnaires and sleep-wake diaries. A sleep diary was used to collect information on sleepiness at work and sleeping times during the 21 consecutive days of the study. The prevalence of severe sleepiness at work (i.e. Karolinska Sleepiness Scale 7 or higher) was modelled by a logistic regression analysis for repeated measurements (GEE) using different shift schedule related factors and sleep length as explanatory variables. Severe sleepiness was reported in 49% (Tdrs) and 50% (Tcos) of the night shifts and in 20% (Tdrs) and 15% (Tcos) of the morning shifts. The odds ratios showed that the risk for severe sleepiness was 6-14 times higher in the night shift and about twice as high in the morning shift compared with the day shift. Age affected the two occupational samples differently: with Tdrs increased age was associated with an additional 8% reduction of risk for severe sleepiness for each year of age, while the Tcos did not show any age dependency. Shift length increased the risk by 15% for each hour of the shift and main sleep period decreased the risk by 15% for each hour of the main sleep. The risk of severe sleepiness was not consistently related to the time-off period before the shifts. The results indicate that adjustments for shift timing, length and off-duty time, in addition to actions aiming at extending the main sleep period, would probably decrease severe sleepiness in railway transportation.
Adult↗
Sleep-wake rhythm in an irregular shift system.
Sleep in shift work has been studied extensively in regular shift systems but to a lesser degree in irregular shifts. Our main aim was to examine the sleep-wake rhythm in shift combinations ending with the night or the morning shift in two irregular shift systems. Three weeks' sleep/work shift diary data, collected from 126 randomly selected train drivers and 104 traffic controllers, were used in statistical analyses including a linear mixed model and a generalized linear model for repeated measurements. The results showed that the sleep-wake rhythm was significantly affected by the shift combinations. The main sleep period before the first night shift shortened by about 2 h when the morning shift immediately preceded the night shift as compared with the combination containing at least 36 h of free time before the night shift (reference combination). The main sleep period before the night shift was most curtailed between two night shifts, on average by 2.9 and 3.5 h among the drivers and the controllers, respectively, as compared with the reference combination. Afternoon napping increased when the morning or the day shift immediately preceded the night shift, the odds being 4.35-4.84 in comparison with the reference combination. The main sleep period before the morning shift became 0.5 h shorter when the evening shift preceded the morning shift in comparison with the sleep period after a free day. The risk for dozing off during the shift was associated only with the shift length, increasing by 17 and 35% for each working hour in the morning and the night shift, respectively. The results demonstrate advantageous and disadvantageous shift combinations in relation to sleep and make it possible to improve the ergonomy of irregular shift systems.
Adult↗