Acute stressors and clinical characteristics differentiate death by suicide, accident, or natural causes among illicit and prescription opiate users.

BACKGROUND: Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by natural cases, accidents, and suicide using psychological autopsy methods. Groups were compared on substance use characteristics, treatment history, experiences of negative life events, and circumstances at the time of death. METHODS: Substance use and suicide risk were evaluated using psychological autopsy methods in 63 decedents with positive toxicology for opiates at death divided into three groups: adults dying by suicide (n = 19), accident (n = 19), and natural causes (n = 25). Groups were compared on several dependent measures, using chi-square analyses to examine categorical variables and one-way analyses of variance (ANOVA) to examine continuous variables. RESULTS: Individuals who died by suicide were similar in many ways to adults who died by an accidental overdose. However, suicide completers were more likely to have struggled with severe depression, and previously attempted suicide, whereas the accidental overdose sample was more likely to display a chronic pattern of severe drug abuse. CONCLUSIONS: The current study helps to distinguish between opiate users who are at risk for death by an accidental or intentional overdose. In the ongoing opiate crisis, clinicians must understand the risk of overdose and the nuances of accidental behaviors compared to purposeful ones. Signs of suicidal planning, relevant psychopathology, and ongoing life stress may be useful points of intervention for stopping the increasing number of deaths among opiate users.

El papel de la autopsia en la práctica clínica actual / The current role of autopsy in current clinical practice

No disponible

Autopsy Practice in Ghana - Reflections of a Pathologist.

Autopsy practice in Ghana can be said to be far from satisfactory. Most Ghanaians do not know that there are different categories of death, which categories of death require an autopsy and who is required to perform the autopsy. The problems have further been complicated by the fact that, unlike other countries where separate facilities are available for storage of the different categories of dead bodies, all dead bodies in Ghana are conveyed to the hospital mortuary, thus encouraging hospitals to expand body storage facilities in their mortuaries to meet the increasing demand. Public or community mortuaries used elsewhere for storage of bodies of deaths occurring in the community pending the Coroner's directions are non-existent in Ghana. Storage of all categories of dead bodies in hospital mortuaries has resulted in virtually all autopsies being done by the hospital pathologists, especially in the large centres, at the expense of other very important diagnostic functions of the pathologist. This paper explains relevant portions of the Coroner's Act of 1960 and emphasises the need to separate the few hospital autopsies that require the expertise of the pathologist from Coroner's autopsies that may be carried out by any registered medical officer, as specified in the Act, or better still, by specially trained Forensic Physicians/Medical Examiners, as pertains in other countries. The paper also clarifies the different categories of death, those that fall in the jurisdiction of the Coroner and the personnel required to assist the Coroner in his investigastions. Suggestions have also been made on how to approach manpower development to ensure that appropriate personnel are trained to assist the Coroner in the investgation of medico-legal cases.

Performance criteria for verbal autopsy-based systems to estimate national causes of death: development and application to the Indian Million Death Study.

BACKGROUND: Verbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical attention or certification. We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India's ongoing, nationally-representative Indian Million Death Study (MDS). METHODS: Performance criteria include a low ill-defined proportion of deaths before old age; reproducibility, including consistency of COD distributions with independent resampling; differences in COD distribution of hospital, home, urban or rural deaths; age-, sex- and time-specific plausibility of specific diseases; stability and repeatability of dual physician coding; and the ability of the mortality classification system to capture a wide range of conditions. RESULTS: The introduction of the MDS in India reduced the proportion of ill-defined deaths before age 70 years from 13% to 4%. The cause-specific mortality fractions (CSMFs) at ages 5 to 69 years for independently resampled deaths and the MDS were very similar across 19 disease categories. By contrast, CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths. Thus, reliance mostly on urban or hospital data can distort national estimates of CODs. Age-, sex- and time-specific patterns for various diseases were plausible. Initial physician agreement on COD occurred about two-thirds of the time. The MDS COD classification system was able to capture more eligible records than alternative classification systems. By these metrics, the Indian MDS performs well for deaths prior to age 70 years. The key implication for low- and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths, use simple but high-quality field work with built-in resampling, and use electronic rather than paper systems to expedite field work and coding. CONCLUSIONS: Simple criteria can evaluate the performance of VA-based COD systems. Despite the misclassification of VA, the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available.

The value of autopsies for determining the cause of death.

BACKGROUND: Death certificates are the only source of information on the underlying cause of death in more than 90 % of cases. Supplementary information is available for only a small proportion of them, as a rule from a medical or forensic autopsy. We wished to investigate how frequently the findings of medical autopsies influence determination of the underlying cause of death. MATERIAL AND METHOD: Using the Norwegian Cause of Death Register as our basis, we determined from the death certificate the underlying cause of death for deaths for which a medical autopsy was carried out in 2005. Then we investigated whether the underlying cause of death was changed when we took account of the autopsy findings. RESULTS: There were 41,152 deaths in Norway in 2005. The Cause of Death Registry received the results of medical autopsies for 1 773 persons who died at the age of 2 or older. Autopsy findings led to changes in the underlying cause of death in 1,077 cases (61 %). In 567 cases (32 %), the change was a major one, resulting in a change in the ICD 10 chapter for cause of death. The percentage of changed causes of death was greatest for the youngest and oldest age groups and for women. INTERPRETATION: Medical autopsies provide an important corrective to the determination of underlying cause of death.