Shedding Light on Hidden Methamphetamine Abuse: A Nation-wide 7-year Post-mortem Study in Taiwan.

BACKGROUND: The number of methamphetamine-related deaths has been increasing in recent decades. However, current data primarily rely on a few large-scale national surveys, highlighting the need for diverse data sources. Post-mortem studies offer advantages that compensate for the limitations of cohort studies. In this study, we aimed to (1) examine mortality rates and years of potential life lost, (2) compare proportionate mortality with previous cohort studies, and (3) quantitatively investigate causes of death as potential risk factors associated with each manner of death. METHODS: We analyzed 740 cases from 2013 to 2019 in Taiwan. RESULTS: The mean age of cases was 38.4 years, with a notable loss of 30 or more years of potential life, and 79.6% were male. The crude mortality rate was 0.45 per 100,000 person-years. The proportionate mortality indicated that autopsy dataset, compared to cohort studies, provided more accurate estimations for accidental deaths, equivalent suicides, underestimated natural deaths, and overestimated homicides. Accidental deaths were evident in 67% of cases with 80% attributed to drug intoxication. Multiple substances were detected in 61% of cases, with psychiatric medications detected in 43% of cases. Higher methamphetamine concentrations and a greater proportion of multiple substances and benzodiazepines were detected in suicidal deaths. Among accidental deaths, traffic accidents (7.9%) were the second most common cause, particularly motorcycle riders. CONCLUSION: Using autopsy dataset as a secondary source, we identified that over half of the cases involved drug intoxication-related accidental deaths. The significant proportion of cases involving multiple substances, psychiatric medications, and drug-impaired driving raises concerns.

Psychoactive substances in natural and unnatural deaths in Norway and Sweden - a study on victims of suicide and accidents compared with natural deaths in psychiatric patients.

BACKGROUND: The extent of post-mortem detection of specific psychoactive drugs may differ between countries, and may greatly influence the national death register's classification of manner and cause of death. The main objective of the present study was to analyse the magnitude and pattern of post-mortem detection of various psychoactive substances by the manner of death (suicide, accidental, undetermined and natural death with a psychiatric diagnosis) in Norway and Sweden. METHODS: The Cause of Death Registers in Norway and Sweden provided data on 600 deaths in 2008 from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of death and 200 as natural deaths in individuals with a diagnosis of mental disorder as the underlying cause of death. We examined death certificates and forensic reports including toxicological analyses. RESULTS: The detection of psychoactive substances was commonly reported in suicides (66 and 74% in Norway and Sweden respectively), accidents (85 and 66%), undetermined manner of deaths (80% in the Swedish dataset) and in natural deaths with a psychiatric diagnosis (50 and 53%). Ethanol was the most commonly reported substance in the three manners of death, except from opioids being more common in accidental deaths in the Norwegian dataset. In cases of suicide by poisoning, benzodiazepines and z-drugs were the most common substances in both countries. Heroin or morphine was the most commonly reported substance in cases of accidental death by poisoning in the Norwegian dataset, while other opioids dominated the Swedish dataset. Anti-depressants were found in 22% of the suicide cases in the Norwegian dataset and in 29% of suicide cases in the Swedish dataset. CONCLUSIONS: Psychoactive substances were detected in 66 and 74% of suicides and in 85 and 66% of accidental deaths in the Norwegian and Swedish datasets, respectively. Apart from a higher detection rate of heroin in deaths by accident in Norway than in Sweden, the pattern of detected psychoactive substances was similar in the two countries. Assessment of a suicidal motive may be hampered by the common use of psychoactive substances in suicide victims.

Are suicides underreported? The impact of coroners versus medical examiners on suicide reporting.

OBJECTIVE: To evaluate if state death investigation systems affect the reporting of suicides, particularly when comparing medical examiners to coroners. DATA SOURCES AND STUDY SETTING: We used restricted-access state mortality data from National Vital Statistics System between the years 1959 to 2016. These data were matched with state-level changes in death investigation systems reported by the Centers for Disease Control and Prevention database on the Public Health Law Program: Coroner/ME Laws. STUDY DESIGN: We used difference-in-differences and event study methods for the analysis. We estimated the relative per capita changes in suicides, accidental deaths, and homicides when comparing coroner-only states with other death investigation types. Sub-analyses estimated differences by sex, race, and if coroners were required to receive training. DATA COLLECTION/EXTRACTION METHODS: Not Applicable. PRINCIPAL FINDINGS: Coroners-only states underreported suicides by 17.4% (p < 0.05) and performed 20.4% (p < 0.05) fewer autopsies compared to states with county coroners and a state medical examiner. This pattern is consistent by sex and race. Required coroner training did not affect death determination significantly. CONCLUSION: Coroners-only states underreported suicides compared to states with county coroners and a state medical examiner. The disparity in the use of autopsies is a potential mechanism for underreporting of suicides by coroners. If all coroners-only states adopted a state medical examiner, suicide reporting would increase by 2243-3100 deaths in the United States annually.

Five-year review (2014-2019) of paediatric accidental deaths in Cook County, Illinois (USA).

In the USA, intentional and accidental injuries are the most frequent causes of death in children. Many of these deaths could be avoided through preventive measures, and aetiological studies are needed to reduce fatalities. The leading causes of accidental death vary by age. We analysed all paediatric accidental deaths recorded by a busy urban Medical Examiner"s Office in Chicago, Illinois (USA). We searched the electronic database for accidental deaths in children aged under 10 between 1 August 2014 and 31 July 2019. 131 deaths were identified with a preponderance of males and African Americans. This is consistent with ratios of other deaths recorded for this age group (during the same period and area). The leading causes of death were asphyxia due to an unsafe sleeping environment (in subjects <1-year-old), and road traffic accidents/drowning (in subjects >1-year-old). Behaviours, risk factors and environments most likely to contribute to fatal injuries are discussed. Our study highlights the role of forensic pathologists and medico-legal death investigators who identify the causes and circumstances surrounding these deaths. The research results may help from an epidemiological perspective to implement age-specific preventive strategies.

Coupling the effects of extreme temperature and air pollution on non-accidental mortality in Rencheng, China.

Background: Extreme temperatures and air pollution have raised widespread concerns about their impact on population health. Aim: To explore the quantitative exposure risks of high/low temperatures and types of air pollutants on the health of various populations in urban areas in China, this study assessed the effects of temperature and air pollutants on daily non-accidental deaths in Rencheng District, Jining City, China from 2019 to 2021. Methods: A combination of Poisson regression models and distributed lag non-linear models was used to examine the relationships between temperature, air pollutants, and daily non-accidental deaths. We found that temperature and air pollutants had a significant non-linear effect on non-accidental mortality. Both high and low temperatures had a noticeable impact on non-accidental deaths, with heat effects occurring immediately and lasting 2-3 days, while cold effects lasted for 6-12 days. The relative risks of non-accidental deaths from PM2.5, NO2, and SO2 were highest in winter and lowest in autumn. The relative risk of non-accidental deaths from O3 was highest in spring, with no significant variations in other seasons. Older adults (≥75) and outdoor workers were at the greatest risk from temperature and air pollutant exposure. Conclusions/interpretation: Exposure to extreme temperatures and air pollutants in the Rencheng District was associated with an increased mortality rate. Under the influence of climate change, it is necessary for policymakers to take measures to reduce the risk of non-accidental deaths among residents.

Years of life lost and mortality risk attributable to non-optimum temperature in Shenzhen: a time-series study.

To assess YLL and mortality burden attributable to non-optimum ambient temperature, we collected mortality and environmental data from June 1, 2012 to December 30, 2017 in Shenzhen. We applied distributed lag nonlinear models with 21 days of lag to examine temperature-YLL and temperature-mortality associations, and calculated the attributable fractions of YLL and deaths for non-optimum temperature, including four subranges, mild cold, mild heat, extreme cold, and extreme heat. Cold and heat were distinguished by the optimum temperature, and each was separated into extreme and mild by cutoffs at 2.5th (12.2 °C) and 97.5th (30.4 °C) temperature percentile further. The optimum temperature was defined as the temperature that had minimum effect on YLL or mortality risk. The optimum temperature for non-accidental YLL was 24.5 °C, and for mortality it was 25.4 °C. Except for the population older than 65 years, the optimum temperature was generally lower in the YLL model than the mortality model. Of the total 61,576 non-accidental deaths and 1,350,835.7 YLL within the study period, 17.28% (95% empirical CI 9.42-25.14%) of YLL and 17.27% (12.70-21.34%) of mortality were attributable to non-optimum temperature. More YLL was caused by cold (10.14%, 3.94-16.36%) than by heat (7.14%, 0.47-13.88%). Mild cold (12.2-24.5 °C) was responsible for far more YLL (8.78%, 3.00-14.61%) than extreme cold (3.5-12.2 °C). As for cardiovascular deaths, only the fractions attributable to overall and cold temperature were significant, with mild cold contributing the largest fraction to YLL (16.31%, 6.85-25.82%) and mortality (16.08%, 9.77-21.22%). Most of the temperature-related YLL and mortality was attributable to mild but non-optimum weather, especially mild cold, while the YLL model implied a more prominent heat effect on premature death. Our findings can supply additional evidence from multiperspectives for health planners to define priorities and make targeted policies for mitigating the burden of adverse temperatures.

Undercounting of suicides: Where suicide data lie hidden.

ABSTRACT The suicide rates officially reported by most countries are widely believed to be lower than actual rates, attributable partly to inaccuracy of registration of deaths and misclassification of cause of death. In this review paper, we discuss under-counting of deaths and of suicides, referring to findings from international research. We then describe the three main ICD-10 cause of death categories that possibly harbour 'hidden suicides': ill-defined or unknown causes of death, events of undetermined intent (EUI), and accidental deaths. We used the 2017 Australian mortality statistics to illustrate these three categories. The World Health Organization (WHO) data and international research show (1) that mortality data provided to the WHO by a large number of its Member States are of questionable quality and not timely; and (2) substantial variations among countries in rates of suicide, ill-defined or unknown deaths, EUIs, and accidental deaths (notably, poisoning). Accurate reporting of suicides is needed to advance research on suicide prevention and develop more effective suicide prevention programmes. Nations should endeavor to obtain, publish and analyse data regarding annual rates of deaths coded as of ill-defined/unknown cause, EUI, and accidental poisoning and other relevant types of accident.

Muscular hemorrhages around the scapula resulting from excessive upper extremity motion in cases of fatal drowning: autopsy findings for insights on manner of death.

Muscular hemorrhages around the scapula are frequently found in fatal drowning cases without injuries in the upper back at time of autopsy. The present study investigated the frequency of muscular hemorrhages around the scapula and determined the mechanism responsible for this phenomenon. Muscular hemorrhages around the scapula were found in 104 of 164 (63.4%) bodies assessed. Hemorrhage in the infraspinatus muscle was most common, followed by the supraspinatus muscle. These muscular hemorrhages were not associated with upper extremity injuries and were most frequently found in accidental drowning cases (78.7%), followed by cases of suicide (56.0%), and in natural disease prior to drowning (19.0%). We examined muscular hemorrhage around the scapula and cervical injuries that restricted the active motion of upper extremities in drowning cases. The vertebral level of cervical injuries were related to muscular hemorrhages around the scapula. These results suggested that muscular hemorrhages around the scapula were not a result of agonal convulsions but were caused by consciously active excessive motion of the upper extremities while drowning. Investigations of the muscular hemorrhages around the scapula can provide insights towards the manner of fatal drowning.

Projecting temperature-related years of life lost under different climate change scenarios in one temperate megacity, China.

Temperature has been associated with population health, but few studies have projected the future temperature-related years of life lost attributable to climate change. To project future temperature-related disease burden in Tianjin, we selected years of life lost (YLL) as the dependent variable to explore YLL attributable to climate change. A generalized linear model (GLM) and distributed lag non-linear model were combined to assess the non-linear and delayed effects of temperature on the YLL of non-accidental mortality. Then, we calculated the YLL changes attributable to future climate scenarios in 2055 and 2090. The relationships of daily mean temperature with the YLL of non-accident mortality were basically U-shaped. Both the daily mean temperature increase on high-temperature days and its drop on low-temperature days caused an increase of YLL and non-accidental deaths. The temperature-related YLL will worsen if future climate change exceeds 2 °C. In addition, the adverse effects of extreme temperature on YLL occurred more quickly than that of the overall temperature. The impact of low temperature was greater than that of high temperature. Men were vulnerable to high temperature compared with women. This analysis highlights that the government should formulate environmental policies to reach the Paris Agreement goal.

Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States.

Background: Previous studies have shown that heatwaves are associated with increased mortality. However, it remains unclear whether the associations between heatwaves and mortality are modified by the environmental quality. Methods: We used the United States (US) Environmental Protection Agency's Environmental Quality Index (EQI) and its five domain indices (air, water, land, built, and sociodemographic) to represent the cumulative environmental quality. We applied a time-stratified case-crossover design to analyze the disparities in the association between heatwaves and non-accidental deaths (NAD) among counties with different environmental qualities, in metropolitan areas in Alabama (AL), United States. Results: We found significant associations between heatwaves and NAD and a significant effect modification of this relationship by EQI. There were higher odds ratios in counties with the worst cumulative environmental qualities compared to counties with the best cumulative environmental qualities. For example, the percent change in odds ratio (mean and (95% CI)) between heatwave days and non-heatwave days was -10.3% (-26.6, 9.6) in counties with an overall EQI of 1 (the best overall environment) and 13.2% (4.9, 22.2) in counties with an overall EQI of 3 (the worst overall environment). Among the five domains, air quality had the strongest effect modification on the association. Conclusion: Our findings provide evidence that the associations between heatwaves and NAD vary among areas with different environmental qualities. These findings suggest that integration of air quality and heatwave warning systems may provide greater protection to public health.

Manners of Death in Drug-Related Fatalities in Florida.

To understand the mortality patterns among drug users and potential risk factors, we evaluated drug-related deaths reported to the Florida Medical Examiners Commission from 2001 to 2013, by substances, demographics, and manner of death. The annual drug-related fatalities increased by 57% from 2001 to 2013 (total n = 100,882); 51.8% were accidental, 7.9% homicide, 18.6% natural, and 19.6% suicide. The different manners of death exhibited distinct demographic profiles and drug composition. The gender gap was more prominent in homicide. Age ≥55 years was more closely associated with natural death and suicide. Age <35 years and central nervous system (CNS) stimulants including amphetamines and cocaine showed higher relative risks for accidental death and homicide, whereas CNS depressants including benzodiazepines, carisoprodol, opioids, and zolpidem were more strongly associated with accidental death and/or suicide. The findings aid in identifying populations more vulnerable to drug-related deaths, developing targeted interventions and thereby improving efficiency of preventive efforts.

Epidemiological and experimental studies on the effects of methyl isocyanate on the course of pregnancy.

Although press reports indicate that the leakage of methyl isocyanate (MIC) on December 3, 1984, in Bhopal has led to an increase in spontaneous abortions, stillbirths, infant mortality, and fetal abnormalities, no clinical or experimental studies on the reproductive toxicity of MIC were reported in scientific journals for several months after the accident. We therefore conducted, 9 months after the accident, a preliminary survey of 3270 families in Bhopal and experimental studies on the effects of MIC in pregnant mice. It was found that 43% of pregnancies in women residing near the Union Carbide pesticide plant did not result in the birth of a live child. Likewise, exposure of mice to relatively low concentrations of MIC (9 and 15 ppm) for 3 hr caused complete resorption in more than 75% of animals. A decrease in fetal and placental weights was observed at 2 to 15 ppm MIC. In general, the experimental findings in mice corroborate the epidemiological data from Bhopal. The mechanism of the fetal toxicity of MIC remains to be established.

PIP: Both epidemiological and experimental studies conducted by the author clearly indicate that methyl isocyanate (MIC) exposure can have an adverse effect on pregnancy outcome. 9 months after the December 1984 accident in Bhopal, India, in which 3270 families residing adjacent to the Union Carbide pesticide plant were exposed to MIC vapor, a preliminary survey was conducted to assess pregnancy outcomes in these households. 865 of these women indicated they were pregnant at the time of the accident. 44% of these pregnancies did not result in a live birth. Moreover, of the 486 live births, 14% of infants died within 30 days of birth. The rate of pregnancy loss was higher among women who were in their 1st trimester at the time of the accident. Similarly, exposure of pregnant mice to relatively low doses of MIC (9 and 15 ppm) for 3 hours caused complete resorption in more than 75% of the animals; a decrease in fetal and placental weights was noted at doses of 2-15 ppm MIC. There was no evidence of external malformations, although there appeared to be an increased incidence of visceral anomalies. In summary, both sets of data indicate that MIC exerts selective fetal toxicity, the exact mechanism of which remains to be established. For example, it is not clear whether the fetal toxicity is due only to effects on the mother or due to both maternal and fetal effects. The 43% pregnancy loss rate recorded in Bhopal in the post-accident period is 3-4 times higher than the normal incidence of spontaneous abortion.

Estimating deaths and injuries due to road traffic accidents in Karachi, Pakistan, through the capture-recapture method.

BACKGROUND: Road traffic accidents (RTA) are an important yet preventable cause of death and disability in developing countries like Pakistan. Yet accurate epidemiological data on injuries in developing country injuries is often difficult to obtain. We applied the capture-recapture method to estimate the death and injury rates due to RTA in Karachi. METHODS: We applied the two-sample capture-recapture method using traffic police records as one source of capture and the logs of a non-government ambulance service as the second capture source for the same 10 months and 20 days for which 1994 data were available. We generated a conservative adjusted estimate of injuries and deaths by considering entries in the two sources as matched if they reported the same date, time, and place, and at least one of the other matching variables, of name, vehicle registration number, vehicle types or patient outcome. We then compared the estimated rates with the police rates. RESULTS: In 1994 police reported 544 deaths and 793 injuries due to RTA while ambulance records noted 343 deaths and 2048 injuries. The capture-recapture analysis estimated at least 972 (95% CI: 912-1031) deaths and 18,936 (95% CI: 15,507-22,342) injuries attributable to RTA during the study period. Official sources counted only 56% of deaths and 4% of serious injuries. The estimated rates for the year 1994 were 185 injuries and 11.2 deaths per 100,000 population. CONCLUSION: Road traffic injuries and deaths in Karachi are a much more substantial health problem than is evident from official statistics.

Disease problems in the Third World.

PIP: The mean annual rate of decline of the probability of dying 5 years of age in developing countries is 2.5%. Nevertheless disease accounts for a considerable proportion of premature deaths. The leading causes of death in these countries, in order, include respiratory disease, diseases of the circulatory system, low birth weight, diarrhea, measles, injuries, malnutrition, and neoplasms. These conditions represent diseases of poverty and affluence. Respiratory infections are common among 5-year old children and cause a high proportion of child deaths. Circulatory diseases tend to be limited to adults. Control of hypertension, diet, smoking prevention, and exercise can prevent circulatory diseases. The risk of dying in infancy and childhood and of developmental disabilities is higher among low birth weight infants than those who weigh 2500 gm. In Bangladesh, 50% of infants weight 2500 gm. Low birth weight is the underlying cause of death for many infants who die of respiratory infections and diarrhea. Oral rehydration can successfully treat most diarrhea cases. Malnutrition and diarrhea tend to occur together and feed off each other. In fact malnourished people are more susceptible to all infections. Malnourished children suffer from disabilities in development and growth. The greatest sufferers of measles are infants and malnourished children. Immunization of all =or 9-month old infants would eradicate measles. Children and young adults are at the highest risk of injuries. Lung cancer is on the rise in developing countries due to the increase of tobacco smoking. Various means of controlling malaria are use of mosquito nets, antimalarial drugs, reduction of mosquito breeding places, and pesticides. The new infectious disease, AIDS, has emerged as a considerable health problem in developing countries. High priority research areas are vaccines for Streptococcus pneumonia, Plasmodium app., rotavirus, Salmonella typhi (Ty21a), and Shigella spp.^ieng

Relative risks of oral contraceptive usage.

PIP: Women seeking safe, reliable contraception must weigh the risks associated with such methods with their benefits. To make this assessment process more meaningful, the authors have prepared a chart that sets forth the risks of oral contraceptive (OC) use by different user factors (e.g., age, cigarette smoking) in proportion to the risks inherent in a variety of sporting activities and types of accidents. Mortality rates reported for OC use include those due to the method and those due to pregnancies resulting from method failure. Scrutiny of this chart reveals that the risk of death associated with swimming, boating, and automobile use exceeds the risk of death for nonsmokers who use OCs up to 34 years of age (1.6 deaths/100,000 population). OC use by women 15-24 years of age who smoke carries a lower mortality risk (3.0/1000) than scuba diving or falling, while OC users 25-34 years old who smoke are more likely to die as a result of homicide, suicide, or automobile accidents than they are as a result of their use of OCs (mortality rate, 10.2/1000). On the other hand, OC use by smokers 35-44 years of age is associated with a mortality rate of 84.5/1000, which is a higher risk than that associated with the sport of hang-gliding.^ieng

Adolescent (in)vulnerability.

Three groups of subjects were asked to judge the probability that they and several target others (a friend, an acquaintance, a parent, a child) would experience various risks. Subjects were middle-class adults, their teenage children, and high-risk adolescents from treatment homes. All three groups saw themselves as facing somewhat less risk than the target others. However, this perception of relative invulnerability was no more pronounced for adolescents than for adults. Indeed, the parents were viewed as less vulnerable than their teenage children by both the adults and those teens. These results are consistent with others showing small differences in the cognitive decision-making processes of adolescents and adults. Underestimating teens' competence can mean misdiagnosing the sources of their risk behaviors, denying them deserved freedoms, and failing to provide needed assistance.

PIP: Policy choices depend in part of political values and assumptions about adolescents' decision making abilities. The focus of this article is on judging the probability of adverse outcomes and the tendency to be overconfident. Discussion is directed to adolescent and adult invulnerability and evidence of other decision making skills. The conclusion from the review of evidence is that invulnerability is not particularly larger during adolescence. The hypothesis of this study directly tests adolescent invulnerability. A sample of 86 pairs of low-risk teens and parents and 95 high-risk teens were obtained from recruitment efforts at public high schools. The mean age of students was 15 years; the mean age of adults was 43 years. Low-risk persons were primarily girls and adults, more primarily mothers of teens. 23% of high risk teens were girls. Eight events were chosen to reflect high and low controlability (auto accident injury, alcohol dependency, unplanned pregnancy, mugging, sickness from air pollution or pesticides or radiation poisoning, and injury in a fire explosion). Evaluation for each event was made for controlability, probability of occurrence, preventive effort, and experience with the event. Subjects also evaluated 2-3 target individuals. The results pertain to the probability response mode as an ordinal scale; to control, prevention, and experience judgments; and to an examination of the absolute invulnerability hypothesis for group, target, and event factors. 43% of the time adolescents did not perceive any differences between their own level of risk and the target's. Otherwise, respondents were twice as likely to assign a higher risk probability to targets. 10% of the time, subjects assigned a risk of 0 or no chance. 33% of the time, the risk was less than 1 in 10,000. Risk was not any greater for teens than adults. Teens tended to overdifferentiate their situation, as indicated in the Elkind fable. Risk was gauged higher for the more active events. Teens were sensitive to how the question was posed; i.e. one time vs repeated actions. Low-risk teens and adults were moderately overconfident; high risk teens showed greater overconfidence. The theoretical and policy implications are dependent on the event; further research might focus on why adults view teens so harshly and deny them the right to govern their own actions.

Incidence of legal abortion in Sweden after the Chernobyl accident.

The number of legal abortions in Sweden increased around the time of the Chernobyl accident, particularly in the summer and autumn of 1986. Although there was no recording of reasons for legal abortions, one might have suspected this increase to be a result of fear and anxiety after the accident. However, seen over a longer time perspective, the increase in the number of abortions started before and continued far beyond the time of the accident. There was also a simultaneous and pronounced increase in the number of births during the years subsequent to the accident. Therefore, it seems unlikely that fear of the consequences of radioactive fall-out after the Chernobyl accident resulted in any substantial increase of the number of legal abortions in Sweden.

PIP: After the Chernobyl accident, there was concern about the effects of the accident on pregnancy in Sweden. This concern is addressed by analyzing the trends in legal abortion and births between 1960. Although abortion has been legal since 1975, there is no requirement to report the reason, only the incidence to the National Board of Health on a monthly basis. In 1986 legal abortions totaled 33,124, which was an increase over preceding years. The increase continued up to 1990. July 1986 marked an increase particularly among women 15-25 years, but this increase also appeared in July 1988 and 1989. If Chernobyl was the cause, one would expect a decrease in births, which in fact did not occur. There has been an increase in births and a shift toward higher maternal age. This suggests that younger women are using abortion as birth control. 1986 coincidentally marked a period of change in reproductive behavior. If chernobyl had an effect, then it is expected that it would be short term for abortions and births, with an increase in abortion and a decrease in births; instead, there is a 4-year trend in increased abortions and births. The results of the National Board of Health's inquiry into area-specific rates and reported radioactive fallout for each area showed no differences in trends in abortion rates between areas. This also suggests little influence of Chernobyl on abortion rates. Few studies are available that explore the reasons for pregnancy termination and none were conducted after Chernobyl. In a 1982 Stockholm study, over 50% reported unstable or nonexistent relationships with the father, another 25% reported socioeconomic reasons, and the remainder reported too young age as a reason. It is concluded that there is little evidence to support the position that the Chernobyl accident caused pregnancy termination out of fear and anxiety among Swedish women, even though women in antenatal clinics did express concern about the accident's consequences.

Incidence of legal abortions and congenital abnormalities in Hungary.

The annual and monthly distributions of congenital abnormalities and pregnancy outcomes as confounding factors were evaluated in Hungary in reflection of the accident at the Chernobyl reactor. The different congenital abnormality entities and the components of fetal radiation syndrome did not show a higher rate after the Chernobyl accident in the data-set of the Hungarian Congenital Abnormality Registry. Among confounding factors, the rate of induced abortions did not increase after the Chernobyl accident in Hungary. In the 9th month after the peak of public concern (May and June, 1986) the rate of livebirths decreased. Three indicator conditions: 15 sentinel anomalies as indicators of germinal dominant gene mutations, Down syndrome as an indicator of germinal numerical and structural chromosomal mutations, and unidentified multiple congenital abnormalities as indicators of germinal dominant gene and chromosomal mutations were selected from the material of the Hungarian Congenital Abnormality Registry. Diagnoses were checked, familial and sporadic cases were separated and only the sporadic cases were evaluated. The analysis of indicator conditions did not reveal any measurable germinal mutagenic effect of the Chernobyl accident in Hungary.

PIP: The Hungarian Investigation of the effects of radiation from the Chernobyl accident involved evaluation of isolated and multiple congenital anomalies (CAs), unidentified CAs, fetal radiation syndrome, induced abortions, sentinel anomalies, and Down syndrome prevalence. There were no measurable teratogenic and germinal mutagenic effects after the April 28-May 15, 1986 impact. The highest beta activity occurred through late June. The highest external gamma ray level was .4 uSv. Hungary had the 13th highest radiocesium (Cs 137) deposition (7.9 x 10 to the 14th power Bg) and the 10th-11th highest national collective 50-year total body dose (1.3 x 10 to the 4th power person Gy). The level of external dose and individual total body ingestion dose gave Hungary a rank of 70th. The maximum extra dose was around .4 mSv in some regions. Mortality is obligatorily recorded and all births take place in hospitals with obstetrically trained birth attendants where CAs are also recorded. Registration of CAs is considered nearly complete and is available from the Hungarian Congenital Abnormality Registry (HCAR). Data on induced abortion, fetal deaths, and live births is provided by the Central Statistical Office to HCAR. The Hungarian Surveillance of Germinal Mutations (HSGM) provides data on sentinel anomalies, Down syndrome, and unidentified multiple CAs. The results indicate that isolated and multiple CA entities in 1986 and 1987, annually or monthly, did not exceed the rates of previous years. Microencephaly, cataracts, microphthalmos, and CAs of the eyes, and other fetal radiation syndrome showed no monthly increase and did not exceed the expected numbers based on baseline figures of 1973-82, regardless of region. The monthly distribution of induced abortions did not change after Chernobyl. February and March 1987 births decreased in the 9=month period after Chernobyl. An average of 3.7 new mutations/10,000 live births was found annually between 1980-89 which was not a significant change. Down syndrome cases averaged 104.year due to numerical or structural chromosomal changes and was not considered significant. Unidentified MCAs did not show an increased rate.

Pregnancy outcome in Finland after the Chernobyl accident.

The explosion at the Chernobyl nuclear power plant caused radioactive fallout in Finland in April-May 1986. The fallout was unevenly distributed geographically, and, accordingly, the country was divided into 3 fallout zones. Whole-body radioactivity measurements of randomly chosen persons showed that the regional differences prevailed throughout the following 2 years. Data for legal abortions, registered congenital malformations as well as preterm births and stillbirths of malformed children were collected. The corresponding expected figures were obtained from statistics from 1984 and 1985. No differences in the expected/observed rates of the above parameters were detected.

PIP: The effects of the 1986 Chernobyl accident on Finland are reported. Legal abortions, registered congenital malformations, preterm births, and stillbirths showed no differences in observed vs. expected rates after the accident. The limitations are that the population base is small, the detection system is incomplete, no reliable data are available on early abortions, and germinal mutations were not presently analyzed. Measurement of radiocesium (Cs 134 and 137) was accomplished by the Research Institute for Social Security with a stratified random sample of 380 people. 5 fallout zones differentiated groups, which were then collapsed into 3 groups. Regional differences in levels persisted into 1988. The Finnish Register of Congenital Malformations provided the compulsory data on congenital malformations. The 3 groups (children born before the accident in 1984-85, in the latter half of 1986, and in 1987) were analyzed in the 3 zones during 2 study periods (August-December 1986 and January-December 1987). Monthly analysis of induced abortions showed no increase following the accident. There was a slight decrease in births between January and March 1987, which is believed to be related to anxiety reinforced by public advice. There were no differences between expected and observed congenital defects in the 2 study periods. Preterm and stillbirths followed a similar pattern. The analysis showed no association between the temporal and spatial variations in radioactivity and variable incidence of congenital malformations.

Pregnancy outcome in Norway after Chernobyl.

Pregnancy outcome has been studied in terms of legal abortions, early spontaneous abortions and total number of pregnancies (in an ad hoc study covering 6 counties) as well as various perinatal health problems (on the basis of routinely recorded data for epidemiological surveillance from the Medical Birth Registry of Norway). Apparently, no effects were observed in terms of an increased occurrence of legal abortions, while spontaneous abortions increased from 7.2% of all pregnancies during the last 12 months before the accident to 8.3% after the accident [corrected]. At the same time, the total number of pregnancies somewhat decreased. Based on monthly measurements in each municipality of external and internal (food-based) doses, dose-response associations were assessed for a number of perinatal health problems. No associations were observed.

PIP: The effects of Chernobyl on pregnancy outcome were investigated in Norway in terms of legal abortions, early spontaneous abortions, total pregnancies, and perinatal health problems (cataracts, microcephaly, low birth weight, and perinatal mortality). The epidemiological results showed that there were no serious gross changes in pregnancy outcome in Norway after Chernobyl in 1986. Anxiety may have led to the temporary decrease in pregnancies. The statistically significant difference in spontaneous abortions between 19867 and 1987, particularly in the months following Chernobyl, may be related but causation cannot be determined based on the present data; i.e., dietary changes due to anxiety may also be related. Further analyses will be conducted with data spanning 5 years after Chernobyl. The Central Bureau of Statistics provided data on legal abortions as reported by hospitals to county medical officers. Spontaneous abortions (16 weeks) are based on ad hoc notifications from hospitals in 5 counties: Aust-Agder, Hordaland, Oppland, Troms, and Trondelag. Compulsory notification of births is recorded in the Medial birth Registry and includes congenital malformations and other perinatal health problems. The National Institute of Radiation Hygiene recorded data after the accident on indoor gamma rates, radiocesium (Cs 134) soil samples, and municipality specific average food-based dose equivalents of Cs 134 and 137 in meat and meat supplies. The total external and internal dose is provided for May 1986-April 1989. Food-based doses remained at an elevated level for an extended period of time. Infant exposure was considered form the 2nd month of gestation. Legal abortions, induced or spontaneous, were not impacted by Chernobyl, but the effect may have been delayed to the 3rd or 4th quarter with a 1.0% increase. However, at Haukeland Hospital in Bergen, the highest abortion rates were 19.1% in 1985-86 and 19.2% in 1986-87. Pregnancies temporarily decreased in the 3rd and 4th quarters following the accident in a period usually reflecting annual increases. Cataract occurrences increased the year after the accident with 8 observed and 3.8 expected, but the P value was insignificant (P=.74). Microcephaly followed a similar pattern. Birth 2500 gms had observed values of 2726 vs. 2639.2 expected, an insignificant P value of .99. Observed perinatal deaths of 634 were less than the 718.8 expected.