Unintentional Injury Deaths among Children: A Descriptive Study Using Medico-legal Documents in Okayama Prefecture, Japan (2001-2015).

According to the World Health Organization's World Report, approx. 950,000 children and young people < 18 years old die from an injury each year, and unintentional injury deaths account for a large portion of these cases. Here we used medico-legal documents to epidemiologically analyze the cases of unintentional injury deaths among children < 5 years old in Okayama Prefecture, Japan from 2001 to 2015. Age, sex, manner/cause of death, and various circumstances of the incident were investigated. There were 73 unintentional injury deaths during the study period. Drowning (n=29), suffocation (n=24), and transport accidents (n=13) were the major categories of unintentional injury deaths. Twenty-two cases (30.1%) were autopsied. Differences in the characteristics of the unintentional injury deaths by age were observed. Information which cannot be obtained from Vital Statistics was available from medico-legal documents, and detailed characteristics of unintentional injury deaths among children < 5 years old were elucidated. Investigating medico-legal information is one of the meaningful measures for the prevention of unintentional injury deaths among children in Japan.

Child deaths with persistent neglected experiences from medico-legal documents in Japan.

BACKGROUND: Few studies have examined the actual conditions of fatal neglect in Japan. The aims of this study were to investigate persistent neglect among child fatalities using medico-legal documents, and to describe the characteristics of the socio-familial background and biological data. METHODS: The current study analyzed the documents of all postmortem external examinations and autopsies in children <2 years old carried out in one prefecture in Japan from 2006 to 2011. After examining 59 autopsy cases using modified the Maltreatment Classification System, we identified six children who experienced persistent neglect as study samples. RESULTS: Three children were found in unsanitary rooms and one was left alone inside a car. In two cases, age of mother at delivery was <21 years old. Three victims had 1 year older sibling. With regard to history of use of health services, three mothers missed some prenatal care visits, and two refused to receive neonatal home visits. With regard to biological data the average weight Z score of six children was -2.22 after being adjusted to average weight for age (in months) and sex. Three children had acute or chronic undernutrition. Three victims had thymic involution considered as being due to chronic child maltreatment. CONCLUSIONS: The present collaboration between public health and legal medicine has enabled investigation of the background and biological impact of experiences of persistent neglect. A multidisciplinary system of evaluating child death is needed to identify preventable factors in order to intervene in the case of neglected children in a timely manner.

The influence of fixing condition on myoglobin stainability of striated muscle as a tool for forensic diagnosis.

It is reported that immunostaining of Myoglobin (Mb) is useful for forensic diagnosis. In this study, we investigated the condition of fixation of striated muscle in 10 % neutral-buffered formalin to obtain appropriate stationarity of Mb in immunostaining. Firstly, criteria for staining intensity and definition of the stainability of examined were determined for sheep muscle tissue. Sheep myocardial tissue was fixed using 10 % neutral-buffered formalin under the 21 different conditions based on combinations of the following: three ratios of volume of formalin (mL) to weight of myocardium (g) (RFM) of 1, 4 or 9, 7 durations of fixation (DF) of 0.5, 3 or 6 h, and 1, 2, 5 or 7 days. Secondly, detection of Mb diffused form skeletal muscle from autopsy cases into formalin during fixation were confirmed by ELISA. Finally, the evaluation of stainability of Mb of striated muscle in routine autopsy examinations was confirmed using sheep staining intensity standards. From this experimental investigation, it has been demonstrated that the most suitable formalin fixation condition for using Mb staining in forensic diagnosis is RFM4 with a fixation time of at least DF 3 h up to 1 day. It was evident that staining intensity decreases with fixation durations exceeding 2 days, irrespective of the RFM. Thus, the fixation time was deemed the most influential factor affecting the staining properties of Mb staining in skeletal muscle tissue. When conducting Mb staining using striated muscle as an evaluation sample, particular attention should be paid to the fixation time.

Successful Cardiac, Lung, and Kidney Transplantation from a Methanol-poisoned Donor.

Massive methanol exposure can lead to severe and detrimental effects that can result in death or brain death. As organs from patients with brain death after methanol ingestion are less likely to be recovered, these patients have been considered marginal donors. We present a case of successful multiple organ transplantation (heart, lungs, and kidneys) from a methanol-poisoned patient. Our experience illustrates that donor death from methanol intoxication does not preclude organ transplantation.

Symptom definitions for SBS (sick building syndrome) in residential dwellings.

The potential risk factors for sick building syndrome (SBS) in newly built dwellings were investigated. Two different definitions for SBS were used, a narrow definition (symptoms related to home environment and continuously occurring in the last 3 months were regarded as positive) and another relatively broad definition (symptoms related to home environment and either continuously or sporadically occurring in the last 3 months were regarded as positive). With both definitions indoor air chemicals, especially TVOC, and high stress during work were found to be significantly associated with SBS symptoms. Allergic history was more associated with narrow-sense symptoms and odor perception with broad-sense symptoms. The results indicate that the broad definition be preferred to find more potential risk factors.

Unmetabolized VOCs in urine as biomarkers of low level exposure in indoor environments.

This study aimed to test the possible use of unmetabolized volatile organic compounds (VOCs) in urine as biomarkers of low-level indoor environmental exposure. Twenty-four subjects in 13 dwellings in a prefecture of Japan participated in this study. Air samples of the breathing zone were collected in the living room and bedroom, along with spot urine samples (before bedtime and first morning voids). Toluene, ethylbenzene, xylene isomers, styrene and p-dichlorobenzene in the air and urine samples were measured by gas chromatography/mass spectrometry. For the 21 subjects without solvent exposure at work, there were significant correlations between the time-weighted average air concentrations in the bedroom and morning urinary concentrations for toluene, o-xylene, total xylene and p-dichlorobenzene (correlation coefficients of 0.54, 0.61, 0.56 and 0.84, respectively). Multiple linear regression analysis showed only air VOCs in the bedroom influenced the morning urinary VOC concentrations. We concluded that unmetabolized VOCs in the urine can provide a reliable biological indicator for air VOC exposures in non-occupational environments.

Measurement of Postmortem 1,5-anhydroglucitol in Vitreous Humor for Forensic Diagnosis.

In forensic diagnosis, postmortem blood glucose is known to be susceptible to change after death. However, the 1,5-anhydroglucitol (1,5-AG) concentrations in plasma and cerebrospinal fluid (CSF) reflect the mean blood glucose level for a short period of time. In this study, we compared the postmortem 1,5-AG concentrations in vitreous humor and CSF in 47 subjects to evaluate the utility of this concentration in the vitreous humor for forensic diagnosis. The postmortem 1,5-AG concentrations in vitreous humor (mean±SD: 20.2 ± 8.7 µg/mL) and CSF (16.8 ± 8.7 µg/mL) did not differ significantly and showed a strong correlation (r(2) = 0.87, p < 0.01). These results suggest that the vitreous humor 1,5-AG concentration provides useful information on the antemortem blood glucose level, in addition to the HbA1c value and the CSF 1,5-AG concentration.

Practicality of Veterans Specific Activity Questionnaire in evaluation of exercise capacity of community-dwelling Japanese elderly.

OBJECTIVE: The aim of this study is to determine whether a questionnaire-based method using the Veterans Specific Activity Questionnaire (VSAQ) is a practical tool for the development of a safe exercise program to prevent a reduction in physical performance. METHODS: One hundred and twenty-one senior residents of Yakage, Okayama, agreed to voluntarily participate in this study. They were asked to complete a questionnaire for information on age, sex, subjective health status, exercise habits and VSAQ. We investigated the relationship between age and exercise capacity predicted by VSAQ (predicted metabolic equivalents (METs)). In addition, for 36 out of the 121 participants, we performed a 6-min walk distance test (6MD) and investigated whether its results correlate with the predicted METs. Furthermore, we prepared a modified VSAQ and examined its practicality in the evaluation of the exercise capacity of Japanese elderly (n=50). RESULTS: We found that the predicted METs correlate well with age. Habitual exercise and subjective health status did not affect the predicted METs. A significant correlation was observed between the predicted METs and the results of 6MD (r=0.56, p<0.001). We also found that certain activities included in the original VSAQ are unfamiliar to Japanese elderly; thus, we made a few modifications to the original VSAQ in order to evaluate the physical fitness of Japanese elderly. The number of inadequate answers was reduced by employing the modified VSAQ. CONCLUSION: These findings imply that the modified VSAQ is useful in evaluating the exercise capacity of Japanese elderly adequately and is a practical scale for safe exercise.