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PubMedDate not supplied

Sudden infant death syndrome as a socially determined cause of death.

The background characteristics of infant deaths which have been certified by physicians as due to Sudden Infant Death Syndrome (SIDS) are examined. Two alternative models for explaining SIDS deaths are considered. The first views SIDS solely in medical/biological terms, while the second emphasizes the role played by social and cultural factors, either as contributing conditions or as factors in the misattribution of SIDS as the cause of death where other conditions are actually present. Data are based on linked birth and death certificates for the 1980-82 cohort of live births in Florida, which have been merged with NCHS reports of multiple cause of death. Analysis suggests a pattern of SIDS reporting which varies inversely with maternal education, prenatal care, and race/ethnicity. This pattern suggests either that social factors affect the etiology of the syndrome to a greater degree than would be expected from the medical/biological model or that deaths to infants of lower socioeconomic status are attributed to SIDS more often than warranted.

Cause of Death↗
PubMed1998

Toward a broader definition of heat-related death: comparison of mortality estimates from medical examiners' classification with those from total death differentials during the July 1995 heat wave in Chicago, Illinois.

The classification of heat-related deaths solely according to body temperatures underestimates the magnitude of heat-related mortality during heat waves. Broader classifications are often used, but their utility in defining the mortality and identifying at-risk populations has not been evaluated. Using death data from the July 1995 heat wave in Chicago, the authors compared heat-related mortality rates based on the classification of heat-related deaths by the Cook County Medical Examiner's Office (CCMEO), with excess mortality rates based on total mortality differentials during and before the heat wave. In July 1995, the overall mortality in Chicago was 19 deaths per 100,000 population for heat-related mortality and 24 to 26 deaths per 100,000 population for excess mortality. Across Chicago community areas, the two mortality rates were closely related (r = 0.73-0.79; p < .01), but heat-related mortality rates were lower than excess mortality rates in community areas where excess mortality rates were higher (slope < 1; p < .01), a finding indicating an underestimation of heat-related deaths in such areas. The underestimation could not be explained by uncertainties in estimating excess mortality rates or by differences in socioeconomic and demographic characteristics among communities. These results support using the broader CCMEO classification of heat-related deaths as a relative indicator to target communities for prevention and relief efforts, but not as an adequate measure of actual heat-related mortality in a high-risk neighborhood.

Aged↗
PubMed2005

Experiences of families when a relative is diagnosed brain stem dead: understanding of death, observation of brain stem death testing and attitudes to organ donation.

Brain stem death may be a difficult concept for relatives to understand. Our ITU practice follows published recommendations that the use of explanatory leaflets showing CT scans and observing brain stem death testing in some cases may help relatives to understand that death has occurred. Using this strategy, we interviewed 27 relatives 12 months after bereavement following certification by brain stem testing, investigating their understanding of brain stem death, subsequent attitudes to organ donation, grief reactions and attitudes of those who had observed the tests. Most relatives understood that the brain stem death tests indicated that survival was not possible, although three relatives had not fully understood this and valued the opportunity to discuss it again. Only five relatives observed the tests, all were pleased that they had done so as this had confirmed their understanding that death had occurred; however, these relatives had more evidence of psychological distress. No relatives who agreed to organ donation regretted this but three who did not allow donation subsequently expressed regret. Several relatives thought that observing the tests would have helped them to understand that death had occurred, making easier the decision to allow organ donation.

Adult↗
PubMed2002

Trends in postneonatal aspiration deaths and reclassification of sudden infant death syndrome: impact of the "Back to Sleep" program.

OBJECTIVE: The introduction of the "Back to Sleep" campaign for the prevention of sudden infant death syndrome (SIDS) brought with it concern that there might be an increase in the incidence of aspiration-related deaths. The objective of this analysis was to describe the trends in postneonatal mortality and proportionate mortality ratios for the United States for the years 1991 to 1996 for aspiration-related deaths and other causes to which a SIDS death could conceivably be reclassified. METHODS: Linked birth and infant death vital statistic files for the United States were used for the years 1991, 1995, and 1996. US Vital Statistic Mortality files for the years 1992, 1993, and 1994 were used because of the absence of linked files for those years. RESULTS: The overall postneonatal mortality rate between 1991 and 1996 declined 21.9%, whereas the SIDS rate declined 38.9%. The proportion of the postneonatal mortality (PNPMR) contributed by SIDS declined from 37.1% in 1991 to 28.8% in 1996. There was no significant increase in the PNPMR for aspiration, asphyxia, or respiratory failure. There was, however, a significant increase in the PNPMR for suffocation in bed or cradle from 0.9 to 1.3. CONCLUSIONS: These data show no evidence of an increased risk of death from aspiration as a result of the "Back to Sleep" program. Although there has been an increase in the proportion of postneonatal mortality attributable to suffocation, this represents a very small proportion of postneonatal mortality and thus potentially a very small number of SIDS deaths reclassified as suffocation.

Adult↗
PubMed1989

Fetal death ratios in a prospective study compared to state fetal death certificate reporting.

A cohort of 6,254 pregnancies surviving at least 20 weeks of gestation was identified through pregnancy testing and follow-up at three Kaiser Permanente medical offices in northern California in 1981-82. Fetal death ratios per 1,000 live births were 12.1 for all fetal deaths versus 5.0 for the subset of fetal deaths reported to the California state registrar. Only fetal deaths resulting in overnight hospitalization of the mother were reported. Seventy-nine percent of fetal deaths over 28 completed weeks since the last menstrual period (LMP) were reported versus only 10 percent between 20 and 28 completed weeks since the LMP. Ninety-three percent of fetuses over 400 grams were reported. The unreported fetal deaths were mainly those perceived by attending physicians as spontaneous abortion, especially missed or incomplete spontaneous abortion. Physicians apparently preferred the label of spontaneous abortion over stillbirth or fetal death whenever fetal maturity could not be substantiated, regardless of prior estimates of the date of the LMP. Fetuses as large and developed as potentially viable infants were the most likely to be reported.

California↗
PubMed2006

Deaths attributed to X-ray contrast media on U.S. death certificates.

OBJECTIVE: The objectives of our study were to determine the number, rate, and types of deaths attributed to specific X-ray contrast media on the basis of U.S. death certificates and to attempt to assess the comparative safety of commonly used diagnostic X-ray contrast agents using death certificate information. CONCLUSION: From 1999 through 2001, deaths attributed to the International Classification of Diseases (ICD) code for contrast media occurred at the rate of 1.1-1.2 per million contrast media packages distributed. An analysis of 1999 death certificates indicated that most deaths attributed to contrast media predictably were associated with renal failure or nephropathy and anaphylaxis or allergic reactions. Risk assessment of the comparative safety of classes or agents was limited by lack of specific contrast media names. Names of administered contrast agents should be recorded in patients' medical records and communicated to primary care physicians and certifiers of death in the event of serious sequelae after an identified recent radiologic procedure.

Cause of Death↗
PubMed1987

Cause of death. Proper completion of the death certificate.

Mortality statistics derived from death certificates are the only continuously collected, population-based, disease-related information available in most parts of the world, including the United States. For this reason, every effort must be made to ensure that the most specific, accurate, and complete information regarding cause of death is registered on death certificates. This article discusses identification of the underlying and immediate causes of death, the mechanism and manner of death, and completion of the medical certification section of the death certificate. Examples are given to illustrate the appropriate sequencing of casual information and the selection of the proper underlying causes of death.

Cause of Death↗
PubMed1990

[Toxicomania: death beyond risk. Analysis of cause-of-death in drug addicts].

Violent deaths are of considerable importance among young adults, since they account for half the deaths in this age group (average age 26.4 years). Suicide and accidents (both categories including drug overdoses) are the most frequent categories of deaths from non-natural causes, while in the USA deaths by homicide are also of considerable importance. Current repressive policies have not brought the problem of drug addiction under control. Each year deaths by overdose among drug abusers occur. Nevertheless, 40% of deaths among drug addicts are from other causes, principally accidents and suicides. In the near future, AIDS may well account for the majority of deaths among drug addicts, thus adding to the mortality from overdose, both accidental and suicidal. Has the time come to reconsider the problem of drug abuse and to find radical solutions which would previously have been unthinkable?

Accidents↗
PubMed1993

Numbers of infant deaths in Scotland, with special reference to sudden infant death syndrome.

There has been an increased interest during 1992 in the numbers of deaths from Sudden Infant Death Syndrome, because of reports of reductions in the numbers in several countries where changes in advice on infant care had been made. Numbers of infant deaths in general and of those due to the syndrome in particular are described and analysed by some of the variables which are provided at the time of registration. The decline in the number of deaths from the syndrome reported recently by the Scottish Cot Death Trust is supported by the full figures for 1991. This decline probably started about the latter part of 1990, well before the official letters giving advice on infant care that had been associated with a decline elsewhere. It was more marked in some areas of Scotland than others. There appears to be a cyclical pattern in the time-series of the numbers of deaths from the syndrome. Further investigation, both of the cyclical movement and of the recent decline in relation to other variables, would be worthwhile. Deaths in the neonatal period from the syndrome and those from other causes have both declined markedly during 1990 and 1991, after several years when the movements in their numbers seemed to be in opposite directions.

Age Factors↗
PubMed1998

Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community.

BACKGROUND: Some people in states of excited delirium die while in police custody. Emerging evidence suggests that physical restraint in certain positions may contribute to such deaths. In this study the authors determined the frequency of physical restraint among people in a state of excited delirium who died unexpectedly. METHODS: The authors reviewed the records of 21 cases of unexpected death in people with excited delirium, which were investigated by the Office of the Chief Coroner for Ontario between 1988 and 1995. Eyewitness testimony, findings during postmortem examinations, clinical history, toxicological data and other official documents describing the events surrounding the deaths were analyzed. Specific reference was made to documented eyewitness testimony of restraint method, body position and use of capsicum oleoresin (pepper) spray. Because cocaine was detected in the blood of some of these people during the postmortem examination, the role of cocaine in excited delirium was examined by comparing the cocaine levels in these cases with levels in 2 control groups: 19 people who died from acute cocaine intoxication and 21 people who had used cocaine shortly before they died but who had died from other causes. RESULTS: In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivity), with the person either in a prone position (18 people [86%]) or subjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained. The excited delirium was caused by a psychiatric disorder in 12 people (57%) and by cocaine-induced psychosis in 8 (38%). Eighteen people (86%) were in police custody when they died. Four (19%) had been sprayed with capsicum oleoresin, and heart disease was found in another 4 at autopsy. The blood level of cocaine in those whose excited delirium was cocaine induced was similar to levels found in recreational cocaine users and lower than levels found in people who died from cocaine intoxication. INTERPRETATION: Restraint may contribute to the death of people in states of excited delirium, and further studies to test this hypothesis are recommended. Meanwhile, law enforcement authorities and others should bear in mind the potential for the unexpected death of people in states of excited delirium who are restrained in the prone position or with a neck hold.

Adolescent↗
PubMed1995

The relationship of religious variables to death depression and death anxiety.

The present research explored the relationship of religious variables to death anxiety and death depression in 200 persons from the general population in what is apparently the first study to correlate religious variables with death depression. Persons with lower death depression had greater strength of conviction, greater belief in afterlife, and were less likely to say that the most important aspect of religion is that it offers the possibility of life after death. Persons with less death anxiety were found to have greater strength of conviction. The findings were discussed in relationship to previous research that has suggested that religious belief is associated more closely with death anxiety level than is religious practice.

Adaptation, Psychological↗
PubMed1995

Completeness of AIDS reporting and quality of AIDS death certification in Tuscany (Italy): a linkage study between surveillance system of cases and death certificates.

In Italy, the AIDS cases defined according to the CDC criteria are reported to the National AIDS Registry (RAIDS, compulsory surveillance system). The aim of the present study is to evaluate the completeness of AIDS cases reported and the quality of AIDS death certification in an Italian Region (Tuscany, about 3,500,000 inhabitants). The 737 AIDS cases reported to RAIDS as residents in Tuscany (1987-91) were cross-linked (key link: name and date of birth) with the data of the Mortality Registration system of the Region (RMR). For the residents in Tuscany decreased with a 279.1 death diagnosis (the code for AIDS deaths stated by the Italian Census Bureau) and not reported to RAIDS as AIDS cases, the clinical records were reviewed to check whether the diagnosis fitted the 1987-CDC diagnostic criteria. This study shows that there is a high completeness (97-98%) of the AIDS cases resident in Tuscany, reported to the RAIDS. The quality of RAIDS data is not as good with regard to life status assessment (23% of under-reporting of death). In Tuscany, the death certification for AIDS (code 279.1 of ICD IX) has a sensitivity of 88% and a specificity around 100% in comparison to RAIDS. About 50% of 'false negatives' in death certification are due to causes of death presumably unrelated to HIV infection. The evaluation of the quality of AIDS surveillance and mortality data is important in the assessment of the impact for AIDS epidemic in a target population.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Insulinlike growth factor-1 inhibits cell death induced by cycloheximide in MCF-7 cells: a model system for analyzing control of cell death.

Prolonged exposure of cells to the potent protein synthesis inhibitor cycloheximide terminates in cell death. In the present study we investigated the effect of insulinlike growth factor-1, insulin, and epidermal growth factor on cell death induced by cycloheximide in the confluent MCF-7 cells, and correlated this effect to the inhibition rate of protein synthesis. Cell death was evaluated by measuring either dead cells by the trypan blue dye exclusion test or by the release of lactic dehydrogenase into the culture medium. After 48 h incubation, cycloheximide (10 to 50 micrograms/ml) was shown to induce cell death in a concentration-dependent manner. Insulinlike growth factor-1, at physiologic concentrations (0.2 to 5 ng/ml), reduced this cell death. Insulin at supraphysiologic concentrations (1 to 10 micrograms/ml) mimicked the effect of insulinlike growth factor-1, whereas epidermal growth factor (10 to 50 ng/ml) had no effect. More than 90% of protein synthesis measured by [3H]leucine incorporation was inhibited by 10 to 50 micrograms/ml cycloheximide. Insulinlike growth factor-1 and insulin at the concentrations that reduced cell death to control level, had no effect on the protein synthesis inhibition rate induced by cycloheximide. These results indicate that inhibition of cell death by insulinlike growth factor-1 does not depend on protein synthesis and may be mediated via a posttranslational modification effect.

Breast Neoplasms↗
PubMed2000

Deaths from cerebrovascular diseases correlated to month of birth: elevated risk of death from subarachnoid hemorrhage among summer-born.

It has been suggested that maternal nutrition, and fetal and infant growth have an important effect on the risk of cardiovascular disease in adult life. We investigated the population-based distribution of deaths from cerebrovascular diseases (ICD9 codes 430, 431, or 434) in Japan in 1986-1994 as a function of birth month, by examining death-certificate records. For a total of 853 981 people born in the years 1900-1959, the distribution of the number of deaths according to the month of birth was compared with the distribution expected from the monthly numbers of all births for each sex and for the corresponding birth decade. For those born between 1920 and 1949, there were significant discrepancies between the actual numbers of deaths from subarachnoid hemorrhage (ICD9 430) and the numbers expected, and these differences were related to the month of birth. Those born in summer, June-September, consistently had an elevated risk of death, particularly men, where the excess risk was 8%-23%. This tendency was also observed, less distinctly but significantly, for deaths from intracerebral hemorrhage (ICD9 431), but was not observed for those dying from occlusion of the cerebral arteries (ICD9 434). The observation that the risk of dying from subarachnoid hemorrhage was more than 10% higher among those born in the summer implies that at least one in ten deaths from subarachnoid hemorrhage has its origin at a perinatal stage. Although variations in hypertension in later life, which could possibly be "programmed" during the intra-uterine stages, could be an explanation for this observation, the disease-specific nature of the observation suggests the involvement of aneurysm formation, which is a predominant cause of subarachnoid hemorrhage.

Aged↗
PubMedDate not supplied

Neck extension and rotation in sudden infant death syndrome and other natural infant deaths.

It has been hypothesized that some cases of sudden infant death syndrome (SIDS) are a result of neck extension and/or rotation that causes vertebral artery (VA) compression and brain stem ischemia. There is a paucity of relevant literature on this topic. Therefore, our aim was to compare neck rotation and extension in SIDS and other natural infant deaths. Cases of SIDS and other natural infant deaths within the San Diego SIDS Research Project database were analyzed retrospectively with respect to neck and body position as reported by the trained, experienced scene investigators and/or the caretakers who discovered the infants. Information was used from 246 SIDS cases and 56 cases of other natural deaths. Simultaneous neck extension and rotation was not reported in either group. When data regarding neutral/flexed/extended position and rotation of the neck were combined, no significant differences were found between the two groups (P = 0.94); 40% of the SIDS cases and 41% of the other natural death cases were found with the neck either extended or rotated (odds ratio [OR] 0.97, [reference group = neck either neutral or flexed, and not rotated], 95% confidence interval [CI] 0.45, 2.11). There were also no significant differences between the groups when neck rotation and neck extension were analyzed independent of one another. Neck rotation among cases found in the prone position was common and was not significantly different between the two groups (49% of 146 SIDS cases, 58% of 24 other natural death cases, P = 0.38, OR 0.68, 95% CI 0.28, 1.62). Neck rotation among infants found in the supine position occurred one-third as often in the SIDS group (9% of 33 cases) as in the other natural death group (29% of 14 cases); however, the difference was not significant (P = 0.17; OR 0.25, 95% CI 0.05, 1.31). Although our analysis does not exclude VA compression and brain stem ischemia in some cases of SIDS, we found no evidence to affirm its importance. This study demonstrates the importance of meticulous scene descriptions, including neck position.

Female↗
PubMed1989

Sudden infant death and chronic infant disorders: the N.E.S.T. model versus the lethal Cot-death syndrome hoax.

The Cot-death Syndrome is an out-moded model which is bizarre and unique in medical history for it enables a certificate of cause of death to be issued only if no medical cause can be found. It rewards incompetence. Apart from being a placebo for bereaved parents and a lucrative source of research funds it is unsupportable, lethal nonsense and it must be discarded. There are studies which prove that most infant death and chronic infant illnesses are linked and are primarily associated with environmental stress. The infant death problem is not a medical problem except where the stress trauma is of medical origin. The N.E.S.T. (Non-disease Environmental Stress Trauma) perspective provides a model which has elements of causation, prediction and prevention. It requires that intense investigation be carried out in an unbiased manner that is not hindered by a convenience syndrome barrier to truth. Unfortunately twenty years of adherence to the medical profession's Cot-death Syndrome hoax has meant that the evidence pin-pointing specific, causative environmental stress factors has been denigrated and disregarded. This has permitted the asthma convenience syndrome to thrive. Still-birth or infant death that is not due to disease or inherited causation can only be caused by environment stress trauma. Identifying and preventing such stress trauma is the key to healthy birth and to avoiding infant death and chronic infant disorders.

Environment↗
PubMed2004

Inhibition of both the extrinsic and intrinsic death pathways through nonhomotypic death-fold interactions.

Death-fold domains constitute an evolutionarily conserved superfamily that mediates apoptotic signaling. These motifs, including CARD (caspase recruitment domain), DD (death domain), and DED (death effector domain), are believed to exert their effects solely through homotypic interactions. Herein we demonstrate that the CARD-containing protein ARC engages in nontraditional death-fold interactions to suppress both extrinsic and intrinsic death pathways. The extrinsic pathway is disrupted by heterotypic interactions between ARC's CARD and the DDs of Fas and FADD, which inhibit Fas-FADD binding and assembly of the death-inducing signaling complex (DISC). The intrinsic pathway is antagonized by ARC-Bax binding, involving ARC's CARD and the Bax C terminus. This inhibits Bax activation and translocation to the mitochondria. Knockdown of endogenous ARC facilitates DISC assembly and triggers spontaneous Bax activation and apoptosis. Conversely, physiological levels of ARC suppress these events. These studies establish a critical role for nonhomotypic death-fold interactions in the regulation of apoptosis.

Adenoviridae↗
PubMed1998

Fetal blood sampling immediately before and within 24 hours of death in monochorionic twin pregnancies complicated by single intrauterine death.

OBJECTIVE: Our goal was to investigate the mechanisms that play a role in intrauterine death in monochorionic twins and that contribute to the high perinatal mortality and morbidity in the survivors. STUDY DESIGN: In 8 monochorionic twin pregnancies complicated by the intrauterine death of a single twin, we took samples from 5 twin fetuses immediately before death and from 4 of their cotwins and also from 4 surviving fetuses within 24 hours after death of the cotwin. RESULTS: Four of the 5 fetuses sampled who subsequently died were acidemic and 3 were hypoxemic. None of these fetuses or their cotwins were anemic at that time. All 4 survivors sampled within 24 hours of the death of each cotwin had low hematocrits. CONCLUSION: Fetal anemia, probably the consequence of acute blood loss just before the time of death of the cotwin, may play a role in the high mortality and morbidity found in the surviving twin. It is unlikely that immediate delivery of the surviving twin after death could affect the outcome.

Acid-Base Equilibrium↗