Suicide by helium inhalation in the Netherlands between 2012 and 2019.

INTRODUCTION: In 2012 and 2013 a movie and a book about a 'dignified end of life' were published in the Netherlands. These items described suicide using an 'exit bag' to establish asphyxiation using helium (the helium method). 'Right-to-die-organisations' inform the elderly about this method. The purpose of this study is to investigate whether the use of suicidal asphyxiation by means of the helium method substituted other, related, methods following its publication in the Netherlands. MATERIAL AND METHODS: We analysed suicides in the Netherlands over the period from 1 July 2012 to 30 June 2019. We compared the number of deaths caused by the helium method with other, related, cases. Secondly, we related these deaths to the total number of inhabitants and suicides recorded by Statistics Netherlands. RESULTS: The study showed a stable trend in the use of the helium method in the period 2012-2019 and this was the same for the other, related methods. Individuals using the helium method were significantly younger than those using other, related, methods. At the scene of death, information about suicide and suicide notes were found more often at 'helium method' cases than with the 'other, related, methods' cases. Family was significantly more often present during a helium method suicide than during suicide by other, related, methods. DISCUSSION: The number of suicides by the helium method and other, related, cases is stable in the Netherlands over the past years. Therefore, we conclude that there is no substitution effect within this category of suicides. Whilst 'right-to-die-organisations' strive to inform the old and sick of the helium method, it is noteworthy that the individuals using the helium method are significantly younger than the individuals who choose other, related, methods.

Reliability of proximal migration measurements in shoulder arthroplasty.

Proximal migration is a complication in shoulder arthroplasty. Quantification of this phenomenon would help in identifying its cause. This study assessed the reliability of 4 methods of measuring proximal migration after shoulder arthroplasty on standard anteroposterior radiographs: the glenohumeral center-to-center measure, the glenohumeral arc measure, the acromiohumeral distance, and the scapular spine-humeral head center (spinohumeral) distance. Radiographs were taken of 12 embalmed shoulders, with matching metal humeral head replacements, in the neutral position and rotated both ways for 20 degrees along the vertical and horizontal axes. The measurements were tested for the reliability of the deviating projections against the neutral position, and an estimate of the interobserver and intraobserver reliability was made. Statistics included a paired t test and the interclass correlation coefficient. The acromiohumeral distance and spinohumeral center method proved most reliable. The spinohumeral center method was the least sensitive for projection errors, although only applicable as a relative measure. The coracoid process base can be used as a tell-tale sign for scapular projection.