Forensic Pathology Analysis of 363 Sudden Death Cases in Yunnan Province.

OBJECTIVES: To study the epidemiological and pathological features of sudden death （SD） in Yunnan Province and to provide scientific evidence for prevention and forensic identification of sudden death. METHODS: Totally 363 SD cases were collected from the autopsies between 2009 and 2017 in the Forensic Centre of Kunming Medical University. The related factors such as etiology, age, inducing factor, time interval between the onset of disease and death, morbidity season and pathological change were retrospectively analysed. RESULTS: The incidence of SD in males was significantly higher than that of females. The peak age was ≥35-55 years. The mortality rate was relatively high within 6 h after the onset of disease. The season order with descending number of deaths was spring, summer, winter and autumn. The top ten causes of SD were coronary heart disease, sudden unexplained death （SUD）, cerebral hemorrhage, acute hemorrhagic necrotic pancreatitis, aortic dissection rupture, cardiomyopathy, pneumonia, pulmonary thromboembolism, amniotic fluid embolism and allergy. Exercise, infusion, surgery, medication and minor injury were the most common predisposing factors of sudden coronary death. Consciousness disorder or coma, chest pain or chest tightness, and abdominal pain were the most common premortem symptoms of sudden coronary death. CONCLUSIONS: The SD is more common in middle-aged males, which is the key population for the prevention of SD. For the forensic identification and prevention of SD, the attention on SUD should be paid.

[Analysis of 124 Suicide Cases in Wuhua District in Kunming].

OBJECTIVES: To analyze the relationship between the suicide method and the sex, age, education background and cause of suicide to provide reference for the forensic identification of suicide. METHODS: After scene investigation, external body examination, autopsy and case investigation, 124 identified suicide cases which happened in recent three years in Wuhua district in Kunming were collected. Analytical methods as chi-square test and descriptive statistics were performed by SPSS 22.0. RESULTS: In all the suicide cases, male to female ratio was 1.53∶1. The suicide methods were mainly fatal fall, hanging and drowning. The ratio of local to non-native residents was 1∶1. The suicide rate in the people with primary school or junior middle school education level was highest. The group of >10-50 years tended to choose fatal fall suicide and people over 60 years were more likely to choose hanging. People with different academic background tended to choose fatal fall suicide. The suicide methods as fatal fall and hanging were chosen because of mental and physical diseases and economic problems, while the suicides with emotional problems were more likely to choose fatal fall and poisoning. CONCLUSIONS: Suicide belongs to a kind of complex cases. For the cases of suspected suicide, complete exploration and overall consideration should be done to determine the nature of cases based on comprehensive analysis of all the influence factors.

[Research Progress of Yunnan Unexplained Sudden Death].

Yunnan unexplained sudden death （YUSD） has obvious spatial and temporal aggregations. With the features of sudden onset and rapid death, its causes remain unclear. However, the onset of YUSD is related to the geological and climatic conditions in specific range of altitude of incidence area, which is also influenced by the existed susceptibility gene loci or several multiple mutations in SNP loci, long-term fatigue, low dietary nutrition, trace element deficiency, poor living condition and hygienic habit, and infection by etiologic microorganism or virus among the residents live in the incidence area of YUSD. Under the continuous influence of factors above, the crowd of incidence area finally occurred unexplained sudden death that prominently shown by myocardial injury. Improvements of public health administration, living conditions, villagers' health, living habits and enhancement of indicator measurement of myocardial enzyme and electrocardiogram for the residents in the incidence area of YUSD are effective measures for prevention of YUSD. Timely identification of cause of death and in-depth genetic research are important ways to explore the causes of YUSD, enhance the effectiveness of treatment and reduce the death rate.

Safety culture in a pharmacy setting using a pharmacy survey on patient safety culture: a cross-sectional study in China.

OBJECTIVE: To explore the attitudes and perceptions of patient safety culture for pharmacy workers in China by using a Pharmacy Survey on Patient Safety Culture (PSOPSC), and to assess the psychometric properties of the translated Chinese language version of the PSOPSC. DESIGN: Cross-sectional study. PARTICIPANTS: Data were obtained from 20 hospital pharmacies in the southwest part of China. METHODS: We performed χ(2) test to explore the differences on pharmacy staff in different hospital and qualification levels and countries towards patient safety culture. We also computed descriptive statistics, internal consistency coefficients and intersubscale correlation analysis, and then conducted an exploratory factor analysis. A test-retest was performed to assess reproducibility of the items. RESULTS: A total of 630 questionnaires were distributed of which 527 were responded to validly (response rate 84%). The positive response rate for each item ranged from 37% to 90%. The positive response rate on three dimensions ('Teamwork', 'Staff Training and Skills' and 'Staffing, Work Pressure and Pace') was higher than that of Agency for Healthcare Research and Quality (AHRQ) data (p<0.05). There was a statistical difference in the perception of patient safety culture at different hospital and qualification levels. The internal consistency of the total survey was comparatively satisfied (Cronbach's α=0.89). CONCLUSIONS: The results demonstrated that among the pharmacy staffs surveyed in China, there was a positive attitude towards patient safety culture in their organisations. Identifying perspectives of patient safety culture from pharmacists in different hospital and qualification levels are important, since this can help support decisions about action to improve safety culture in pharmacy settings. The Chinese translation of the PSOPSC questionnaire (V.2012) applied in our study is acceptable.