Death In Australia Research Articles

A descriptive coronial study of heroin toxicity deaths in Australia, 2020-2022: Characteristics, toxicology and survival times.

Mortality rates among people who use heroin are estimated to be 15 times that of the general population. The study aimed to determine (1) the case characteristics and circumstances of death of heroin-related toxicity deaths in Australia, 2020-2022; (2) their toxicological profile and major autopsy findings; (3) the proportion of cases in which blood 6-acetyl morphine (6AM) was detected, as a proxy measure of survival times; and (4) compare 6AM positive and negative cases on toxicology, circumstances of death and acute clinical presentation. Retrospective study of heroin toxicity deaths in Australia, 2020-2022, retrieved from the National Coronial Information System. This study was conducted Australia-wide. There were 610 cases of fatal heroin-related drug toxicity. Information was collected on characteristics, manner of death, toxicology and autopsy results. The mean age was 42.6 years (range 18-73 years), 80.5% were male and 7.5% were enrolled in a drug treatment programme. The circumstances of death were as follows: unintentional drug toxicity (86.2%), combined unintentional drug toxicity/disease (11.3%) and intentional drug toxicity (2.5%). The median free morphine concentration was 0.17 mg/L (range 0.00-4.20 mg/L). Psychoactive drugs other than heroin were present in 95.2% (Confidence Interval 93.1%-96.8%), most commonly hypnosedatives (62.3%, 58.2%-66.4%) and psychostimulants (44.8%, 40.7%-49.1%). Major autopsy findings of clinical significance included acute bronchopneumonia (14.8%, 11.3%-18.8%), emphysema (16.9%, 13.2%-21.1%), cardiomegaly (30.1%, 12.7%-28.2%), coronary artery disease (27.4%, 23.0%-32.3%), coronary replacement fibrosis (13.4%, 10.1%-17.3%), hepatic cirrhosis (8.8%, 6.6%-12.2%) and renal fibrosis (10.3%, 7.3%-14.0%). In 47.0% (42.3%-51.2%), 6AM was present in blood. The 'typical' heroin overdose case in Australia from 2020 to 2022 was a male who injected heroin, aged in the 40s, not enrolled in a treatment programme and had used multiple drugs. In over half of cases, there had been a sufficient survival time for 6-acetyl morphine to have been metabolised, which may indicate times in excess of 20-30 min.

Sex as a Predictor of Response to Immunotherapy in Advanced Cutaneous Squamous Cell Carcinoma.

Approximately 3-5% of patients with cutaneous squamous cell carcinoma (CSCC) develop advanced disease, accounting for roughly 1% of all cancer deaths in Australia. Immunotherapy has demonstrated significant clinical benefit in advanced CSCC in several key phase II studies; however, there are limited data for patients treated outside of clinical trials. This is particularly relevant in advanced CSCC, which is most often seen in elderly patients with significant comorbidities. Thus, we aim to describe our experience with immunotherapy in a cohort of patients with advanced CSCC in Australia. We retrospectively reviewed all advanced CSCC patients treated with immunotherapy within the Illawarra and Shoalhaven Local Health District. Among the 51 patients treated with immunotherapy, there was an objective response rate (ORR) of 53% and disease control rate (DCR) of 67%. Our most significant predictor of response was sex, with male patients more likely to have better responses compared to female patients (DCR 85% vs. 41%, p < 0.0001), as well as improved progression-free survival (HR 4.6, 95%CI 1.9-10.8, p = 0.0007) and overall survival (HR 3.0, 95%CI 1.3-7.1, p = 0.006). Differential expression analysis of 770 immune-related genes demonstrated an impaired CD8 T-cell response in female patients. Our observed ORR of 53% is similar to that described in current literature with durable responses seen in the majority of patients.

Initial Implementation of the My Heart, My Life Program by the National Heart Foundation of Australia: Pilot Mixed Methods Evaluation Study.

Coronary heart disease (CHD) remains the leading cause of death in Australia, with a high residual risk of repeat events in survivors. Secondary prevention therapy is crucial for reducing the risk of both death and other major adverse cardiac events. The National Heart Foundation of Australia has developed a consumer-facing support program called My Heart, My Life (MHML) to address the gap in the secondary prevention of CHD in Australia. The MHML pilot program supplies advice and support for both patients and their caregivers, and it was conducted over 8 months from November 2019 to June 2020. This study aims to describe and examine the implementation of a novel multimodality secondary CHD prevention pilot program called MHML, which was delivered through booklets, text messages, emails, and telephone calls. This pilot study consists of a mixed methods evaluation involving surveys of participants (patients and caregivers) and health professionals, in-depth interviews, and digital communication (SMS text message, electronic direct mail, and call record analytics). This study was performed in people older than 18 years with acute coronary syndrome or angina and their caregivers in 38 Australian hospitals from November 2019 to June 2020 through the National Heart Foundation of Australia web page. The main outcome measures were reach, accessibility, feasibility, barriers, and enablers to implementation of this program. Of the 1004 participants (838 patients and 164 caregivers; 2 missing), 60.9% (608/1001) were males, 50.7% (491/967) were aged between 45 and 64 years, 27.4% (276/1004) were from disadvantaged areas, 2.5% (24/946) were from Aboriginal or Torres Strait Islander background, and 16.9% (170/1004) reported English as their second language. The participants (patients and their caregivers) and health professionals reported high satisfaction with the MHML program (55/62, 88.7% and 33/38, 87%, respectively). Of the 62 participants who took the survey, 88% (55/62) used the text messaging service and reported a very high level of satisfaction. Approximately 94% (58/62) and 89% (55/62) of the participants were satisfied with the quick guide booklets 1 and 2, respectively; 79% (49/62) were satisfied with the monthly email journey and 71% (44/62) were satisfied with the helpline calls. Most participants reported that the MHML program improved preventive behaviors, that is, 73% (45/62) of them reported that they maintained increased physical activity and 84% (52/62) reported that they maintained a healthy diet even after the MHML program. The findings of our pilot study suggest that a multimodal support program, including digital, print, phone, and web-based media, for the secondary prevention of CHD is useful and could be a potential means of providing customized at-scale secondary prevention support for survivors of acute coronary syndrome.

Snorkelling and breath-hold diving fatalities in Australian waters, 2014 to 2018.

This study investigated snorkelling and breath-hold diving deaths in Australia from 2014-2018 and compared these to those from 2001-2013 to identify ongoing problems and assess the effectiveness of countermeasures. Media reports and the National Coronial Information System were searched to identify snorkelling/breath-hold diving deaths for 2014-2018, inclusive. Data were extracted from witness and police reports, medical histories, and autopsies. An Excel® database was created and a chain of events analysis conducted. Comparisons were made with the earlier report. Ninety-one fatalities (78 males, 13 females, median age 48 years [range 16-80]) were identified with one third likely doing some breath-hold diving. Fifty-two of 77 with known body mass index were overweight or obese. Approximately two thirds were inexperienced snorkellers and 64 were alone. Fifty-one were tourists. Planning shortcomings, such as solo diving and diving in adverse conditions, as well as pre-existing health conditions and inexperience predisposed to many incidents. Primary drowning was the likely disabling condition in 39% of cases with drowning recorded as the cause of death (COD) in two thirds. Cardiac events were the likely disabling conditions in 31% although recorded as the COD in 21% of cases. Increasing age, obesity and associated cardiac disease have become increasingly prevalent in snorkelling deaths and there is a need for improved health surveillance and risk management. Closer supervision of inexperienced snorkellers is indicated. Apnoeic hypoxia from extended breath-holding and poor supervision remain a problem. The increased risk of harvesting seafood in areas frequented by large marine predators needs to be appreciated and managed appropriately.

P15 - Changing care for parents in subsequent pregnancies following stillbirth or neonatal death in Australia: Exploring support for optimising psychosocial wellbeing outcomes

P15 - Changing care for parents in subsequent pregnancies following stillbirth or neonatal death in Australia: Exploring support for optimising psychosocial wellbeing outcomes

Compressed gas diving fatalities in Australian waters 2014 to 2018.

This study aimed to investigate compressed gas diving deaths in Australia from 2014-2018 and make comparison to those from 2001-2013 to identify ongoing problems and assess countermeasures. Media reports and the National Coronial Information System were searched to identify scuba diving deaths for 2014-2018, inclusive. Data were extracted from the witness and police reports, medical histories, and autopsies. An Excel® database was created and a chain of events analysis conducted. Comparisons were made with the earlier report. Forty-two fatalities were identified, 38 using scuba and four using surface-supplied breathing apparatus involving 30 males and 12 females. The mean age of victims was 49.7 years, six years higher than the previous cohort. Fifty-four percent were obese. Six victims were unqualified, three were under instruction and at least 28 were experienced divers, significantly more than in the previous cohort. Health-related predisposing factors, predominantly obesity and cardiac-related, were identified as likely contributory to 26 incidents, and planning shortcomings to at least 22 deaths. One-third of the disabling conditions were primary drowning and one-quarter were cardiac. Three divers died subsequent to carbon monoxide poisoning and three likely from immersion pulmonary oedema. Advancing age, obesity and the associated cardiac disease have become increasingly prevalent in diving fatalities and the need for appropriate assessment of fitness to dive is evident.

Creutzfeldt-Jakob disease surveillance in Australia: update to 31 December 2022.

Nationwide surveillance of Creutzfeldt-Jakob disease (CJD) and other human prion diseases is performed by the Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR). National surveillance encompasses the period since 1 January 1970, with prospective surveillance occurring from 1 October 1993. Over this prospective surveillance period, considerable developments have occurred in pre-mortem diagnostics; in the delineation of new disease subtypes; and in a heightened awareness of prion diseases in healthcare settings. Surveillance practices of the ANCJDR have evolved and adapted accordingly. This report summarises the activities of the ANCJDR during 2022. Since the ANCJDR began offering diagnostic cerebrospinal fluid (CSF) 14-3-3 protein testing in Australia in September 1997, the annual number of referrals has steadily increased. In 2022, a total of 599 domestic CSF specimens were referred for diagnostic testing and 79 persons with suspected human prion disease were formally added to the national register. As of 31 December 2022, just under half of the 79 suspect case notifications (36/79) remain classified as 'incomplete'; 15 cases were classified as 'definite' and 23 as 'probable' prion disease; five cases were excluded through neuropathological examination. For 2022, fifty-five percent of all suspected human-prion-disease-related deaths in Australia underwent neuropathological examination. No cases of variant or iatrogenic CJD were identified. The SARS-CoV-2 pandemic did not affect prion disease surveillance outcomes in Australia during 2022.

HealthyRHearts - reducing cholesterol in rural adults via telehealth-based medical nutrition therapy: protocol for a cluster randomised controlled trial

BackgroundFew randomised controlled trials specifically focus on prevention in rural populations. Cardiovascular disease (CVD) contributes to approximately one quarter of deaths in Australia. Nutrition is a key component affecting many risk factors associated with CVD, including hypercholesterolaemia. However, access to medical nutrition therapy (MNT) is limited for people living in rural areas, potentially exacerbating inequities related to health outcomes. Telehealth services present an opportunity to improve MNT access and address healthcare disparities for rural populations. The present study aims to evaluate feasibility, acceptability, and cost-effectiveness of a telehealth MNT CVD intervention program in lowering CVD risk over 12-months in regional and rural primary health care settings.Methods/designA cluster randomised controlled trial set in rural and regional general practices in NSW, Australia, and their consenting patients (n = 300 participants). Practices will be randomised to either control (usual care from their General Practitioner (GP) + low level individualised dietetic feedback) or intervention groups (usual care from their GP + low level individualised dietetic feedback + telehealth MNT intervention). Telehealth consultations will be delivered by an Accredited Practising Dietitian (APD), with each intervention participant scheduled to receive five consultations over a 6-month period. System-generated generic personalised nutrition feedback reports are provided based on completion of the Australian Eating Survey – Heart version (AES-Heart), a food frequency questionnaire. Eligible participants must be assessed by their GP as at moderate (≥ 10%) to high (> 15%) risk of a CVD event within the next five years using the CVD Check calculator and reside in a regional or rural area within the Hunter New England Central Coast Primary Health Network (HNECC PHN) to be eligible for inclusion. Outcome measures are assessed at baseline, 3, 6 and 12 months. The primary outcome is reduction in total serum cholesterol. Evaluation of the intervention feasibility, acceptability and cost-effective will incorporate quantitative, economic and qualitative methodologies.DiscussionResearch outcomes will provide knowledge on effectiveness of MNT provision in reducing serum cholesterol, and feasibility, acceptability, and cost-effectiveness of delivering MNT via telehealth to address CVD risk in rural regions. Results will inform translation to health policy and practice for improving access to clinical care in rural Australia.Trial registrationThis trial is registered at anzctr.org.au under the acronym HealthyRHearts (Healthy Rural Hearts), registration number ACTRN12621001495819.

A focus on sex differences in drowning deaths in Australia: the need for reporting on sex and gender in drowning research

AimAn evidence gap exists on sex and gender differences in drowning with previous research neglecting females. Drowning studies have largely focused on accidental drowning and submersion, excluding other classifications such as intentional, water transport-related, and undetermined drowning. This study examined all external causes of drowning deaths over a 13-year period in Australia disaggregated by sex. Drowning deaths were compared by sex with drowning classification, year, month, age, place of death, Indigenous status, socioeconomic, and visitor status.Subject and methodsThis retrospective total population study included all females and males who died from drowning in Australia from 2006 to 2019. Data was extracted from the Australian Bureau of Statistics Cause of Death Unit Record Files. Australian population data were extracted to calculate the crude death rate and relative risk for drowning.ResultsThere were 4007 drowning deaths recorded, and females represented 25.2% of drowning fatalities. Females were less likely than males to drown, including by drowning classification, year, month, state, remoteness and visitor status, age, socioeconomic, and Indigenous status. The highest proportion of female drowning deaths were from intentional drowning, fall into swimming pools, and in natural water. Drowning deaths among females increased as age increased.ConclusionThere is a clear need for improved disaggregation of sex and gender in drowning research. Without the detailed exploration of females in drowning statistics there will be limited knowledge translation specific to females. The development of drowning prevention strategies targeted to females is required to reduce the incidence and risk of drowning.

Mortality and cause of death during inpatient psychiatric care in New South Wales, Australia: A retrospective linked data study

BackgroundPremature mortality in people with mental illness is well-documented, yet deaths during inpatient psychiatric care have received little research attention. This study investigates mortality rates and causes of death during inpatient psychiatric care in New South Wales (NSW), Australia. Risk factors for inpatient death were also explored. MethodsA retrospective cohort study using linked administrative datasets with complete capture of psychiatric admissions in NSW from 2002 to 2012 (n = 421,580) was conducted. Univariate and multivariate random-effects logistic regression analyses were used to explore risk factors for inpatient death. ResultsThe mortality rate during inpatient psychiatric care was 1.12 deaths per 1000 episodes of care and appeared to decline over the study period. Suicide accounted for 17% of inpatient deaths, while physical health causes accounted for 75% of all deaths. Thirty percent of these deaths were considered potentially avoidable. In the multivariate model, male sex, unknown address and several physical health diagnoses were associated with increased deaths. ConclusionsThe mortality rate and number of avoidable deaths during inpatient psychiatric care were substantial and warrant further systemic investigation. This was driven by a dual burden of physical health conditions and suicide. Strategies to improve access to physical health care on psychiatric inpatient wards and prevent inpatient suicide are necessary. A coordinated approach to monitoring psychiatric inpatient deaths in Australia is not currently available and much needed.

Causes of Perinatal Deaths in Australia: Slow Progress in the Preterm Period

(Aust N Z J Obstet Gynaecol. 2022;62:511–517) The rate of stillbirth in Australia decreased from 25% to 15% over the last 20 years. Ninety percent of Australian stillbirths are born before 28 gestational weeks (EGA), and the number of deaths following preterm birth in Australia has remained stable. Despite perinatal and neonatal death being relatively similar, many studies attempt to ignore their similarities and focus on one of them. This study researched the impact of EGA on preterm stillbirth and neonatal death to identify where future research should focus.

The characteristics of drowning among different types of international visitors to Australia and how this contributes to their drowning risk

ObjectiveAustralia is a popular destination for international visitors. This study reviews international visitor drowning deaths in Australia and analyses drowning by visitor type. MethodsA total population retrospective study exploring drowning deaths of international visitors was conducted between 2008 and 2018. Data were extracted from the Royal Life Saving National Fatal Drowning Database and categorised into four subgroups: overseas tourists, international students, working holiday makers and work-related visitors. Descriptive statistics, non-parametric tests and relative risk (RR) were calculated. ResultsIn total, 201 international visitors drowned in Australia, 7% of all drowning deaths; a crude drowning rate of 0.27/100,000 visitors versus 0.95/100,000 for residents (RR=0.19 [95% CI: 0.16–0.22]). Most deaths were males (79%) and people aged 18–34 years (50%). Visitors frequently drowned at beaches (33%), and when swimming (41%). Thirty-five percent recorded a pre-existing medical condition. Overseas tourists on holiday were the most likely to drown compared to other subgroups. ConclusionInternational visitors represent a small but increasing proportion of people drowning in Australia. The circumstances of which visitors drown vary by travel purpose, age, country of origin, location of drowning and activity. Implications for public healthInternational visitors have unique safety needs, requiring tailored prevention based on the purpose of travel and country of origin.

Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study

BackgroundHepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A cost-effectiveness model was then developed to assess surveillance strategies in Australia.MethodsA microsimulation model was used to evaluate three strategies: biannual ultrasound, biannual ultrasound with alpha-fetoprotein (AFP) and no formal surveillance for patients having one of the conditions: non-cirrhotic CHB, compensated cirrhosis or decompensated cirrhosis. One-way and probabilistic sensitivity analyses as well as scenario and threshold analyses were conducted to account for uncertainties: including exclusive surveillance of CHB, compensated cirrhosis or decompensated cirrhosis populations; impact of obesity on ultrasound sensitivity; real-world adherence rate; and different cohort’s ranges of ages.ResultsSixty HCC surveillance scenarios were considered for the baseline population. The ultrasound + AFP strategy was the most cost-effective with incremental cost-effectiveness ratios (ICER) compared to no surveillance falling below the willingness-to-pay threshold of A$50,000 per quality-adjusted life year (QALY) at all age ranges. Ultrasound alone was also cost-effective, but the strategy was dominated by ultrasound + AFP. Surveillance was cost-effective in the compensated and decompensated cirrhosis populations alone (ICERs < $30,000), but not cost-effective in the CHB population (ICERs > $100,000). Obesity could decrease the diagnostic performance of ultrasound, which in turn, reduce the cost-effectiveness of ultrasound ± AFP, but the strategies remained cost-effective.ConclusionsHCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.

Characteristics and circumstances of volatile solvent misuse-related death in Australia, 2000–2021

Introduction Volatile solvent misuse-related death is associated with neuropsychiatric, cardiovascular, respiratory and renal pathology, as well as sudden death. The study aimed to determine: (1) the circumstances of death and case characteristics of volatile solvent misuse-related death in Australia, 2000–2021; (2) the toxicological profile of cases; and (3) the major autopsy findings. Methods Retrospective study of volatile solvent misuse-related death in Australia, 2000–2021 retrieved from the National Coronial Information System. Findings One hundred and sixty-four cases were identified, 79.9% male, mean age 26.5 years (8.5% aged 40 years or older). Circumstances of death were unintentional toxicity (61.0%), unintentional asphyxia (20.1%), intentional self-harm (12.2%) and traumatic accident (6.7%). The most commonly reported acute presentation prior to death was sudden collapse (22 of 47 witnessed events). The most frequently used solvents at the fatal incident were gas fuels (35.4%), gasoline (petrol) (19.5%) adhesives/paints (19.5%), aerosol propellants (12.8%), and volatile anaesthetics (12.8%). The most commonly detected volatile substances were butane (40.7%), toluene (29.6%), and propane (25.9%). Cannabis was present in 27.6% and alcohol in 24.6%. The prevalence of acute pneumonia amongst autopsied cases was low (5.8%) which, together with reports of sudden collapse, suggests that in many cases, death was extremely rapid. There were low levels of major organ pathology. Conclusions While the average age of volatile solvent misuse-related death was in the mid-twenties, a substantial proportion occurred amongst people aged 40 years or older. Reflecting availability, gas fuels predominated. In many cases, death appeared to have been rapid.

Psychosocial impact of the COVID-19 pandemic on Australian nurses and midwives: a cross-sectional study

Objective: To investigate the psychosocial effects of the COVID-19 pandemic on nurses and midwives working in acute care settings, specifically psychological distress, self-reported concerns, and perceived impact on their work and personal lives. Background: Little is known about the psychosocial impact of the pandemic on nurses and midwives in Australia, a country with a substantially lower number of COVID-19 cases and deaths than many others. Few studies investigating the prevalence of psychological distress among nurses during the pandemic have been conducted in more than one setting, especially in the Australian context. Study design and methods: Cross-sectional survey design (STROBE checklist). Nurses and midwives (n=1,611) at four metropolitan tertiary health services in Melbourne, Australia completed an anonymous online survey between 15 May and 31 August 2020, which assessed symptoms of depression, anxiety and stress (DASS-21); concerns related to COVID-19; and other effects of COVID-19. Space was provided for free-text comments. Results: Approximately one fifth of respondents reported moderate to extremely severe symptoms of depression, anxiety and stress. Fewer years of clinical experience were significantly associated with higher levels of psychological distress. More than half of the respondents were extremely/very concerned about passing COVID-19 on to family members and about their family's health, and almost half were concerned about caring for a patient who had confirmed or suspected COVID-19. Respondents reported that certain precautionary measures such as personal protective equipment (PPE) interfered with their ability to provide optimal patient care. Positive aspects of the pandemic were also reported including a sense of togetherness and cooperation among staff. Conclusion: The COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of nurses and midwives working in acute care settings in Melbourne, Australia, particularly those with less clinical experience. Implications for nursing and health services research, policy and practice: Nurses and midwives, particularly those with less clinical experience, would benefit from additional, targeted wellbeing and support initiatives. For those with less experience, initiatives could include being partnered with more experienced colleagues and educators who can provide practical and emotional support and monitor their stress levels. What is already known about the topic? Nurses and midwives have experienced more psychological distress than other healthcare workers during the COVID-19 pandemic. Most studies about the psychosocial impact of the COVID-19 pandemic on nurses and midwives have been conducted in a single health service. Few studies have concurrently investigated the experiences of nurses and midwives from different health services during the COVID-19 pandemic especially in the Australian context. What this paper adds Despite the relatively low number of COVID-19 cases and deaths in Australia, the COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of Australian nurses and midwives. About one in five of the nurses and midwives surveyed reported moderate to extremely severe symptoms of depression, anxiety and stress during the first wave of the pandemic. Nurses and midwives with fewer years of clinical experience experienced higher levels of psychological distress than those with more experience.

Poisonings from hydrocarbon inhalant misuse in Australia.

Inhalational misuse of volatile substances has been a significant public health concern because of the risk of sudden death and associated chronic complications such as encephalopathy. The Australian Government released a Consensus-based clinical practice guideline in 2011 on the management of volatile substance use in Australia, which noted a lack of available data particularly on harms. This study aimed to measure (1) the number of calls received by the New South Wales Poisons Information Centre (NSWPIC) regarding inhalational hydrocarbon exposures or poisonings and (2) the number of unintentional deaths reported to the National Coronial Information System (NCIS) in Australia. We performed a retrospective review of all recreational inhalational hydrocarbon exposure calls to the NSWPIC between 1 January 2010 and 31 December 2020. A search was made of the NCIS database in all states and territories over the same period to determine the number of non-intentional inhalational hydrocarbon-related deaths in Australia. Between January 2010 and December 2020, there were 752 primary calls made to the NSWPIC regarding hydrocarbon use or exposure. Age or age bracket was recorded in 748 cases, with 508 (67%) calls involving children or adolescents. Over the same time, there were 58 unintentional deaths involving the recreational use of inhalational hydrocarbons. The median age at death was 23 years (interquartile range = 15-30 years), and 72% (42 cases) were male. Cause of death was predominately acute suffocation/asphyxia, encephalopathy related to chronic use, cardiac arrest likely from sudden sniffing syndrome or thermal injuries secondary to unintentional fires sparked by the volatile agents. Although death and cardiac arrest are uncommon among people in Australia who misuse hydrocarbons for recreational use, the deaths and cardiac arrests tend to occur in adolescents.

Changing trends and characteristics of one punch deaths in Australia (2012–2018)

One-punch assaults also known as ‘coward punches’, are characterised by a single severe blow to the head causing the victim to lose consciousness, resulting in a secondary impact between the head and surrounding environment. Such impacts may result in brain injury leading to fatality or permanent neurological impairment. In a previous publication, there were 90 one punch deaths around Australia between 2000 and 2012, mostly involving young men drinking alcohol at a licensed venue at the weekend. This prompted a surge of public education and awareness campaigns around Australia, in addition to regulatory and legislative changes aimed at curbing social violence. This retrospective descriptive study aimed to examine one punch deaths since 2012 in Australia to determine if there has been a decrease in deaths, and whether the demographics and circumstances of these deaths have changed. A search of the National Coronial Information System was undertaken for all closed coronial cases between 1 January 2012 and 31 December 2018. Additional information was collected from medicolegal reports including toxicology, pathology and coronial findings. There were 80 one punch fatalities in Australia, almost exclusively involving males. The median age was 43.5 (range 18–71) years and there was a decreasing trend in the number of deaths annually. Most fatal assaults occurred in the state of New South Wales (28.8%) followed by Queensland (23.8%), and in metropolitan locations (64.6%) rather than regional areas (35.4%). Alcohol was the most commonly detected drug, found in 47 cases of the 71 cases where toxicology results were available (66%), with a median concentration of 0.14 and 0.19 g/100 mL in antemortem and postmortem samples, respectively (range 0.005–0.32 g/100 mL). Five deaths reported methylamphetamine, with THC detected in 21.1% of cases. Assaults more commonly occurred on a footpath or roadside (41.3%), followed by a home or dwelling (32.5%). 8.8% of assaults occurred inside hotels, bars or other licenced venues. Most transpired on a weekday, which differed from the pre-2012 period when these assaults occurred mainly on the weekend. While some trends are positive, there has been a shift in the victim demographic as well as the typical environment for fatal one punch assaults, highlighting the importance of public health surveillance in providing a current evidence base to inform policy and practice.

Characteristics and circumstances of cocaine-related completed suicide in Australia, 2000–2021

BackgroundThere has been a substantial global increase in cocaine use and associated harms. The current study aimed to: 1. Determine the case characteristics and circumstances of death of cocaine-related suicide in Australia 2000–2021; and 2. Determine the toxicological profiles of cases. MethodsRetrospective study of cocaine-related death in Australia, 2000–2021, retrieved from the National Coronial Information System (NCIS). Suicide intent was based upon the NCIS code for “Intentional Self-harm”, derived from case circumstances and coroners’ conclusions. Sex comparisons were made for all major variables. ResultsA total of 157 cases were identified, 82.2% male, 79.5% employed, with a mean age of 32.3 years. Concerns for mental health were documented in 65.6%, a previous suicide attempt in 21.0%, a history of substance use treatment and/or negative consequences of substance use in 45.9% and injecting drug use in 14.6%. Manner of death amongst both sexes was predominantly by physical means (82.8%). Written intent was documented in 29.3%. Intense agitation prior to the incident was noted in 28.0% and conflict in 24.8%. The median blood cocaine concentration was 0.060 mg/L (range 0.007–5.500). Other drugs were present in 95.5%, most commonly alcohol (63.1%) with a median concentration of 0.140 g/100 ml. Psychostimulants other than cocaine were present in 31.2%. ConclusionsThe ‘typical’ cocaine-related suicide case was a male, aged in their early thirties, who was highly likely to be employed. The majority of cases used physical means, and a substantial minority were highly agitated and engaged in conflict prior to the fatal incident.

A Call for Reform: The Need for An Effective Response to Asbestos in Australian Workplaces and Residential Settings

This article argues for greater regulatory efforts to prevent unnecessary deaths from asbestos exposure in Australia. Despite asbestos-related diseases being responsible for a large number of deaths in Australia every year, the danger from exposure to asbestos is not well understood in the community and the regulatory response has been inadequate. A survey of 43,000 Australians between April 2020 and May 2021 found that only 28 percent of respondents knew that asbestos is dangerous to health and only 5 percent were aware that once diagnosed, most cases of asbestos-related disease are fatal within relatively short timeframes. Despite the significant risk to Australian lives posed by in situ asbestos, governments have failed to ensure that Australians are accurately informed about that risk, and responsible corporations have not been fully held to account.

Treatment patterns and long-term survival outcomes for patients with stage III non-small cell lung cancer: A retrospective study.

Lung cancer is the leading cause of cancer-related deaths in Australia with poor long-term survival outcomes. Stage III non-small cell lung cancer (NSCLC) is a highly heterogenous group with diverse tumor characteristics and multiple, possible treatment options. We present retrospective data on patient characteristics, treatment patterns, and long-term outcomes in stage III NSCLC patients treated at a single cancer center in New South Wales, Australia. Stage III NSCLC patients were identified from the 'Nepean Cancer Research Biobank'. Patient demographics, cancer-related information, and long-term follow-up data were collected and analyzed. A total of 88 patients were eligible for analysis with 61% of them diagnosed as stage IIIA, 35% IIIB, and 4% IIIC. Induction chemotherapy was administered in 20% of the patients. Overall, 48% of the study population underwent surgery, and 38% underwent concurrent chemoradiotherapy (CCRT). Both median progression-free survival and overall survival (OS) were superior in stage IIIA patients in comparison to stage IIIB (and IIIC) patients (22 vs. 11 months, p=.018; and 58 vs. 19 months, p=.048, respectively). Patients who were younger (<65 years old), good Eastern Cooperative Oncology Group performance status (ECOG PS <2), and females had better prognosis on univariate analysis. There was a nonstatistically significant trend toward better median OS with CCRT in comparison to surgery (58 vs. 37 months, p=.87). Long-term outcomes remain poor, and hence better treatment strategies are urgently needed in stage III NSCLC. Equally, more robust, prospective studies would help delineate the optimal treatment modality in these patients.