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At least 253 records · Page 14Linked to original sources
PubMed1998

Trends in opiate overdose deaths in Australia 1979-1995.

AIMS: To determine if there had been an increase in the rate of opioid overdose deaths between 1979 and 1995, and to describe the characteristics of persons who died of an opioid overdose. METHOD: Opioid overdose deaths were defined according to ICD-9 as deaths due to drug dependence (codes 304.0 and 304.7) and accidental opiate poisoning (code E850.0). Data were obtained from a national register of deaths compiled by the Australian Bureau of Statistics on: age at death, sex and jurisdiction of all such deaths between 1979 and 1995 inclusive. Mortality rates were calculated for each sex for the 15-24, 25-34 and 35-44 age groups. RESULTS: The number of opioid overdose deaths rose from 70 in 1979 to 550 in 1995. The rate (per million of the population aged 15-44) increased from 10.7 to 67.0. The increase was more marked among males than females, increasing 6.8 times among males (from 15.3 in 1979 to 104.6 in 1995) and 4.7 times among females (from 5.9 in 1979 to 27.9 in 1995). New South Wales consistently accounted for around a half of all male overdose fatalities and its overdose mortality rate was almost twice that in Victoria, and three times that in the remaining states. The average age at death for males increased from 24.5 years in 1979 to 30.6 years in 1995. The increase in overdose mortality was greatest among men and women aged 35 to 44 years, and 25 and 34 years. An analysis by birth cohort showed that 46% of male overdose deaths and 50% of female overdose deaths in the period occurred among those born between 1960 and 1969. Deaths among persons born between 1950 and 1959 accounted for 38% of male and 33% of female deaths. CONCLUSIONS: There has been a statistically significant increase in opioid overdose mortality between 1979 and 1995, most of it occurring among persons who initiated heroin use in the late 1970s and early 1980s. Recent initiations of heroin use among those born between 1970 and 1979 have begun to be reflected in an increased rate of opioid overdose deaths. If their mortality experience replicates that of earlier birth cohorts then opioid overdose mortality will continue to increase.

Adolescent↗
PubMed1998

Unexplained and explained natural deaths among persons above 1 year of age in a series of medico-legal autopsies.

The aim of this study was to describe unexplained and explained natural deaths among decreased above 1 year of age in a series of medico-legal autopsies collected over a 20-year period (1972-1992). Unexplained natural deaths can be defined as those deaths where no cause-of-death is revealed after post-mortem and without circumstances indicating violent death. The death was considered to be natural in 491 cases above 1 year of age among a total of 2004 medico-legal autopsies. In 428 of these cases an explanation as to the cause-of-death was reached. The three most frequently encountered causes-of-death were complications to coronary atherosclerosis (62.6%), diseases of the lung (12.4%) and diseases in the central nervous system (9.8%). Among 59 cases with unexplained natural death, 50 had various chronic diseases or fatty liver. In 43 of these cases the deceased had epilepsy or chronic alcoholism. In nine cases (1.8% of the natural deaths) no explanation to the cause-of-death could be given.

Adolescent↗
PubMed1999

A practical approach to evaluate the potential donor pool and trends in cadaveric kidney donation.

BACKGROUND: The potential supply of transplantable cadaver kidneys is often expressed as donors per million population (pmp), which ignores some essential factors governing organ donation. METHODS: We performed a modeled analysis of kidney donor extraction rates by age, gender, race, cause of death, geographic region, and year in a cohort of evaluable deaths and actual cadaver donors between the ages of 1 and 65 years (1988-1993). Evaluable death was defined as an in-hospital death in patients between the ages of 1 and 65 years whose ICD-9-CM cause of death was not an obvious contraindication to kidney donation. The main outcome measures were the crude donation rate and an adjusted donor extraction rate (DER) per 1000 evaluable deaths. RESULTS: A total of 1.4x10(6) in-hospital deaths produced 300,502 evaluable deaths and 20,575 actual donors. Between 1989 and 1993, DER increased from 61.1 to 75 per 1,000 evaluable deaths. DERs were highest among the youngest age groups, declining significantly with age from 405.0 to 16.7/1,000 evaluable deaths for age groups 1-10 and 56-65 years, respectively. There was a small difference in donors pmp between blacks and whites (15 vs. 18). In contrast, DER was seven times higher in whites compared with blacks (112.5 vs. 16.5/1,000 evaluable deaths; P<0.001). The crude donation rate (per 1,000 evaluable deaths) was high for stroke (604.8) and trauma-related deaths (230.6), resulting in highly efficient donor extraction from these deaths. Region-specific DERs ranged from 49.4 to 83/1,000 evaluable deaths and differed significantly from the corresponding donors pmp. CONCLUSIONS: Estimating kidney donation relative to in-hospital evaluable deaths is a meaningful measure of organ procurement efficiency. Efforts to enhance cadaveric kidney donation should seek to understand and reduce the marked demographic and regional disparity in donor extraction rates.

Adult↗
PubMed1978

Sudden death in Auckland.

A representative sample of all sudden cardiac deaths occurring in Auckland in one year is reported. Data describing demographic variables, personal characteristics and habits, previous symptoms, prodromal symptoms, the acute phase and post mortem results, is presented. Incidence values are very close to those of other similar communities. The syndrome of "sudden death" probably defines a heterogenous group of cases. Deaths were significantly more common in the cooler months, and in the lowest social class. Some evidence is presented consistent with the hypothesis that a high alcohol intake is associated with sudden death. No differences were found between cases dying within five minutes and those dying later but within 24 hours, considering several variables. Myocardial fibrosis at post mortem was a common finding. The role of the coronary ambulance is briefly discussed.

Adult↗
PubMed1999

Birth-weight-specific perinatal mortality in Japan, 1989-1993: singleton versus multifetal pregnancies.

OBJECTIVE: To investigate the relation between birth weight and perinatal mortality in multifetal pregnancies, which is more than 5 times higher than for singleton infants. METHODS: We assessed the incidence of perinatal deaths based on birth weight in 89,566 infants of multifetal pregnancies and 6,025,199 infants of singleton pregnancies in Japan. Perinatal death was defined as stillbirth and early neonatal death (death <1 week of age). RESULTS: The incidence of perinatal death was consistently lower for infants of multifetal pregnancies than for infants of singleton pregnancies at birth weights of 500-2,499 g. However, the incidence of infants of multifetal pregnancies with birth weights >/=2,500 g consistently exceeded that in singleton infants weighing >/=2,500 g. The relative risk (95% CI) of perinatal death among infants of multifetal pregnancies compared with singleton infants in the same category of birth weight was 0.88 (0.84-0.93) at 500 g. The relative risk decreased to 0.31 (0.25-0.39) at 1,900 g, increased to >1.0 at 2,500 g, to 3.7 (2.2-6.1) at 3,000 g, and to 14.9 (7.8-28.4) at >/=3,500 g. CONCLUSIONS: Japanese infants of multifetal pregnancies reaching >/=2,500 g in body weight have a significantly higher risk of perinatal death than singleton infants in the same category of body weight. Increased monitoring of fetuses of multifetal pregnancies who weigh >/=2,500 g may be helpful in reducing the incidence of perinatal mortality.

Birth Weight↗
PubMed1993

Statutory definitions of death and the management of terminally ill patients who may become organ donors after death.

The law stipulates that death is irreversible. Patients treated in accord with the Pittsburgh protocol have death pronounced when their condition might well be reversed by intervention that is intentionally withheld. Nevertheless, the protocol is in accord with the medical "Guidelines for the Determination of Death." However, the Guidelines fail to capture the intent of the law, which turns out to be a good thing, for the law embodies a faulty definition of death. The inclusion of "irreversible" in the legal definition makes that definition excessively demanding and out of step with the ordinary concept of death. On this basis the protocol is absolved of the moral but not the legal charge that it involves vivisection.

Death↗
PubMed1991

Brain death, religious freedom, and public policy: New Jersey's landmark legislative initiative.

"Whole brain death" (neurological death) is well-established as a legal standard of death across the country. Recently, New Jersey became the first state to enact a statute recognizing a personal religious exemption (a conscience clause) protecting the rights of those who object to neurological death. The Act also mandates adoption through the regulatory process of uniform and up-to-date clinical criteria for determining neurological death.

Advisory Committees↗
PubMed1991

Ascertainment of maternal deaths in New York City.

Maternal deaths in New York City are defined as deaths from any cause in a woman while pregnant or within six months of pregnancy termination. Pilot studies seeking to improve maternal death ascertainment found that selected medical examiner reports contributed an additional 10.5 percent of the total maternal deaths, vital statistics review contributed 6.3 percent, linkage of death tapes of women of reproductive age to live birth and fetal death tapes contributed 1.0 percent. Medical examiner cases should be incorporated into surveillance data for accurate ascertainment of pregnancy associated deaths.

Adolescent↗
PubMedDate not supplied

Causes of mortality in an African city.

Registered deaths from the vital statistics registration system of Lagos City, a system that was judged to be 60% complete, were analysed for the year 1977. Nearly 40% of total registered deaths were from infections, parasitic diseases and motor vehicle accidents. Of the reported deaths, 17.3% were from ill-defined conditions. Deaths from neoplasms, diseases of the nervous and sense organs, diseases of the digestive and genitourinary systems as well as those from congenital anomalies are relatively less frequent. Maternal mortality appears to be very high. The age pattern of mortality is different from that in the developed countries, a high proportion of the deaths in Lagos City being those of children aged under 5 years. Infant mortality is dominated by perinatal causes which constituted a huge 38.4% of deaths of infants under 1 year, the other important causes being dysentery and diarrhoea, pneumonia and tetanus. Among adults, death from motor vehicles accidents is the most important cause accounting for more than 26% of deaths in the age group 15 years and above. Other important causes of adult deaths are cerebrovascular disease, hypertensive disease, heart disease, pneumonia, dysentery and diarrhoea and complications of pregnancy. Well organized health services stressing antenatal care, preventive and health education services are needed to effect a reduction in mortality and bring about a general improvement in the health of the people.

Adolescent↗
PubMedDate not supplied

Paternal involvement after perinatal death.

This study describes paternal involvement after perinatal death in a large, mostly minority, lower socioeconomic status sample. Paternal presence at birth, holding the baby, and presence at a follow-up appointment were the indicators of paternal involvement. Perinatal death was defined as miscarriage, stillbirth, or neonatal death within 12 hours of birth. Data were collected from a retrospective chart review under the auspices of the Perinatal Mortality Counseling Program at Shands Hospital at the University of Florida, a tertiary care referral center in north central Florida. The sample included 722 cases of perinatal death between July 1978 and April 1991. The results indicated that many fathers experienced perinatal grief. More than half attended the birth, a quarter chose to hold their baby, and one fifth returned with the mother to follow-up appointments. Paternal-maternal cohabitation was the variable most predictive of the fathers' involvement after perinatal death. Race was predictive of the father being present at birth and at the follow-up visit, with white fathers more likely to be present than black fathers. Married fathers and those employed in a professional or manual labor occupation were more likely to be present at the birth than fathers who were unemployed, students, incarcerated, or in the military. Gestational age was predictive of the father holding the baby, with the likelihood increasing 1.04 times for each week of increase in gestational age. This study supports the need to include fathers in grief counseling, and the further investigation of the involvement of fathers when a perinatal death occurs.

Adult↗
PubMed1993

[Theological-ethical theses of organ transplantation].

The message of the resurrection from the dead is meant to human beings living and dying in the unity of body and soul. The personality of man is unseparably connected with this unity--even beyond the death. The brain death only marks a (decisive) point during the process of dying, but the brain death cannot be defined as the death of a human being (in general). Theological ethics object to this definition and to a new dualism of brain and body as well as of body and personality (resp. soul), because this dualism socializes the organs of individuals and denies the personal dignity of disappearing life. Therefore the explantation of organs must depend on a personal declaration of consent given by the adult sponsor himself. And each information given on organ transplants must clarify that the explantation of organs means an interruption of dying.

Ethics, Medical↗
PubMed1998

Clinical outcome and predictive factors of failure of highly active antiretroviral therapy in antiretroviral-experienced patients in advanced stages of HIV-1 infection.

OBJECTIVE: To verify the effectiveness of highly active antiretroviral therapy (HAART) and to identify any factors predictive of clinical outcome in a clinical setting. DESIGN: Observational study. METHODS: Treatment failure (i.e., the occurrence of new or recurrent AIDS-defining events, death or any definitive discontinuation) and the course of CD4+ cell counts and HIV RNA copies were evaluated in 250 heavily pretreated HIV-infected patients starting HAART [153 with indinavir (IDV), 55 with ritonavir (RTV), 43 with saquinavir (SQV)]. Univariate and multivariate analyses were performed to identify predictors of worse outcome. RESULTS: During a median follow-up of 8 months, 75 patients (30%) had treatment failure because of the occurrence of an AIDS-defining event or death (n = 24), inefficacy (n = 24), or severe intolerance (n = 27). Twenty new and six recurrent AIDS-defining events, and nine deaths occurred (six out of 20 AIDS-defining events and two out of nine deaths within 1 month of treatment). CD4+ counts were above 200 x 10(6)/l at AIDS diagnosis in only two patients. None of the SQV patients, 12 (7.8%) of the IDV patients, and 15 (27.3%) of the RTV-treated patients were considered non-compliant. The SQV-containing regimens independently correlated with treatment failure (relative risk, 2.46; 95% confidence interval, 1.20-5.03; versus IDV). Low compliance partially determined outcome in RTV-treated patients; both severe immunodepression and AIDS at baseline were predictive of treatment failure. There was a 10-fold increase in CD4+ cell counts in the patients treated with IDV and RTV; the best virological outcome occurred in IDV-treated patients, with 68.4% of patients showing undetectable HIV RNA copies after 6 months. CONCLUSIONS: HAART was effective in 70% of patients; low compliance and previous AIDS diagnosis represented predictive factors of therapy failure.

Adult↗
PubMed1999

Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis.

BACKGROUND AND PURPOSE: Treatment of cerebral sinus thrombosis with heparin is controversial. We conducted a double-blind, placebo-controlled multicenter trial to examine whether anticoagulant treatment improves outcome in patients with sinus thrombosis. METHODS: Patients were randomized between body weight-adjusted subcutaneous nadroparin (180 anti-factor Xa units/kg per 24 hours) and matching placebo for 3 weeks (double-blind part of trial), followed by 3 months of oral anticoagulants for patients allocated nadroparin (open part). Patients with cerebral hemorrhage caused by sinus thrombosis were also included. RESULTS: Sixty patients were enrolled, and none were lost to follow-up. In 1 patient the diagnosis proved wrong after randomization. After 3 weeks, 6 of 30 patients (20%) in the nadroparin group and 7 of 29 patients (24%) in the placebo group had a poor outcome, defined as death or Barthel Index score of <15 (risk difference, -4%; 95% CI, -25 to 17%; NS). After 12 weeks, 4 of 30 patients (13%) in the nadroparin group and 6 of 29 (21%) in the placebo group had a poor outcome, defined as death or Oxford Handicap Score of >/=3 (risk difference, -7%; 95% CI, -26% to 12%; NS). There were no new symptomatic cerebral hemorrhages. One patient in the nadroparin group had a major gastrointestinal hemorrhage, and 1 patient in the placebo group died from clinically suspected pulmonary embolism. CONCLUSIONS: Patients with cerebral sinus thrombosis treated with anticoagulants (low-molecular-weight heparin followed by oral anticoagulation) had a favorable outcome more often than controls, but the difference was not statistically significant. Anticoagulation proved to be safe, even in patients with cerebral hemorrhage.

Adolescent↗
PubMed2001

Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage.

OBJECTIVE: To investigate whether accurate prognostic rules can be derived from the combined results of studies concerning prediction of poor prognosis in anoxic-ischaemic coma with biochemical markers of brain damage in cerebrospinal fluid (CSF) or serum. DESIGN: A meta-analysis of prognostic studies in anoxic-ischaemic coma, selected from Medline and EMBASE databases, according to predefined criteria. SUBJECTS: Twenty-eight studies, with a total of 802 unselected, consecutive patients, in which tests, sampling time and outcome measures were described unequivocally and results were described using clear cut-off values or raw data. MAIN OUTCOME MEASURES: Poor outcome, defined as death or vegetative state, versus good outcome, defined as any other outcome state. ANALYSES: The overall prognostic accuracy of these variables was expressed as the 95% CIs of the pooled false-positive test rate and the pooled positive-likelihood ratios. RESULTS: Only markers in CSF (creatine kinase isoenzyme (CKBB) >204 U/l, neuron specific enolase (NSE) >33 ng/ml, lactate dehydrogenase (LDH) >82 U/l and glutamate oxaloacetate (GOT) >62 U/l) reached a 0% false-positive rate. However, due to small sample sizes, the confidence limits were wide. The accuracy of prediction of poor outcome seemed acceptably high for CSF-CKBB (pooled false-positive rate 0% [95% CI 0-2.3%]; pooled positive-likelihood ratio 33.2 [95% CI 4.8-230.2]), but this result was based on two retrospective studies without blinding of the treating physicians for the test result. CONCLUSIONS: Because of small numbers of patients studied and methodological limitations the combined results are not sufficiently accurate to provide a solid basis for non-treatment decisions.

Aspartate Aminotransferases↗
PubMed2002

Prospective study of coroner's autopsies in Benin City, Nigeria.

A prospective study of 726 cases of coroner's autopsies carried out over a period of two years (1st January, 1996 - 31st December, 1997) was reviewed. The causes and circumstances of death are defined and classified into natural and unnatural deaths. Fifty cases (6.3%) were children while the remaining 676 cases (93.1%) were adults in a male to female ratio of 2.6 to 1. The most common indications for coroner's autopsies were sudden unnatural deaths (SUDs) accounting for 485 cases (66.8%) and also sudden unexpected natural deaths (SUNDs) (241 cases) accounting for 33.2%. In the first category, road traffic accidents accounted for 86.7% of cases with deaths involving motor vehicle drivers and their passengers (41.8%); pedestrians (37.1%); and motorcyclists and their passengers (18.6%). The commonest causes of death in all road traffic accidents were craniocerebral injuries and haemorrhagic shock. In the second category the most common causes of sudden unexpected natural death were cardiovascular diseases resulting from complications of hypertension (54.7%) occurring in apparently healthy individuals. Other causes of death were pneumonia, pulmonary tuberculosis, typhoid fever and neoplastic diseases. This study showed that in Nigeria, with an increasing acquisition of dietary and life style habits of the developed western world, there is becoming a concomitant risk of deaths from road traffic accidents and sudden unexpected natural deaths from hypertensive cardiovascular disease.

Abortion, Induced↗
PubMed2006

[Estimation of the range of excess death associated with influenza epidemics: application of a model using annual mortality rates and the seasonal index for determining minimum excess mortality estimates].

OBJECTIVE: To determine the range of excess death associated with influenza in Japan. METHODS: The monthly rates for mortality from all causes other than accidents (ICD9: E800-E949, ICD-10: V01-X59) were determined from the Japanese national vital statistics for 1987-2003. By employing a model using the annual mortality rates and the seasonal index, the number of expected deaths and the 95% range of mortality in the absence of influenza-associated deaths (normal range) were obtained. Point estimation of excess mortality during an influenza season was performed by calculation of differences between the number of deaths observed and the number of deaths expected. The range of excess death was defined: the lower limit of the excess death was performed by calculation of difference between the number of deaths observed and the upper limit of the normal range. The upper limit of the excess death, on the contrary, was performed by calculation of difference between the number of deaths observed and the lower limit of the normal range. Based on the results of a survey of tendencies in the occurrence of infectious diseases, months showing a high prevalence of influenza and associated deaths were regarded as "months when the rate of death from influenza was 0.9 deaths/100,000 person-years or higher". RESULTS: The excess death determined by point estimation was largest in 1999, followed by 1995, 1993, 1997, 2000, and 2003. The point estimation (range of excess death) in 1999 was approximately 49,000 (approximate range, 37,000-60,000). Correspondingly, the excess death in 1995 was approximately 38,000 (approximate range, 27,000-48,000). While values in 1993, 1997, 2000, and 2003 were in the approximate range of 21,000 to 25,000, the range of excess death of each year showed the differences: approximate range from 15,000 to 36,000 in 1993, from 18,000 to 31,000 in 1997, from 18,000 to 28,000 in 2000, and from 11,000 to 34,000 in 2003, respectively. From comparison of the range of excess deaths by year, that in 1995 appeared to be the largest among the examined years. CONCLUSION: By considering the range of variation in the number of deaths in the years when no influenza epidemics occurred, the increase (the largest number and smallest number of deaths) associated with elevation the prevalence of influenza could be determined. Estimation of the range of excess deaths can be considered a useful method for understanding the influence of influenza on public health.

Disease Outbreaks↗