PubMed · 3217788
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J Horgan. 1988. All fall down.. https://doi.org/10.1038/scientificamerican0988-32a
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BACKGROUND: Whether putative suicide risk factors, such as conduct and emotional disorders, are specific to suicide or are general associations of a continuum between subintentional and intentional self-destruction is not clear. We undertook an investigation of this issue in a UK population-based birth cohort. METHODS: Using competing-risks analysis, we examined links between prospectively collected childhood and adolescent temperamental and behavioural variables and the risk of natural, accidental, and suicidal death, occurring between the ages of 16 and 50 years. Of the 5362 members of the cohort, full data were available for 3591. A panel of psychiatrists scored deaths on likely suicidal intention. These scores were used in a weighted logistic regression to examine independence of risk factors for (sub)intentional self-destruction. FINDINGS: There were 167 deaths among the risk-set between the 16th and 50th birthdays. 120 were due to natural causes; of the other 47, the panel of psychiatrists judged that 36 were accidental deaths and 11 were suicides (certainty rating > or = 51%). Adolescent emotional instability and conduct problems had different associations with the various causes of premature death, being lowest for natural death (odds ratio 1.0 [95% CI 0.8-1.2] and 1.2 [1.0-1.5]), intermediate for accidental death (1.1 [0.8-1.5] and 1.3 [1.0-1.7]), and highest for suicidal death (2.0 [1.2-3.6] and 1.8 [1.3-2.5]). Emotional instability (boys 1.3 [1.0-1.7], girls 1.4 [1.0-1.9]) increased risk for subintentional or intentional self-destruction, as did low anxiety in adolescence (1.7 [1.3-2.5]) and nocturnal enuresis at age 4 (1.4 [1.2-1.7]) in boys, and conduct problems in girls (1.4 [1.0-2.0]). INTERPRETATION: Suicide shares important risk factors with other causes of premature death. These findings suggest an aetiological continuum of self-destruction from subintentional to intentional. Research on premature mortality associated with psychological disorder should include all causes of death.
OBJECTIVES: To examine whether elimination of fatal diseases will increase healthcare costs. DESIGN: Mortality data from vital statistics combined with healthcare spending in a cause elimination life table. Costs were allocated to specific diseases through the various healthcare registers. SETTING AND SUBJECTS: The population of the Netherlands, 1988. MAIN OUTCOME MEASURES: Healthcare costs of a synthetic life table cohort, expressed as life time expected costs. RESULTS: The life time expected healthcare costs for 1988 in the Netherlands were 56,600 Pounds for men and 80,900 Pounds for women. Elimination of fatal diseases--such as coronary heart disease, cancer, or chronic obstructive lung disease--increases healthcare costs. Major savings will be achieved only by elimination of non-fatal disease--such as musculoskeletal diseases and mental disorders. CONCLUSION: The aim of prevention is to spare people from avoidable misery and death not to save money on the healthcare system. In countries with low mortality, elimination of fatal diseases by successful prevention increases healthcare spending because of the medical expenses during added life years.
We present two cases of a rare entity: pharyngeal perforation caused by blunt external neck trauma. In both cases the patients were asymptomatic for the first 24 h and the results of laryngoscopic study were negative, and it was only possible to demonstrate rupture through the radiologic findings. Early diagnosis is essential as delay in treatment increases morbidity and mortality.