"Death talk": debating euthanasia and physician-assisted suicide in Australia.
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[Cause od death statistics and death certificate documentation. 1. Historical development of cause of death statistics of fetal death, infants and children and current regulations in the GDR].
After having described the beginnings of documentation and statistics of causes of death of newborns and children the development of this branch of medical statistics in the GDR and the introduction of a special death certificate in 1961 is dealt with. To help obstetricians, perinatologists and pediatrists to tackle the problem of documentation of the causes of death of stillborns and newborns the 9th revision of ICD, the nowadays valid death certificate and special rules of signing are explained to avoid mistakes, which are often met with in the daily practice.
Cause of Death↗
Effect of quinidine or procainamide versus no antiarrhythmic drug on sudden cardiac death, total cardiac death, and total death in elderly patients with heart disease and complex ventricular arrhythmias.
A prospective study correlated the effect of quinidine or procainamide versus no antiarrhythmic drug on sudden cardiac death, total cardiac death and total death in 406 elderly patients with heart disease and asymptomatic complex ventricular arrhythmias detected by 24-hour ambulatory electrocardiograms. Of 397 patients treated with quinidine, 184 (46%) developed adverse effects during the first 2 weeks of therapy and were given no further antiarrhythmic therapy. Of 9 patients treated with procainamide, 2 (22%) developed adverse effects during the first 2 weeks of therapy and were given no further antiarrhythmic therapy. Adverse effects developed during long-term therapy in 6 patients (2%) receiving quinidine and in 3 patients (33%) receiving procainamide. Mean follow-up was 24 +/- 15 months in both groups. Sudden cardiac death, total cardiac death and total death occurred in 21, 43 and 65% of patients receiving quinidine or procainamide, respectively, and in 23, 44 and 63% of patients receiving no antiarrhythmic drug, respectively (difference not significant). Survival by Kaplan-Meier analysis showed no significant difference between the 2 groups for sudden cardiac death, total cardiac death or total death through 4 years. Patients with abnormal left ventricular ejection fraction had a 3.4 times higher incidence of sudden cardiac death, a 2.4 times higher incidence of total cardiac death and a 1.4 times higher incidence of total death than patients with normal left ventricular ejection fraction. These data showed no significant difference in sudden cardiac death, total cardiac death or total death between patients treated with quinidine or procainamide or with no antiarrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Lack of precision in neonatal death classifications based on the underlying causes of death stated on death certificates.
Large-scale analyses of causes of neonatal deaths are usually based on death-certificate information. A new computer-based method has been introduced to define the cause of stillbirths and neonatal deaths in large amounts of material and to classify them according to two different models [Wigglesworth and Neonatal and Intrauterine death Classification according to (a)Etiology (NICE)]. The method is based on a combination of detailed information from health care registries and the death-certificate information. The present study aimed to compare these two classification models with a previously published method based solely on death certificate information [International Collaborative Effort (ICE)]. The study population comprised 2378 neonatal deaths in Sweden between 1987 and 1992. Cross-tabulation was made between the ICE classification and the other two classification models. In addition, case examples are presented in detail, exemplifying how classification errors arose. The ICE classification gives a rather low precision, notably for two important causes of death: asphyxia and immaturity. Among 328 infants dying from asphyxia according to computerized Wigglesworth classification, ICE classified 59% as asphyxia and 22% were labelled immaturity. When ICE classified the deaths as due to asphyxia, this was verified in only 50%. Among 792 infants dying from immaturity according to computerized Wigglesworth classification, 64% were classified as such by ICE. The findings cast doubts on the results of studies based exclusively on death-certificate information. Whenever possible in the analysis of neonatal deaths, death-certificate information should be supplemented with more detailed data. The computer-based method introduced here makes such analyses possible for large databases.
Cause of Death↗
Why are a quarter of all cancer deaths in south-east England registered by death certificate only? Factors related to death certificate only registrations in the Thames Cancer Registry between 1987 and 1989.
This paper describes the results of a study set up to investigate factors associated with the high proportions of 'death certificate only' registrations (DCOs) for all cancers registered in south-east England between 1987 and 1989 and to identify those which might be subject to registry intervention. DCOs as a proportion of all registrations (n = 162,131) were analysed by age, sex, district of residence, place of death and survival. DCO registration ratios (standardised for age and sex) were then derived for each of the 56 districts in the Thames Regions. A multiple logistic regression model was generated to estimate the effect of age at diagnosis, tumour survival and patient sex on final source of registration. To minimise the number of dummy variables needed, each of the 56 districts was ranked into quartiles: quartile 1 contained the 14 districts with the lowest age- and sex-standardised ratios for DCO registrations and quartile 4 comprised the 14 districts with the highest DCO ratios. Final source of registration was treated as a binomial trial (case notes or death certificates). The significance of associations was measured using the deviance difference as an approximate chi-square statistic. The effect of each variable on source of registration was estimated as an odds ratio. Interaction terms were also fitted. To estimate the effect of place of death on DCO registrations, a second model was generated for deceased patients only (n = 98,455, adding 'place of death' to the list of explanatory variables already used. A further interaction term was fitted to account for interaction between place of death and district quartile of residence. Around 24% of all patient deaths were registered as DCOs by the Thames Cancer Registry between 1987 and 1989. Of these, 40.9% died in an acute NHS hospital setting, 37.1% died at home, 10.4% died in hospices and 3.4% died in non-NHS hospitals. Increasing age, decreasing survival, district of residence and place of death were positively associated with death certificate registrations. The district effect was sustained in the regression model with significant positive associations shown for DHA quartile of residence. In the deceased group of patients, both district of residence and place of death were independent predictors of DCOs. Death occurring outside the acute NHS hospital setting increased the odds of being a DCO within and across district quartiles. DCOs could be reduced by better case ascertainment in some districts.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: results of a four-year, population-based, death-scene investigation study of sudden infant death syndrome and related deaths.
BACKGROUND: Prone sleep and unsafe sleep surfaces increase the risk of sudden infant death. Recent epidemiologic studies also suggest that when an infant's head or face is covered by bedding, or when a sleep surface is shared with others, the risk of dying increases. The inference of a causal role for these risk factors is supported by physiologic studies and by the consistent finding that fewer infants die when risk factors are reduced. The prevalence of most of these risk factors in infant deaths in the United States is uncertain. OBJECTIVE: To describe the prevalence of several important risk factors related to sleep practices among a defined population of infants dying suddenly and unexpectedly. METHODS: In this population-based study, we retrospectively reviewed death-scene information and medical examiners' investigations of deaths in the city of St Louis and St Louis County between January 1, 1994 and December 31, 1997. Because of the potential for diagnostic overlap, all deaths involving infants <2 years old with the diagnoses of sudden infant death syndrome (SIDS), accidental suffocation, or cause undetermined were included. RESULTS: The deaths of 119 infants were studied. Their mean age was 109.3 days (range: 6-350). The diagnoses were SIDS in 88 deaths, accidental suffocation in 16, and undetermined in 15. Infants were found prone in 61.1% of cases and were found on a sleep surface not designed for infants in 75.9%. The head or face was covered by bedding in 29.4%. A shared sleep surface was the site of death in 47.1%. Only 8.4% of deaths involved infants found nonprone and alone, with head and face uncovered. CONCLUSIONS: Using detailed death-scene descriptions, we found that similar unsafe sleeping practices occurred in the large majority of cases diagnosed as SIDS, accidental suffocation, and cause undetermined. Considering these diagnoses together may be useful in public health campaigns during a time when there may be diagnostic overlap. Regardless of the diagnosis, recommendations that infants sleep supine on firm sleep surfaces that lessen the risk of entrapment or head covering have the potential to save many lives. Campaigns are needed to heighten awareness of these messages and of the risks of dangerous bedsharing.
Asphyxia↗
Determination of death (Uniform Determination of Death Act of 1981); natural death (Natural Death Act of 1981).
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Brain Death↗
When is a maternal death a maternal death? A review of maternal deaths at the Mercy Maternity Hospital, Melbourne.
The limiting of the reporting of maternal deaths to those that are included in the criteria of the World Health Organization excludes deaths which yield useful information for further improvements in clinical performance. In this series of 22 maternal deaths, six deaths would have been excluded from reporting: one "direct" obstetric death of pre-eclampsia; one "indirect" death as a result of renal and cardiac failure; two deaths as a result of postnatal depression which led to suicide three and four months postpartum, respectively; and two deaths of cancers, where diagnostic delay may have been a result of the coexistent pregnancy. The importance of primary pulmonary hypertension, cardiomyopathy and psychiatric illness is emphasized. We endorse the recent recommendation of the International Federation of Gynaecology and Obstetrics (FIGO) that all maternal deaths that occur more than 42 days after the end of a pregnancy should be assessed for possible relationships with childbirth, and suggest that a time limit of one year would include all deaths that are worthy of scrutiny.
Adult↗
[Risk factors of sudden infant death and of death by accidents. According to a national survey in the total postneonatal death].
BACKGROUND: The incidence of sudden infant death syndrome (SIDS) peaks at 2-4 month of age and during the colder months of the year. Other risk factors such as sex, birth weight, maternal age and multiple pregnancy also seem to be shared by the other causes of death after the neonatal period. POPULATION AND METHODS: A retrospective, exhaustive survey of all deaths of infants aged 28 days-one year was carried out between September 1986 to December 1987. The control group was a representative sample of the live births in France during 1989. The deaths were classified into 3 groups: group I, 1184 SIDS, group II 228 SIDS remaining unexplained after autopsy (out of 315 autopsied SIDS), and group III 83 accidental deaths. The factors studied were: sex, birth weight, maternal age, number of infants born from the pregnancy. The risk factors were measured by Odds Ratios and the variables related to mortality were introduced into a logistic model. RESULTS: Incidence of deaths peaked between the 2nd and the 4th month of age in groups I and II while deaths were evenly distributed throughout the first year in group III. Colder months, male gender, low birthweight, multiple birth and the young age of the mother all increased the risk of death in SIDS (groups I and II) but the same factors were also linked to accidental deaths. CONCLUSION: The results confirm those of earlier reports and raise the question why the risk factors for accidental deaths are similar to those for explained or unexplained SIDS, except for infant age.
Accidents↗
[Death and neurosis. Anxiety, the death instinct, object loss and narcissism as the background of the human experience of death].
The present study gives an overview of concepts which try to explain the meaning of death in neurosis. Phenomenological-anthropological and psychoanalytic approaches are drawn into consideration. After an introductory phenomenological description the significance of death in symptomatology, in the inducing situation and in psychodynamic is discussed. The attempts to integrate the phenomenon of death into psychoanalytic metapsychology are represented by means of drive theory and objectrelation-theory. In the "anthropological-integrative" concept of death (D. Wyss) death is proved in the experience of time and separation. D. Wyss emphasized the connection between the experience of death on one side and the development of reflection or the process of structuring consciousness on the other side. Experience of time, separation and thinking are closely related with anxiety which may become another keyword for understanding the meaning of death. Finally the author discusses the question whether Narcissistic Neurosis and Narcissistic Personality Disorders could be connected with the unsolved death problem or a denial of death. The "narcissistic human being" is described as someone who is thrown back on himself because he is not able to cope with his basic anxieties, his limitations and his transitoriness.
Adaptation, Psychological↗
The seasonal distribution of infant deaths by age: a comparison of sudden infant death syndrome and other causes of death.
OBJECTIVE: To examine the possibility that among deaths in infancy the increase in the winter/summer ratio with increasing age is not peculiar to sudden infant death syndrome (SIDS). METHODOLOGY: Details of the winter (December-February)/summer (June-August) ratio among deaths in neonates (< 28 days) and post neonates dying in the United States of America between 1979 and 1990 were abstracted from published statistics. The primary causes of death were classified according to the ninth Revision of the International Classification of Diseases. RESULTS: For every non-traumatic cause of death including SIDS, the winter/summer ratio was higher among postneonates than neonates. This was not seen for deaths due to trauma. Cases of SIDS and deaths due to infection had the highest ratios in both age categories. Causes of death occurring predominantly in the neonatal period (e.g. anencephaly) had the lowest overall ratios. CONCLUSIONS: Neither the greater number of SIDS cases in the winter, nor the increasing winter/summer ratio with increasing age is unique to SIDS.
Age Distribution↗
Death anxiety and death denial: Nigerian and Australian students' metaphors of personal death.
Ninety-two Nigerian students and 114 Australian students completed Templer's (1970) Death Anxiety Scale (DAS) and Feifel and Nagy's (1981) death fantasy measure of positive and negative death metaphors. They were each also asked to write his or her own metaphor of personal death. Results of the DAS showed that the two groups did not differ significantly on the level of conscious death anxiety, but Nigerian students' scores were significantly higher on both positive and negative personal death metaphors scales. Also, significantly more Nigerian students wrote personal metaphors of their own and more often used a neutral metaphor to describe their personal death. Australian students more often used a positive or a negative metaphor. The Nigerian students thus evidenced less death denial than the Australian students did.
Adult↗
Newcastle survey of deaths in early childhood 1974/76, with special reference to sudden unexpected deaths. Working party for early childhood deaths in Newcastle.
All early childhood deaths within a total population of 297 000 were studied by prospective methods. 70 deaths of children aged 1 week to 5 years occurred during a 27-month period; 36 died at home, 29 suddenly and unexpectedly. An extensive standardized necropsy showed a disease process clearly or probably related to death in half the sudden unexpected deaths; in the remainder no recognized disease process was identified. The events preceding sudden unexpected death, and the child's environment, were investigated by a controlled parental interview. Symptoms of serious illness within 24 hours of death were identified in 9 of the 29 children, but in the majority symptoms were thought to have been absent or no more severe than those of the control children. Most children with major symptoms had been seen by a doctor within a few days of death. The two most striking social findings were that 16 of the 29 sudden unexpected deaths occurred at a weekend or bank holiday, and that 45% occurred in three adjacent city wards which contain only 13% of the under-five study population. The additional support and explanation provided during the home visits was greatly appreciated by the bereaved families.
Age Factors↗
"Brainstem death," "brain death" and death: a critical re-evaluation of the purported equivalence.
The author challenges brain-based diagnoses of death by re-examining the concept of death, its definition, the anatomical criterion, and the clinical signs or tests. Dr. Shewmon challenges the fundamental assumptions underlying brain death: (1) that the brain is the body's "critical system"; and (2) that the body even has a localized "critical system." He does not redefine death, but shifts the anatomical criterion from a single focus (the brain) to the entire body. The clinical tests correspondingly shift from those implying loss of brain function to those implying thermodynamically supracritical microstructural damage diffusely throughout the body. He concludes that the notion of "brain death" as bodily death is logically and physiologically incoherent, and that its replacement by something scientifically more credible would promote not only the sanctity of life, but ironically even transplantation as well.
Age Factors↗
Sudden infant death syndrome in Sweden, 1983-1990: season at death, age at death, and maternal smoking.
Several risk factors for sudden infant death syndrome (SIDS) have been consistently reported, while results regarding seasonality and age at death of SIDS victims are conflicting. In the present population-based cohort study, single births in Sweden from 1983 through 1990 were used to estimate the relative and absolute risks for SIDS associated with season at death, age at death, and maternal smoking. In the winter period, 283 SIDS deaths occurred, while only 98 infants died during summer (winter/summer ratio = 2.9). Taking person-time at risk into account and restricting the analysis to infants aged 7-180 days, the authors determined the relative risk for SIDS to be 3.5 times higher in winter than in summer. When comparing incidence rate differences, they found a more noticeable seasonal variation for early SIDS (7-90 days at death) than for late SIDS (91-180 days at death). For early SIDS, the incidence rate was 0.6 cases per 100,000 person-days higher among smokers than among nonsmokers; for late SIDS, the corresponding difference was 0.3. The effect of smoking on SIDS was not associated with seasonality. Since exposure to passive smoking is likely to vary by season, the results suggest that the effect of smoking on SIDS is prenatal rather than the result of passive smoking after birth.
Adolescent↗
Coronary atherosclerosis in cases of coronary death as compared with that occurring in the populatiom. A study of a medico-legal autopsy series of coronary deaths and violent deaths.
The severity of coronary atherosclerosis at autopsy was studied in two series comprising 169 cases of coronary death and 231 people who died of violent causes. In the former the fatal attack lasted less than 24 hours from the onset of symptoms in 70% of cases. In only three men did the terminal attack last more than 24 hours, while in the remaining 28% of cases, although death was not witnessed these were also likely to have been sudden deaths. A recent infarct with or without an old myocardial infarct was found at autopsy in 47% of cases and an old infarct alone in 34%. In 19% of coronary deaths no recent or old infarct was detected. The surface areas of the atherosclerotic lesions were assessed in arterial specimens by pointcounting. The degree of stenosis was estimated visually. The mean extent of raised lesions and clacification and the median value of stenosis score, which expressed the degree of stensosi in the coronary arterial tree, were significantly higher in all age groups in persons who died of coronary heart disease than in those who died violently. A marked overlapping between the individuals in the two series was, however, found in both for the exent of raised lesions and the severity of stenosis score. Raised lesions in coronary patients were calcified to about the same extent as those in persons ten years older in the series of violent deaths. Coronary atherosclerosis was most severe in coronary patients who had had symptomatic heart disease and had an old myocardial infarct and least severe in those in whome sudden death was the first manifestation of coronary heart disease from violent deaths as regards the extent of the raised lesions or prevalence of occlusion. The degree of coronary stenosis in coronary patients was closely related to the total extent of advanced coronary atherosclerosis.
Adult↗
[Criteria of death. Heart death or brain death--is it the same death?].
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Brain Death↗
[Clinical death. Legal death; somatic death; complete death].
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Adult↗