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PubMed1984

The biochemical changes in pericardial fluid after death. An investigation of the relationship between the time since death and the rise or fall in electrolyte and enzyme concentrations and their possible usefulness in determining the time of death.

This paper reports the biochemical changes that occur in pericardial fluid after death. Significant changes in relation to the time since death occurred in potassium, sodium, phosphate, protein and several commonly measured enzymes. The variation in individual results at similar times since death would limit the use of pericardial fluid biochemistry in determining the time of death.

Body Fluids↗
PubMed1996

Smoking and the sudden infant death syndrome: results from 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers.

OBJECTIVE: To investigate the effects of exposure to tobacco smoke and of parental consumption of alcohol and illegal drugs as risk factors for the sudden infant death syndrome after a national risk reduction campaign which included advice on prenatal and postnatal avoidance of tobacco smoke. DESIGN: Two year population based case-control study. Parental interviews were conducted for each infant who died and four controls matched for age and date of interview. SETTING: Three regions in England with a total population of 17 million people. SUBJECTS: 195 babies who died and 780 matched controls. RESULTS: More index than control mothers (62.6% v 25.1%) smoked during pregnancy (multivariate odds ratio = 2.10; 95% confidence interval 1.24 to 3.54). Paternal smoking had an additional independent effect when other factors were controlled for (2.50; 1.48 to 4.22). The risk of death rose with increasing postnatal exposure to tobacco smoke, which had an additive effect among those also exposed to maternal smoking during pregnancy (2.93; 1.56 to 5.48). The population attributable risk was over 61%, which implies that the numbers of deaths from the syndrome could be reduced by almost two third if parents did not smoke. Alcohol use was higher among index than control mothers but was strongly correlated with smoking and on multivariate analysis was not found to have any additional independent effect. Illegal drug use was more common among the index parents, and paternal use of illegal drugs remained significant in the multivariate model (4.68; 1.56 to 14.05). CONCLUSIONS: This study confirms the increased risk of the sudden infant death syndrome associated with maternal smoking during pregnancy and shows evidence that household exposure to tobacco smoke has an independent additive effect. Parental drug misuse has an additional small but significant effect.

Alcohol Drinking↗
PubMed2004

Synthetic peptides corresponding to ligand-binding region of death receptors, DR5, Fas, and TNFR, specifically inhibit cell death mediated by the death ligands, respectively.

Apoptosis as well as cell growth and cell differentiation play an important role in the maintenance of homeostasis in multicellular organisms. Disruption of apoptosis causes serious diseases, such as cancer, chronic inflammatory diseases, and autoimmune diseases; therefore, the control of apoptosis is one of the most promising therapeutic approaches to these apoptosis-disrupted diseases. Apoptosis is mediated by soluble factors, which belong to the TNF superfamily, such as TNF-alpha, FasL, and TRAIL. Here, we report that we deduced ligand-binding domains based on the structure of apoptosis ligand-receptor complex, and the synthetic peptide corresponding to residues 91-102 of DR5 indeed showed specific binding to TRAIL molecule and inhibited TRAIL-induced cell death both in L929 cells and in HeLa cells. The other death receptor-derived peptides, which are the corresponding regions of TNFR1 and Fas, also showed specific binding to TNF-alpha and FasL and inhibited the ligand-induced cell death, respectively. These results suggest that the position of the ligand-binding region is conserved among these death-receptor family members, whereas the primary amino acid sequence determines ligand specificity.

Amino Acid Sequence↗
PubMed1998

NICE, a new cause of death classification for stillbirths and neonatal deaths. Neonatal and Intrauterine Death Classification according to Etiology.

BACKGROUND: Stillbirths and neonatal deaths are often the result of a complicated chain of events. For epidemiological purposes a classification into single cause of death groups is essential. For large-scale studies, a method is needed which enables such grouping based on available register data. METHODS: A cause of death classification system called NICE is presented. It is hierarchical and is aetiologically orientated. A computerized method is adapted which makes use of data in four central Swedish registries. A validation of the computer method has been made from the medical records on a 10% sample of all stillbirths and neonatally dead infants in Sweden from 1983 to 1990. RESULTS: The specificity of the computer method is high, sensitivity is less satisfactory for some subgroups. A time trend analysis illustrates the usefulness of the classification system and shows a decline with time for two groups: placental abruption and obstetric complications. CONCLUSIONS: The NICE classification system fulfils the criteria of an aetiologically orientated classification system which can be used in a computerized environment.

Cause of Death↗
PubMed1989

[Cause of death statistics and death certificate documentation of stillborn infants and infants. II: Preventable errors in filling out death certificates for stillborn infants and for infants dying before 1 year of age].

The analysis of 311 death certificates of stillbirths and dead persons under one year revealed a lot of mistakes both in the diagnostic and nondiagnostic part of the form. All mistakes are mentioned and discussed. 90% of the death certificates had been written out by obstetricians and pediatrists, but also pathologists made many mistakes. It is recommended to perform a training referring hereto for obstetricians, pediatrists, neonatologists, pathologists and specialists in forensic medicine on the one hand and to combine the various rules printed in the pocket- and handbook of ICD and in the interpretations of LEOPOLD and HUNGER on the other.

Cause of Death↗
PubMed1996

Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers.

OBJECTIVE: To investigate the role of sleeping arrangements as risk factors for the sudden infant death syndrome after a national risk reduction campaign. DESIGN: Two year population based case-control study. Parental interviews were conducted for each infant who died and for four controls matched for age and date of interview. SETTING: Three regions in England with a total population of 17 million people. SUBJECTS: 195 babies who died and 780 matched controls. RESULTS: Prone and side sleeping positions both carried increased risks of death compared with supine when adjusted for maternal age, parity, gestation, birth weight, exposure to smoke, and other relevant factors in the sleeping environment (multivariate odds ratio = 9.00 (95% confidence interval 2.84 to 28.47) and 1.84 (1.02 to 3.31), respectively). The higher incidence of side rather than prone sleeping led to a higher population attributable risk (side 18.4%, prone 14.2%). More of the infants who died were found with bed covers over their heads (21.58; 6.21 to 74.99). The use of a dummy had an apparent protective effect (0.38; 0.21 to 0.70). Bed sharing for the whole night was a significant risk factor for infants whose mothers smoked (9.25; 2.31 to 34.02). No protective effect of breast feeding could be identified on multivariate analysis. CONCLUSIONS: This study confirms the importance of certain risk factors for the sudden infant death syndrome and identifies others-for example, covers over the head, side sleeping position-which may be amenable to change by educating and informing parents and health care professionals.

Bedding and Linens↗
PubMed2003

Death anxiety, death depression, and death obsession.

In a sample of 67 students, scores from Templer's and the Collett-Lester death anxiety scales, Templer, et al.'s death depression scale, and Abdel-Khalek's death obsession scale were only moderately associated, suggesting that the scales are measuring somewhat different constructs.

Adult↗
PubMed1993

Legal status of brain death in Japan: why many Japanese do not accept "brain death" as a definition of death.

Several speculations on the reasoning for the lack of performance of organ transplants from brain-dead donors in Japan for the last 8 months since the official acceptance of the recent Final Report will be presented. Such obstinate reluctance shown by the Japanese population against organ transplantation from brain-dead donors is certainly an unusual situation. There must be definitely some serious reasons underlying it. No one seems, however, to be able to pinpoint them, although there have been several speculations. The main purpose of my paper today concerns "Why many Japanese do not accept 'brain death' as a definition of death of a person".

Advisory Committees↗
PubMed2006

Conformational diseases and ER stress-mediated cell death: apoptotic cell death and autophagic cell death.

The expanded polyglutamine (polyQ) tracts observed in autosomal dominant neurodegenerative disorders have the tendency to form intracellular aggregates, thus enhancing apoptotic cell death and the formation of autophagic vesicles. PolyQ accumulation inhibits the ER-associated degradation system (ERAD) resulting in reduced retrotranslocation from the ER and increased accumulation of misfolded proteins in the lumen of ER. Autophagy is an early cellular defense mechanism associated with ER stress, but prolonged ER stress may induce autophagic cell death, with destruction of cellular components and apoptotic cell death. Endoplasmic reticulum (ER) stress may be the key signal for both of these events.

Animals↗
PubMed2005

[Epidemiology of 25 years of crib death (sudden infant death syndrome) in the Netherlands; incidence of crib death and prevalence of risk factors in 1980-2004].

OBJECTIVE: To describe the prevalence of risk factors and the incidence of cot death (sudden infant death syndrome; SIDS) in the Netherlands during the last 25 years. DESIGN: Descriptive. METHOD: The incidence of cot death/SIDS in infants aged 7-365 days in 1980-2004 was derived from Statistics Netherlands, the Dutch Central Bureau of Statistics. The prevalence of risk factors for cot death/SIDS in the general population was derived from national surveys of baby clinics (0-9 months; 1985-2004) and studies of cot death/SIDS victims (0-23 months; 1984-1991 and 1996/'04). RESULTS: The prevalence of the following risk factors for cot death/SIDS has decreased: primary prone sleeping position (from 60% to 8%), the use of a duvet (from 85% to 18%), maternal smoking (from 34% to 20%), paternal smoking (from 48% to 32%). The prevalence of routine bed-sharing with a parent increased from nearly 0% to 5%. The registered incidence of cot death/SIDS per 100,000 live births decreased from 103 in 1986 to < 15 in 2003 and 2004. The incidence of cot deaths/SIDS that occurred during habitual bed-sharing with a parent, in a playpen, in child-care settings, or in a secondary prone sleeping position increased. CONCLUSION: The incidence of cot death/SIDS and the prevalence of known risk factors for cot death/SIDS has decreased. New risk factors have emerged in recent years. Considering the evolving conditions of infant care, an ongoing study on the special features of child care and the factors involved in cases of cot death/SIDS is warranted. This knowledge is essential for periodic adaptation of the national prevention programme.

Bedding and Linens↗
PubMed1976

What middle-aged men know of their parents' cause of death and age at death. A comparison between history and death certificate.

Middle-aged men's knowledge of the circumstances of their parents' diseases and death is reliable to such an extent that it can be used when appropriate for therapeutic purposes in familial diseases. This conclusion is based on findings in a health examination survey of 441 middle-aged men in Uppsala, Sweden where the men were asked whether their parents were dead and, if so, the known cause of death and at what age they had died. The information reported was then compared with the official data kept by the authorities. In 87% of cases it was possible to perform such a comparison. The study showed good conformity of the two sources, in general.

Accidents↗
PubMed2002

A single-center review of the death notification form: discontinuing dialysis before death is not a surrogate for withdrawal from dialysis.

BACKGROUND: Form 2746, the death notification form, is the primary source of data on cause of death for patients with end-stage renal disease in the United States. Since the revised form was introduced in May 1990, withdrawal from dialysis is no longer a specific cause of death code. A separate section of form 2746 asks whether dialysis was discontinued before death. Based on US Renal Data System data from form 2746, more than 20% of dialysis patients discontinue dialysis before death. It is not known whether stopping dialysis is a proximate cause of death in these patients. METHODS: Two hundred twelve death notification forms completed between January 1, 1993, and December 31, 2000, from a single dialysis center were reviewed for location of death, primary and secondary causes of death, and whether dialysis therapy was discontinued before death. Dialysis unit and hospital billing records of patients who discontinued dialysis before death were reviewed to obtain the dates of hospitalization and last dialysis treatment before death. RESULTS: Fifty-six patients (26%) discontinued dialysis therapy before death. In only 8 of those patients' deaths (8 of 212 deaths; 4% of all patient deaths), nephrologists used form 2746 to attribute the death to uremia from stopping dialysis therapy. Time in days from the last dialysis treatment to death in these 8 patients was longer than in the remaining 48 patients who stopped dialysis therapy before death, but in whom cause of death was not coded as uremia (median, 12.5 versus 5 days, respectively; P = 0.01). Patients who stopped dialysis therapy before death were more likely to have malignancy and less likely to have cardiovascular disease coded as cause of death. Most patients died in the hospital; only 2 patients died in hospice. CONCLUSION: There is physician variability in interpretation of discontinuation of dialysis before death. Thirty percent of patients who discontinued dialysis therapy before death died 3 or fewer days from their last dialysis treatment, making uremia an unlikely cause of death, but suggesting that nephrologists wanted to note that a decision not to continue dialysis therapy had been made before the patient died. Discontinuing dialysis therapy as noted on the death notification form is not a surrogate for withdrawal from dialysis as a cause of death. Providing criteria for reporting discontinuing dialysis therapy would allow us to clarify the incidence of withdrawal from dialysis as a cause of death.

Adult↗
PubMed2000

Coping of parents and siblings with the death of a child with cancer: death after terminal care compared with death during active anticancer therapy.

Seventy pediatric patients with cancer treated at the Hospital for Children and Adolescents, University of Helsinki, Finland, died while in terminal care and 30 children of therapy-related complications during active anticancer therapy in the period 1987-92. The purpose of this study was to compare these groups and characterize the main problems of the families during the mourning process. The method of evaluation was a structured interview of every parent separately. Parents of 60/70 children after terminal care, and parents of 26/30 children who died during active anticancer therapy, were interviewed. Unexpectedly, differences were minimal between families who lost a child after terminal care and those whose child died during active anticancer therapy. Parents reported physical and/or mental problems with similar frequency (39% and 34%); average self-reported recovery times were similar (14 and 16 mo); return to work was similar in both groups, 70% returning doing so within 1 mo. However, pronounced differences were observed between the mothers and the fathers; the mothers requiring longer recovery times and returning to work later. Of the siblings, 18% in the terminal care group had problems compared with 32% in the active therapy group. These included fear, behavioral problems, problems with friends and school-related problems. In conclusion, when a child with cancer dies, the ability of the respective families to cope does not seem to differ whether the child dies after terminal care or during active anticancer therapy. The inevitable loss of the child is the major event. Most parents and siblings have the potential and ability to recover normally after the death of a child, although they will never be completely the same.

Adaptation, Psychological↗
PubMed1991

Benefits of implantable defibrillators are overestimated by sudden death rates and better represented by the total arrhythmic death rate.

Benefits of the implantable defibrillator on survival were studied in 56 consecutive patients (concomitant coronary bypass or arrythmia surgery in 15) during an 8 year period between 1982 and 1990. During a follow-up period of 29 +/- 25 months, six patients had a sudden death and eight patients had a nonsudden cardiac death. Nonsudden cardiac deaths included three surgical deaths (death within 30 days after the surgery; two in patients without and one in a patient with concomitant cardiac surgery), one arrhythmia-related nonsudden death (death within 24 h after an arrhythmic event despite initial termination of the arrhythmia by the implantable defibrillators) and four nonarrhythmic cardiac deaths. The actuarial survival rate free of events at 1, 2 and 3 years was 96%, 96% and 92%, respectively, for sudden death, 91%, 91% and 87% for sudden death and surgical mortality and 89%, 89% and 85% for total arrhythmic death (sudden death, surgical mortality and arrhythmia-related nonsudden death). Thus, in patients treated with an implantable defibrillator, 1) the rate of sudden death is low (8% at 3 years); 2) 50% of nonsudden cardiac deaths are causally related to arrhythmia (surgical mortality or arrhythmia-related nonsudden death); 3) the total arrhythmic death rate is substantially higher than the sudden death rate; and 4) benefits of an implantable defibrillator are overestimated by reported sudden death and nonsudden cardiac death rates. The benefits may be better represented by the total arrhythmic death and nonarrhythmic cardiac death rates.

Actuarial Analysis↗
PubMed1997

Endothelial cell death in organ-cultured donor corneae: the influence of traumatic versus nontraumatic cause of death.

BACKGROUND: Donors who have suffered a traumatic death are, on average, younger than those who have died from other causes, and the time from death to enucleation (DET) also tends to be shorter. Corneae obtained from such donors are therefore considered particularly suitable for grafting. One of the reasons for excluding a donor cornea from transplantation is the occurrence of endothelial cell necrosis during organ culture, and we investigated whether the incidence of this phenomenon bears a relationship to death by traumatic or nontraumatic means. METHODS: Data from 2125 donor corneae were collected using standardized evaluation protocols between January 1991 and December 1995 and included information on cause of death, age and DET, as well as endothelial cell loss and necrosis. Traumatic deaths were recorded in 346 cases, nontraumatic deaths in the other 1779 cases. Since differences in age (P = 0.006) but not in DET occurred within each of these groups, a more refined comparison, with matched data (< 35 years), was also undertaken. RESULTS: Forty (11.6%) of the 346 corneae derived from traumatic death donors manifested total or partial endothelial cell death in organ culture. The corresponding figure in the nontraumatic death group was only 105/1779 (5.8%; P = 0.0002). After matching for age, endothelial cell death during culturing was revealed in 18 (13.5%) of the 133 of the traumatic death corneae and in 3 (2.6%) of the 115 nontraumatic death ones (P = 0.004); the overall incidence of endothelial cell death (total or partial) during organ culture was 6.8% (145/2125). Endothelial cell loss during culturing of the 227 age-matched donor corneae which still had an intact endothelial monolayer at the end of the incubation period was 340 +/- 388 cells/mm2 in traumatic death corneae (n = 115) and 255 +/- 318 cells/mm2 in nontraumatic death ones (n = 112; P = 0.051). CONCLUSION: Corneae obtained from traumatic death donors were more liable to undergo total or partial endothelial cell death during organ culture than were those procured from nontraumatic death ones. However, in corneae which survived the period of culture, there was no significant difference in endothelial cell loss between the two groups. Whilst the mechanism underlying this increased susceptibility of traumatic death corneae to cell death remains elusive, the data gleaned from this investigation nonetheless emphasize the potential importance of being able to perform meaningful in vitro viability tests on donor corneae; this is possible only under organ culture conditions.

Adult↗
PubMed1998

Accuracy of death certificates for coding coronary heart disease as the cause of death.

BACKGROUND: Death certificates are widely used in epidemiologic and clinical investigations and for national statistics. OBJECTIVE: To examine the accuracy of death certificates for coding coronary heart disease as the underlying cause of death. DESIGN: Community-based inception cohort followed since 1948. SETTING: Framingham, Massachusetts. PATIENTS: 2683 deceased Framingham Heart Study participants. MEASUREMENTS: Sensitivity, specificity, and predictive values of the death certificate. The reference standard was cause of death adjudicated by a panel of three physicians. RESULTS: Among 2683 decedents, the death certificate coded coronary heart disease as the underlying cause of death for 942; the physician panel assigned coronary heart disease for 758. The death certificate had a sensitivity of 83.8% (95% CI, 81.1 % to 86.4%), positive predictive value of 67.4% (CI, 64.4% to 70.4%), specificity of 84.1% (CI, 82.4% to 85.7%), and negative predictive value of 92.9% (CI, 91.7% to 94.1%) for coronary heart disease. The death certificate assigned coronary heart disease in 51.2% of 242 deaths (9.0% of total deaths) for which the physician panel could not determine a cause. Compared with the physician panel, the death certificate attributed 24.3% more deaths to coronary heart disease overall and more than twice as many deaths to coronary heart disease in decedents who were at least 85 years of age. When deaths that were assigned unknown cause by the physician panel were excluded, the death certificate still assigned more deaths to coronary heart disease (7.9% overall and 43.1% in the oldest age group). CONCLUSIONS: Coronary heart disease may be overrepresented as a cause of death on death certificates. National mortality statistics, which are based on death certificate data, may overestimate the frequency of coronary heart disease by 7.9% to 24.3% overall and by as much as two-fold in older persons.

Adult↗
PubMed2002

National underascertainment of sudden unexpected infant deaths associated with deaths of unknown cause.

OBJECTIVE: To investigate underascertainment of unexpected infant deaths at the national level as a result of probable classification as attributable to unknown cause. METHODS: Using linked birth and death certificates for all US birth cohorts from 1983-1991 and 1995-1996, we identified 53 470 sudden infant death syndrome (SIDS) fatalities, 9071 unintentional injury deaths, 3473 injury deaths classified with intentional or suspicious intent, and 8097 deaths with unknown underlying cause. For these deaths, we compared relative risks (RRs) for maternal and infant variables available on birth certificates known to be predictive of SIDS, unintentional injury, and homicides. Variables available on death certificates were compared for unlinked and linked records. Factors related to state and national management of cases pending final cause determination are reviewed. RESULTS: For deaths from unknown cause, rates were consistently high among the same risk groups that have been shown to be at increased risk for SIDS, unintentional injury, and homicides. For most risk factors, RRs for deaths attributable to unknown causes were somewhat lower than for RRs for intentional/suspicious injury deaths but higher than for SIDS or unintentional injury, indicating combined contributions from all causes. For example, age at death from unknown cause includes RRs that more strongly resemble patterns of intentional/suspicious injuries than SIDS or unintentional injury. Deaths from unknown cause were more likely to occur during the first week of life for unattended births occurring outside clinical settings or when birth certificates were not found, similar to intentional/suspicious injury deaths. CONCLUSIONS: Risk profiles indicate that deaths of unknown cause are likely to represent a mixture of unexpected deaths. The process for determination of cause of unexpected death affects national underascertainment of SIDS and injury deaths. Better coordination among child fatality review teams and local, state, and national officials should reduce underascertainment and improve documentation of circumstances surrounding deaths for prevention efforts.

Adolescent↗