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Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs – a retrospective study, 1992–2009

Authors: Kristin Ahlm, Britt-Inger Saveman, Ulf Björnstig

Published in: BMC Public Health | Issue 1/2013

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Abstract

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.
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Literature
2.
go back to reference Peden MM, McGee K: The epidemiology of drowning worldwide. Inj Control Saf Promot. 2003, 10: 195-199. 10.1076/icsp.10.4.195.16772.CrossRefPubMed Peden MM, McGee K: The epidemiology of drowning worldwide. Inj Control Saf Promot. 2003, 10: 195-199. 10.1076/icsp.10.4.195.16772.CrossRefPubMed
3.
go back to reference Hyder AA, Borse NN, Blum L, Khan R, El Arifeen S, Baqui AH: Childhood drowning in low- and middle-income countries: Urgent need for intervention trials. J Paediatr Child Health. 2008, 44: 221-227. 10.1111/j.1440-1754.2007.01273.x. ReviewCrossRefPubMed Hyder AA, Borse NN, Blum L, Khan R, El Arifeen S, Baqui AH: Childhood drowning in low- and middle-income countries: Urgent need for intervention trials. J Paediatr Child Health. 2008, 44: 221-227. 10.1111/j.1440-1754.2007.01273.x. ReviewCrossRefPubMed
4.
go back to reference Irwin CC, Irwin RL, Ryan TD, Drayer J: Urban minority youth swimming (in) ability in the United States and associated demographic characteristics: toward a drowning prevention plan. Inj Prev. 2009, 15: 234-239. 10.1136/ip.2008.020461.CrossRefPubMed Irwin CC, Irwin RL, Ryan TD, Drayer J: Urban minority youth swimming (in) ability in the United States and associated demographic characteristics: toward a drowning prevention plan. Inj Prev. 2009, 15: 234-239. 10.1136/ip.2008.020461.CrossRefPubMed
5.
go back to reference Lunetta P, Smith GS, Penttilä A, Sajantila A: Unintentional drowning in Finland 1970–2000: a population-based study. Int J Epidemiol. 2004, 33: 1053-1063. 10.1093/ije/dyh194.CrossRefPubMed Lunetta P, Smith GS, Penttilä A, Sajantila A: Unintentional drowning in Finland 1970–2000: a population-based study. Int J Epidemiol. 2004, 33: 1053-1063. 10.1093/ije/dyh194.CrossRefPubMed
7.
go back to reference Wintemute GJ, Kraus JF, Teret SP, Wright MA: The epidemiology of drowning in adulthood: implications for prevention. Am J Prev Med. 1988, 4: 343-348.PubMed Wintemute GJ, Kraus JF, Teret SP, Wright MA: The epidemiology of drowning in adulthood: implications for prevention. Am J Prev Med. 1988, 4: 343-348.PubMed
8.
go back to reference Stjernbrandt A, Öström M, Eriksson A, Björnstig U: Land motor vehicle-related drownings in Sweden. Traffic Inj Prev. 2008, 9: 539-543. 10.1080/15389580802339150.CrossRefPubMed Stjernbrandt A, Öström M, Eriksson A, Björnstig U: Land motor vehicle-related drownings in Sweden. Traffic Inj Prev. 2008, 9: 539-543. 10.1080/15389580802339150.CrossRefPubMed
9.
go back to reference Byard RW, Houldsworth G, James RA, Gilbert JD: Characteristic features of suicidal drownings: a 20-year study. Am J Forensic Med Pathol. 2001, 22: 134-138. 10.1097/00000433-200106000-00005.CrossRefPubMed Byard RW, Houldsworth G, James RA, Gilbert JD: Characteristic features of suicidal drownings: a 20-year study. Am J Forensic Med Pathol. 2001, 22: 134-138. 10.1097/00000433-200106000-00005.CrossRefPubMed
10.
go back to reference Jansson B, Ahmed N: Epilepsy and injury mortality in Sweden-the importance of changes in coding practice. Seizure. 2002, 11: 361-370. 10.1053/seiz.2002.0680.CrossRefPubMed Jansson B, Ahmed N: Epilepsy and injury mortality in Sweden-the importance of changes in coding practice. Seizure. 2002, 11: 361-370. 10.1053/seiz.2002.0680.CrossRefPubMed
11.
go back to reference Bell GS, Gaitatzis A, Bell CL, Johnson AL, Sander JW: Drowning in people with epilepsy: how great is the risk?. Neurology. 2008, 71: 578-582. 10.1212/01.wnl.0000323813.36193.4d.CrossRefPubMed Bell GS, Gaitatzis A, Bell CL, Johnson AL, Sander JW: Drowning in people with epilepsy: how great is the risk?. Neurology. 2008, 71: 578-582. 10.1212/01.wnl.0000323813.36193.4d.CrossRefPubMed
12.
go back to reference Lunetta P, Penttilä A, Sarna S: Water traffic accidents, drowning and alcohol in Finland, 1969–1995. Int J Epidemiol. 1998, 27: 1038-1043. 10.1093/ije/27.6.1038.CrossRefPubMed Lunetta P, Penttilä A, Sarna S: Water traffic accidents, drowning and alcohol in Finland, 1969–1995. Int J Epidemiol. 1998, 27: 1038-1043. 10.1093/ije/27.6.1038.CrossRefPubMed
13.
go back to reference Franklin RC, Scarr JP, Pearn JH: Reducing drowning deaths: the continued challenge of immersion fatalities in Australia. Med J Aust. 2010, 192: 123-126.PubMed Franklin RC, Scarr JP, Pearn JH: Reducing drowning deaths: the continued challenge of immersion fatalities in Australia. Med J Aust. 2010, 192: 123-126.PubMed
14.
go back to reference World Health Organization (WHO): Manual of International Classification of Diseases. 1977, Geneva: Injuries and Causes of Deaths (ICD9) World Health Organization (WHO): Manual of International Classification of Diseases. 1977, Geneva: Injuries and Causes of Deaths (ICD9)
15.
go back to reference Jones AW, Schuberth J: Computer-aided headspace gas chromatography applied to blood-alcohol analyses: importance of online process control. J Forensic Sci. 1989, 34: 1116-1127.PubMed Jones AW, Schuberth J: Computer-aided headspace gas chromatography applied to blood-alcohol analyses: importance of online process control. J Forensic Sci. 1989, 34: 1116-1127.PubMed
16.
go back to reference Druid H, Holmberg P: A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci. 1997, 42: 79-87.CrossRefPubMed Druid H, Holmberg P: A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci. 1997, 42: 79-87.CrossRefPubMed
18.
go back to reference Kugelberg FC, Jones AW: Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic Sci Int. 2007, 165: 10-29. 10.1016/j.forsciint.2006.05.004. ReviewCrossRefPubMed Kugelberg FC, Jones AW: Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic Sci Int. 2007, 165: 10-29. 10.1016/j.forsciint.2006.05.004. ReviewCrossRefPubMed
20.
go back to reference Mitchell RJ, Williamsson AM, Olivier J: Estimates of drowning morbidity and mortality adjusted for exposure to risk. Inj Prev. 2010, 16: 261-266. 10.1136/ip.2009.024307.CrossRefPubMed Mitchell RJ, Williamsson AM, Olivier J: Estimates of drowning morbidity and mortality adjusted for exposure to risk. Inj Prev. 2010, 16: 261-266. 10.1136/ip.2009.024307.CrossRefPubMed
21.
go back to reference Steensberg J: Epidemiology of accidental drowning in Denmark 1989–1993. Accid Anal Prev. 1998, 30: 755-762. 10.1016/S0001-4575(98)00028-1.CrossRefPubMed Steensberg J: Epidemiology of accidental drowning in Denmark 1989–1993. Accid Anal Prev. 1998, 30: 755-762. 10.1016/S0001-4575(98)00028-1.CrossRefPubMed
22.
go back to reference Nasrullah M, Muazzam S: Drowning mortality in the United States, 1999–2006. J Community Health. 2011, 36: 69-75. 10.1007/s10900-010-9281-2.CrossRefPubMed Nasrullah M, Muazzam S: Drowning mortality in the United States, 1999–2006. J Community Health. 2011, 36: 69-75. 10.1007/s10900-010-9281-2.CrossRefPubMed
23.
go back to reference Howland J, Hingson R, Mangione TW, Bell N, Bak S: Why are most drowning victims men? Sex differences in Aquatic skill behaviors. Am J Public Health. 1996, 86: 93-96. 10.2105/AJPH.86.1.93.CrossRefPubMedPubMedCentral Howland J, Hingson R, Mangione TW, Bell N, Bak S: Why are most drowning victims men? Sex differences in Aquatic skill behaviors. Am J Public Health. 1996, 86: 93-96. 10.2105/AJPH.86.1.93.CrossRefPubMedPubMedCentral
24.
go back to reference Melinder KA, Andersson R: Differences in injury mortality between the Nordic countries-with special reference to differences in coding practices. J Soc Med. 1998, 26: 190-197. Melinder KA, Andersson R: Differences in injury mortality between the Nordic countries-with special reference to differences in coding practices. J Soc Med. 1998, 26: 190-197.
25.
go back to reference Bowman SM, Aitken ME, Robbins JM, Baker SP: Trends in US pediatric drowning hospitalizations, 1993–2008. Pediatrics. 2012, 129: 275-281. 10.1542/peds.2011-2491.CrossRefPubMedPubMedCentral Bowman SM, Aitken ME, Robbins JM, Baker SP: Trends in US pediatric drowning hospitalizations, 1993–2008. Pediatrics. 2012, 129: 275-281. 10.1542/peds.2011-2491.CrossRefPubMedPubMedCentral
26.
go back to reference Lindholms P, Steensberg J: Epidemiology of unintentional drowning and near-drowning in Denmark in 1995. Inj Prev. 2000, 6: 29-31. 10.1136/ip.6.1.29.CrossRef Lindholms P, Steensberg J: Epidemiology of unintentional drowning and near-drowning in Denmark in 1995. Inj Prev. 2000, 6: 29-31. 10.1136/ip.6.1.29.CrossRef
27.
go back to reference Suresh Kumar Shetty B, Shetty M: Epidemiology of drowning in Mangalore, a coastal Taluk of South India. J Forensic Leg Med. 2007, 14: 410-415. 10.1016/j.jflm.2007.01.004.CrossRefPubMed Suresh Kumar Shetty B, Shetty M: Epidemiology of drowning in Mangalore, a coastal Taluk of South India. J Forensic Leg Med. 2007, 14: 410-415. 10.1016/j.jflm.2007.01.004.CrossRefPubMed
28.
go back to reference Håkanson L: How many lakes are there in Sweden?. Phys Geogr. 1994, 76: 203-205. Håkanson L: How many lakes are there in Sweden?. Phys Geogr. 1994, 76: 203-205.
29.
go back to reference Wirthwein DP, Barnard JJ, Prahlow JA: Suicide by drowning: a 20-year review. J Forensic Sci. 2002, 47: 131-136.CrossRefPubMed Wirthwein DP, Barnard JJ, Prahlow JA: Suicide by drowning: a 20-year review. J Forensic Sci. 2002, 47: 131-136.CrossRefPubMed
30.
go back to reference Sarma K, Kola S: Firearms, hanging, and drowning suicides in the Republic of Ireland. Crisis. 2010, 31: 69-75.CrossRefPubMed Sarma K, Kola S: Firearms, hanging, and drowning suicides in the Republic of Ireland. Crisis. 2010, 31: 69-75.CrossRefPubMed
31.
go back to reference Corcoran P, Reulbach U, Perry IJ, Arensman E: Suicide and deliberate self harm in older Irish adults. Int Psychogeriatr. 2010, 22: 1327-1336. 10.1017/S1041610210001377.CrossRefPubMed Corcoran P, Reulbach U, Perry IJ, Arensman E: Suicide and deliberate self harm in older Irish adults. Int Psychogeriatr. 2010, 22: 1327-1336. 10.1017/S1041610210001377.CrossRefPubMed
32.
go back to reference Ingoldsby H, Callagy G: Alcohol and unnatural deaths in the West of Ireland: a 5-year review. J Clin Pathol. 2010, 63: 900-903. 10.1136/jcp.2010.078741.CrossRefPubMed Ingoldsby H, Callagy G: Alcohol and unnatural deaths in the West of Ireland: a 5-year review. J Clin Pathol. 2010, 63: 900-903. 10.1136/jcp.2010.078741.CrossRefPubMed
33.
go back to reference Stemberga V, Bralic M, Coklo M, Cuculic D, Bosnar A: Suicidal drowning in Southwestern Croatia: a 25-year review. Am J Forensic Med Pathol. 2010, 31: 52-54. 10.1097/PAF.0b013e3181c215c8.CrossRefPubMed Stemberga V, Bralic M, Coklo M, Cuculic D, Bosnar A: Suicidal drowning in Southwestern Croatia: a 25-year review. Am J Forensic Med Pathol. 2010, 31: 52-54. 10.1097/PAF.0b013e3181c215c8.CrossRefPubMed
35.
go back to reference Qin P, Agerbo E, Westergård-Nielsen N, Eriksson T, Mortensen PB: Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000, 177: 546-540. 10.1192/bjp.177.6.546.CrossRefPubMed Qin P, Agerbo E, Westergård-Nielsen N, Eriksson T, Mortensen PB: Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000, 177: 546-540. 10.1192/bjp.177.6.546.CrossRefPubMed
36.
go back to reference Salib E: Trends in suicide by drowning in the elderly in England and wales 1979–2001. Int J Geriatric Psychiatry. 2004, 19: 175-181. Salib E: Trends in suicide by drowning in the elderly in England and wales 1979–2001. Int J Geriatric Psychiatry. 2004, 19: 175-181.
37.
go back to reference Denning DG, Conwell Y, King D, Cox C: Method choice, intent, and gender in completed suicide. Suicide Life Threat Behav. 2000, 30: 282-828.PubMed Denning DG, Conwell Y, King D, Cox C: Method choice, intent, and gender in completed suicide. Suicide Life Threat Behav. 2000, 30: 282-828.PubMed
39.
go back to reference Putkonen H, Amon S, Eronen M, Klier CM, Almiron MP, Cederwall JY, Weizmann-Henelius G: Gender differences in filicide offense characteristics-a comprehensive register-based study of child murder in two European countries. Child Abuse Negl. 2011, 35: 319-328. 10.1016/j.chiabu.2011.01.007.CrossRefPubMed Putkonen H, Amon S, Eronen M, Klier CM, Almiron MP, Cederwall JY, Weizmann-Henelius G: Gender differences in filicide offense characteristics-a comprehensive register-based study of child murder in two European countries. Child Abuse Negl. 2011, 35: 319-328. 10.1016/j.chiabu.2011.01.007.CrossRefPubMed
40.
go back to reference Browne ML, Lewis-Michl EL, Stark AD: Watercraft-related drownings among New York State residents, 1988–1994. Public Health Rep. 2003, 118: 459-463.PubMedPubMedCentral Browne ML, Lewis-Michl EL, Stark AD: Watercraft-related drownings among New York State residents, 1988–1994. Public Health Rep. 2003, 118: 459-463.PubMedPubMedCentral
41.
go back to reference Warner M, Smith GS, Langley JD: Drowning and alcohol in New Zealand: what do the coroner’s files tell us?. Aust N Z J Public Health. 2000, 24: 387-390. 10.1111/j.1467-842X.2000.tb01599.x.CrossRefPubMed Warner M, Smith GS, Langley JD: Drowning and alcohol in New Zealand: what do the coroner’s files tell us?. Aust N Z J Public Health. 2000, 24: 387-390. 10.1111/j.1467-842X.2000.tb01599.x.CrossRefPubMed
42.
go back to reference Smith GS, Keyl PM, Hadley JA, Bartley CL, Foss RD, Tolbert WG, McKnight J: Drinking and recreational boating fatalities: a population-based case–control study. JAMA. 2001, 286: 2974-2980. 10.1001/jama.286.23.2974.CrossRefPubMed Smith GS, Keyl PM, Hadley JA, Bartley CL, Foss RD, Tolbert WG, McKnight J: Drinking and recreational boating fatalities: a population-based case–control study. JAMA. 2001, 286: 2974-2980. 10.1001/jama.286.23.2974.CrossRefPubMed
43.
go back to reference Meister KA, Whelan EM, Kava R: The health effects of moderate alcohol intake in humans: an epidemiologic review. Crit Rev Clin Lab Sci. 2000, 37: 261-296. 10.1080/10408360091174222.CrossRefPubMed Meister KA, Whelan EM, Kava R: The health effects of moderate alcohol intake in humans: an epidemiologic review. Crit Rev Clin Lab Sci. 2000, 37: 261-296. 10.1080/10408360091174222.CrossRefPubMed
44.
go back to reference Evans L: Traffic Safety, Alcohol. Bloomfield, Michigan; Science Serving Society Printed in United States of America. 2006, 237-269. Evans L: Traffic Safety, Alcohol. Bloomfield, Michigan; Science Serving Society Printed in United States of America. 2006, 237-269.
45.
go back to reference Howland J, Smith GS, Mangione T, Hingson R, DeJong W, Bell N: Missing the boat on drinking and boating. JAMA. 1993, 270: 91-92. 10.1001/jama.1993.03510010097037.CrossRefPubMed Howland J, Smith GS, Mangione T, Hingson R, DeJong W, Bell N: Missing the boat on drinking and boating. JAMA. 1993, 270: 91-92. 10.1001/jama.1993.03510010097037.CrossRefPubMed
46.
go back to reference Cummings P, Quan L: Trends in unintentional drowning: the role of alcohol and medical care. JAMA. 1999, 281: 2198-2202. 10.1001/jama.281.23.2198.CrossRefPubMed Cummings P, Quan L: Trends in unintentional drowning: the role of alcohol and medical care. JAMA. 1999, 281: 2198-2202. 10.1001/jama.281.23.2198.CrossRefPubMed
47.
go back to reference Ohberg A, Lonnqvist J: Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998, 98: 214-218. 10.1111/j.1600-0447.1998.tb10069.x.CrossRefPubMed Ohberg A, Lonnqvist J: Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998, 98: 214-218. 10.1111/j.1600-0447.1998.tb10069.x.CrossRefPubMed
48.
go back to reference Taylor C, Cooper J, Appleby L: Is suicide risk taken seriously in heavy drinkers who harm themselves?. Acta Psychiatr Scand. 1999, 100: 309-311. 10.1111/j.1600-0447.1999.tb10866.x.CrossRefPubMed Taylor C, Cooper J, Appleby L: Is suicide risk taken seriously in heavy drinkers who harm themselves?. Acta Psychiatr Scand. 1999, 100: 309-311. 10.1111/j.1600-0447.1999.tb10866.x.CrossRefPubMed
49.
go back to reference O’Hanlon JF: Ten ways for physicians to minimize the risk of patients causing traffic accidents while under influence of prescribed psychoactive medication. Primary Care Psychiatr. 1995, 1: 77-85. O’Hanlon JF: Ten ways for physicians to minimize the risk of patients causing traffic accidents while under influence of prescribed psychoactive medication. Primary Care Psychiatr. 1995, 1: 77-85.
50.
go back to reference Engeland A, Skurveit S, Mørland J: Risk of road traffic accidents associated with the prescription of drugs: a registry-based cohort study. Ann Epidemiol. 2007, 17: 597-602. 10.1016/j.annepidem.2007.03.009.CrossRefPubMed Engeland A, Skurveit S, Mørland J: Risk of road traffic accidents associated with the prescription of drugs: a registry-based cohort study. Ann Epidemiol. 2007, 17: 597-602. 10.1016/j.annepidem.2007.03.009.CrossRefPubMed
51.
go back to reference Mørland J: Driving under the influence of non-alcohol drugs. Forensic Sci. 2000, 12: 80-105. Review Mørland J: Driving under the influence of non-alcohol drugs. Forensic Sci. 2000, 12: 80-105. Review
52.
go back to reference Hindmarch I, Kerr JS, Sherwood N: The effects of alcohol and other drugs on psychomotor performance and cognitive function. Alcohol Alcohol. 1991, 26: 71-79.PubMed Hindmarch I, Kerr JS, Sherwood N: The effects of alcohol and other drugs on psychomotor performance and cognitive function. Alcohol Alcohol. 1991, 26: 71-79.PubMed
54.
go back to reference Suominen P, Baillie C, Korpela R, Rautanen S, Ranta S, Olkkola KT: Impact of age, submersion time and water temperature on outcome in near-drowning. Resuscitation. 2002, 52: 247-254. 10.1016/S0300-9572(01)00478-6.CrossRefPubMed Suominen P, Baillie C, Korpela R, Rautanen S, Ranta S, Olkkola KT: Impact of age, submersion time and water temperature on outcome in near-drowning. Resuscitation. 2002, 52: 247-254. 10.1016/S0300-9572(01)00478-6.CrossRefPubMed
55.
go back to reference Driscoll TR, Harrison JA, Steenkamp M: Review of the role of alcohol in drowning associated with recreational aquatic activity. Inj Prev. 2004, 10: 107-113. 10.1136/ip.2003.004390.CrossRefPubMedPubMedCentral Driscoll TR, Harrison JA, Steenkamp M: Review of the role of alcohol in drowning associated with recreational aquatic activity. Inj Prev. 2004, 10: 107-113. 10.1136/ip.2003.004390.CrossRefPubMedPubMedCentral
56.
go back to reference Wintemute GJ, Teret SP, Kraus JF, Wright M: Alcohol and drowning: an analysis of contributing factors and a discussion of criteria for case selection. Accid Anal Prev. 1990, 22: 291-296. 10.1016/0001-4575(90)90020-L.CrossRefPubMed Wintemute GJ, Teret SP, Kraus JF, Wright M: Alcohol and drowning: an analysis of contributing factors and a discussion of criteria for case selection. Accid Anal Prev. 1990, 22: 291-296. 10.1016/0001-4575(90)90020-L.CrossRefPubMed
Metadata
Title
Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs – a retrospective study, 1992–2009
Authors
Kristin Ahlm
Britt-Inger Saveman
Ulf Björnstig
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-216

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