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1.
BMJ ; 372: n529, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627438
2.
J Forensic Leg Med ; 76: 102072, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33157341

RESUMO

All Covid-19 deaths and all nursing home and residential home deaths in Ireland must by law be reported to the Coroner, the independent Judicial Officer of the State, in the District in which they occur. This enables accurate and early collation of these death reports. Between January 1, 2015 and June 30, 2020 3342 deaths were reported to the Coroner's District for Kildare. From March 11, 2020, when the first Covid-19 death occurred in Ireland in County Kildare, to June 30, 2020 there were 1738 Covid-19 deaths nationally of which 139 were reported in Kildare with 113 (81%) of these deaths in nursing and residential homes. The calculated excess number of deaths notified for January to June 2020 compared with 2015-2019 was 198 (41%) of the 484 total deaths reported with a 131 (45%) excess in the 293 deaths in nursing and residential homes. Covid-19 deaths accounted for 70% and 86% of these excess deaths respectively. Following subtraction of the 18 non-natural cause deaths and 139 Covid-19 deaths from the total excess there remained an unexplained excess of 60 deaths due to natural causes in March to June of 2020 compared with 2015-2019. The peak excess total death percentage was 359% in April 2020, commencing with a small excess in March (30%), continuing into May (63%) and falling again in June (37%). In the nursing and residential home setting those excess death percentages were most marked at 527% in April, with 27% in March, 54% in May and 17% in June. Underlying medical conditions were recorded in 99% of those dying from Covid-19 and the average age of the deceased was 82.5 years with median of 78 years and 55% of those dying were female and 45% male. The clinical epidemiology and documented excess mortality of the reported deaths are chronicled and analysed to learn also about the future challenges with the continuing Covid-19 infection. A centralized national mortality database providing near real-time death certification enhances infectious disease surveillance and prompt clinical epidemiology and mortality excess studies and reduces under-reporting of Covid-19 deaths.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Sistema de Registros/estatística & dados numéricos , Adulto , Causas de Morte , Médicos Legistas , Bases de Dados Factuais , Atestado de Óbito , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pandemias
4.
Occup Med (Lond) ; 70(7): 515-522, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-32954421

RESUMO

BACKGROUND: By law, covid-19 disease and deaths in workers may lead to coroners' inquests and/or Health and Safety Executive (HSE) investigations. AIMS: This study assesses the adequacy of these statutory means to yield recommendations for prevention of acquiring covid-19 infection from work. METHODS: Covid-19 guidance from the chief coroner and the HSE was appraised, including using Office for National Statistics (ONS) data. Practitioners were asked to estimate the likelihood that covid-19 disease may have arisen from 'near-miss' scenarios. Data from the judiciary and the HSE were analysed. RESULTS: The coroners' guidance allowed a wider range of reports of death than did the HSE and conformed better with ONS data on covid-19 mortality by occupation. In the practitioner survey, 62 respondents considered a higher likelihood that reported covid-19 cases would have arisen from the scenario deemed unreportable as a 'dangerous occurrence' by HSE than the reportable scenario (P < 0.001). On average there was only one coroner's report to prevent future death from occupational disease every year in England and Wales. The HSE dealt with a yearly average of 1611 reports of work-related disease including 104 on biological agents, but has received about 9000 covid-19 reports. CONCLUSIONS: Current HSE guidance for reporting work-related covid-19 may miss many thousands of cases and needs further iteration. Coroners have very limited experience of inquiry into occupational disease caused by biological agents compared with the HSE. Concerns regarding national policy such as on protective equipment warrant a full public inquiry.


Assuntos
Betacoronavirus , Causas de Morte , Infecções por Coronavirus/mortalidade , Doenças Profissionais/mortalidade , Exposição Ocupacional/análise , Saúde do Trabalhador , Pneumonia Viral/mortalidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Médicos Legistas , Notificação de Doenças , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Reino Unido/epidemiologia
5.
J Forensic Leg Med ; 74: 102028, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32990601

RESUMO

COVID-19 has swamped the entire world and turned into a pandemic. Its high contagiousness compelled authorities to categorize all autopsies as 'high risk' considering the risk of exposure to the healthcare workers. In India, the Criminal Procedure Code authorizes investigating police officer to hold an inquest into suspicious deaths. The present article draw attention towards the 'needless autopsies' in times of COVID-19 and emphasizes on causes and recommendations.


Assuntos
Autopsia/normas , Infecções por Coronavirus/epidemiologia , Médicos Legistas/organização & administração , Pneumonia Viral/epidemiologia , Polícia/legislação & jurisprudência , Betacoronavirus , Médicos Legistas/legislação & jurisprudência , Médicos Legistas/normas , Humanos , Índia , Pandemias , Equipamento de Proteção Individual
8.
Acad Med ; 95(9): 1290-1291, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32841993
9.
Acad Med ; 95(9): 1291, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32841994
11.
Rev. clín. esp. (Ed. impr.) ; 220(4): 215-227, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194885

RESUMO

INTRODUCCIÓN: El certificado médico de defunción es un documento con una doble función: registro oficial del fallecimiento de una persona y análisis estadístico de las causas de muerte de la población. La cumplimentación de este documento en la práctica clínica genera grandes conflictos. OBJETIVOS: Analizar la cumplimentación y detectar los principales errores que existen al rellenar estos documentos. Se procedió a la comparación de las variables más importantes entre los diferentes tipos de documentos analizados. MATERIAL Y MÉTODOS: Estudio transversal descriptivo. Se analizaron 513 certificados del municipio de Madrid. El análisis incluía documentos oficiales, nuevos y antiguos, y de los hospitales. RESULTADOS: Como principal hallazgo destacó que 316 documentos empleaban el término «parada cardiorrespiratoria» como causa inmediata de muerte. En otros 98 casos se emplearon otras causas inmediatas mal definidas. También se pudo concluir que los documentos de los hospitales no siempre tienen los apartados requeridos para que el certificado haga su función legal. En los certificados de la Organización Médica Colegial existe una peor cumplimentación en el documento actual porque el propio documento dificulta que se rellene adecuadamente y precisa una mejor formación del médico para rellenarlo. CONCLUSIONES: Se proponen posibles mejoras en el propio documento oficial para que se consideren las exigencias legales, se facilite su cumplimentación y cumpla su función. También se proponen recomendaciones para los hospitales que tengan su propio documento y sugerencias de mejora de la cumplimentación


BACKGROUND: The medical certificate of cause of death is a dual-purpose document: an official registration of an individual's death and a statistical analysis of the populational causes of death. However, the completion of this document in clinical practice creates significant conflicts. OBJECTIVES: To analyse the completion and detect the main errors that occur when filling in these documents. We then compared the most important variables between the various types of documents analysed. MATERIAL AND METHODS: We conducted a descriptive cross-sectional study that analysed 513 certificates in the municipality of Madrid, Spain. The analysis included official documents (new and old versions) and hospital documents. RESULTS: The study's main finding was that 316 documents employed the term "cardiopulmonary arrest" as the immediate cause of death. In 98 other cases, other poorly defined immediate causes were listed. We were able to conclude that the hospital documents do not always have the required sections for the certificate to be legally functional. In the Professional Medical Association certificates, there is poorer completion of the current document because the document itself hinders its appropriate completion and requires better physician training to complete. CONCLUSIONS: We propose possible improvements to the official document so that it meets the legal requirements, facilitates its completion and fulfils its function. We also offer recommendations for hospitals that have their own document and suggestions for improving its completion


Assuntos
Humanos , Causas de Morte , Atestado de Óbito , Estudos Transversais , Erros de Diagnóstico , Epidemiologia Descritiva , Médicos , Médicos Legistas , Controle de Formulários e Registros/normas , Espanha/epidemiologia
14.
Med. leg. Costa Rica ; 37(1): 101-113, ene.-mar. 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1098377

RESUMO

Abstract Forensic microbiology is a scientific area that has emerged with the need to investigate biocrimes, as in the case of intentional transmission of the Human Immunodeficiency Virus (HIV). The present exploratory work aimed to demonstrate how biomedical technology, such as phylogenetics and quantification of viral load and CD4+ T lymphocytes, can be used to produce technical evidence that brings more certainty in determining the authorship and materiality of these criminal behaviors.


Resumen La microbiología forense es un área científica que ha surgido con la necesidad de investigar los delitos biológicos, como en el caso de la transmisión intencional del virus de la inmunodeficiencia humana (VIH). Este trabajo exploratorio tuvo como objetivo demostrar cómo la tecnología biomédica, como la filogenética y la cuantificación de la carga viral y los linfocitos T CD4+, puede usarse para producir evidencia técnica que brinde más certeza para determinar la autoría y la materialidad de estas conductas criminales.


Assuntos
Delitos Sexuais , HIV , Terapia Antirretroviral de Alta Atividade/métodos , Microbiologia , Síndrome de Imunodeficiência Adquirida/etiologia , Médicos Legistas , Competência de Transformação por DNA , Medicina Legal
15.
J Forensic Sci ; 65(2): 544-549, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31990383

RESUMO

In 2007, the Bureau of Justice Statistics reported on 2004 data collected from the Census of Medical Examiner and Coroner Offices (CMEC). The CMEC was one of the first comprehensive reports on the state of the medicolegal death investigation system in the United States and included information on administration, expenditure, workload, specialized death investigations, records and evidence retention, and resources. However, the report did not include responses on questions that were related to toxicology such as specimen retention and type of testing. The purpose of this publication is to provide the community with toxicology laboratory-specific responses from nearly 2000 medical examiner and coroner (MEC) offices. Data obtained from a BJS CMEC public use dataset for any remaining information that was not reported in the 2007 BJS report were evaluated specific to the operation of toxicology laboratories within a MEC office or specific to toxicology testing. The CMEC includes information on average operating budget for MEC offices with internal or external toxicology services, budget for toxicology/microbiology services, respondents' routine uses of toxicology analysis, toxicology specimen retention time, average turnaround times, use of computerized information management systems, and participation in federal data collections. These historical data begin to address the present state of our nation's toxicology laboratories within the medicolegal death investigation system and their preparedness for the current drug overdose epidemic.


Assuntos
Médicos Legistas/organização & administração , Toxicologia Forense/organização & administração , Laboratórios/organização & administração , Conjuntos de Dados como Assunto , Overdose de Drogas , Humanos , Estados Unidos
16.
N Z Med J ; 133(1508): 65-71, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945043

RESUMO

AIM: Sudden unexpected death in epilepsy (SUDEP) is well recognised and widely reported but remains poorly understood. SUDEP in young adults is 27 times more common than sudden death in control populations. The incidence of SUDEP in New Zealand is not known but up to 40 people with epilepsy may die from SUDEP every year. A review of coroner's reports of SUDEP was undertaken to learn more about SUDEP in New Zealand. METHOD: Coroner's reports of all cases of possible SUDEP in New Zealand from 2007-2016 (n=190) were obtained and post-mortem and toxicology results were reviewed. Cases were categorised using published criteria. RESULTS: We obtained reports of 190 cases from the coroner's office. Of these 190 cases, we determined that 123 were definite SUDEP, 40 were definite SUDEP plus, three were probable SUDEP, seven were possible SUDEP and 17 were probably not SUDEP. The number of cases per year varied from 11-26 (2013). Cases were aged 1.5-67 years, with 63% aged 15-45 (mean 37 years). Sixty-one percent were male. Eighty-seven percent of the deaths occurred at home, with 74% found dead in their bed or bedroom. The majority were not employed, with only 33% working or retired at the time of death; 15% were children or students. Information regarding work status was not available for 11%. Toxicology results were available for 155 cases; antiepileptic drug (AED) use was detected in 67% of these cases, with a single AED detected in 44%, two AEDs in 21%, and three AEDs in 3% of samples taken at autopsy. Approximately half who took an AED were taking either sodium valproate or carbamazepine. CONCLUSION: This study suggests that people with epilepsy who die from SUDEP in New Zealand are young and are often compliant with their medication. We plan to establish a nationwide SUDEP registry using the EpiNet database to determine the incidence of SUDEP in New Zealand, and to track changes in SUDEP rates. We are also planning to take part in an international case-control study of SUDEP in the hope that we might learn more about risk factors that predispose people with epilepsy to SUDEP, and factors that might reduce the risk.


Assuntos
Morte Súbita/epidemiologia , Epilepsia/mortalidade , Morte Súbita Inesperada na Epilepsia/epidemiologia , Adolescente , Adulto , Idoso , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Autopsia/estatística & dados numéricos , Causas de Morte/tendências , Criança , Pré-Escolar , Médicos Legistas/estatística & dados numéricos , Epilepsia/tratamento farmacológico , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
17.
Public Health Rep ; 135(1): 40-46, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31835013

RESUMO

OBJECTIVES: Violence due to firearms is a substantial public health problem. Death data from medical examiner and vital records were linked to evaluate the use of medical examiner data to augment routine surveillance and determine any differences in sex, age, manner of death, or race and ethnicity between the 2 data systems. MATERIALS AND METHODS: Medical examiner data were searched for keywords of interest, and vital records data were obtained and linked for deaths occurring in Multnomah County, Oregon, from January 1, 2010, through December 31, 2016. Both data sets were compared for the number and proportion of firearm-related deaths by sex, age, manner of death, and race/ethnicity. Sensitivity and positive predictive values were calculated for variables that had discordant results. RESULTS: A total of 568 firearm-related deaths were identified in the medical examiner data. After matching with manual review, the 2 data systems had 100% case agreement. A reverse match showed that most cases not found in medical examiner data were due to transfer of case jurisdiction. The 2 systems matched nearly perfectly in sex, age, and manner of death but differed in characterization of race and ethnicity. Sensitivity was 62% for Hispanic ethnicity but 93% for white and black race. PRACTICE IMPLICATIONS: Using medical examiner data was a useful way to augment routine surveillance of firearm-related deaths in our jurisdiction in close to real time. However, caution is needed when analyzing data by subgroups because of discordant classifications of race between the data systems.


Assuntos
Médicos Legistas/estatística & dados numéricos , Coleta de Dados/métodos , Registros/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adulto , Distribuição por Idade , Idoso , Grupos de Populações Continentais , Coleta de Dados/normas , Grupos Étnicos , Feminino , Armas de Fogo , Humanos , Masculino , Pessoa de Meia-Idade , Oregon , Vigilância da População , Reprodutibilidade dos Testes , Distribuição por Sexo , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/etnologia , Adulto Jovem
18.
J Forensic Leg Med ; 69: 101882, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704629

RESUMO

The death certificate form used in England and Wales is analysed, compared to other available forms in top ranking economies, to determine its fitness for purpose. There are several restrictions linked to its use and also many limitations. Areas where it can evolve and where improvement can be achieved are suggested.


Assuntos
Atestado de Óbito , Causas de Morte , Médicos Legistas , Inglaterra/epidemiologia , Humanos , Gestão da Informação , Internacionalidade , Informática Médica , Mortalidade , País de Gales/epidemiologia
19.
Am J Obstet Gynecol ; 222(3): 269.e1-269.e8, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31639369

RESUMO

BACKGROUND: Maternal mortality rates in the United States appear to be increasing. One potential reason may be increased identification of maternal deaths after the addition of a pregnancy checkbox to the death certificate. In 2016, 4 state health departments (Georgia, Louisiana, Michigan, and Ohio) implemented a pregnancy checkbox quality assurance pilot, with technical assistance provided by the Centers for Disease Control and Prevention. The pilot aimed to improve accuracy of the pregnancy checkbox on death certificates and resultant state maternal mortality estimates. OBJECTIVE: To estimate the validity of the pregnancy checkbox on the death certificate, and to describe characteristics associated with errors using 2016 data from a 4-state quality assurance pilot. MATERIALS AND METHODS: Potential pregnancy-associated deaths were identified by linking death certificates with birth or fetal death certificates from within 1 year preceding death or by pregnancy checkbox status. Death certificates that indicated that the decedent was pregnant within 1 year of death via the pregnancy checkbox, but that did not link to a birth or fetal death certificate, were referred for active follow-up to confirm pregnancy status by either death certifier confirmation or medical record review. Descriptive statistics and 95% confidence intervals were used to examine the distributions of demographic characteristics by pregnancy confirmation category (confirmed pregnant, confirmed not pregnant, and unable to confirm). We compared the proportion confirmed pregnant and confirmed not pregnant within age, race/ethnicity, pregnancy checkbox category, and certifier type categories using a Wald test of proportions. Binomial and Poisson regression models were used to estimate prevalence ratios for having an incorrect pregnancy checkbox (false positive, false negative) by age group, race/ethnicity, pregnancy checkbox category, and certifier type. RESULTS: Among 467 potential pregnancy-associated deaths, 335 (72%) were confirmed pregnant via linkage to a birth or fetal death certificate, certifier confirmation, or review of medical records. A total of 97 women (21%) were confirmed not pregnant (false positives) and 35 (7%) were unable to be confirmed. Women confirmed pregnant were significantly younger than women confirmed not pregnant (P < .001). Deaths certified by coroners and medical examiners were more likely to be confirmed pregnant than confirmed not pregnant (P = .04). The association between decedent age category and false-positive status followed a dose-response relationship (P < .001), with increasing prevalence ratios for each increase in age category. Death certificates of non-Hispanic black women were more likely to be false positive, compared with non-Hispanic white women (prevalence ratio, 1.41; 95% confidence interval, 1.01, 1.96). The sensitivity of the pregnancy checkbox among these 4 states in 2016 was 62% and the positive predictive value was 68%. CONCLUSION: We provide a multi-state analysis of the validity of the pregnancy checkbox and highlight a need for more accurate reporting of pregnancy status on death certificates. States and other jurisdictions may increase the accuracy of their data used to calculate maternal mortality rates by implementing quality assurance processes.


Assuntos
Atestado de Óbito , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Adulto , Médicos Legistas , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Gravidez , Estados Unidos/epidemiologia
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