Drug-Related Deaths Among Young People in a Scottish Region: A Socio-Ecological Autopsy Approach to Understanding the Context of Drug Deaths.

BackgroundFew longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.MethodsFollow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.ResultsOf 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.ConclusionsThe cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.

Is there a north–south mortality divide in England or is London the outlier?

A study of causes of neonatal deaths

Immediate and contributory causes of death in patients hospitalized with COVID-19

OBJECTIVE To understand patterns of care at end of life in glioma patients. BACKGROUND Patients with gliomas often inquire about end-of-life issues. Understanding common clinical outcomes of tumor progression and end-of-life circumstances may reduce anxiety among patients and caregivers and inform care planning. METHODS Following IRB approval, we retrospectively analyzed circumstances surrounding death among patients with intracranial gliomas at Columbia University Irving Medical Center from 1/2014-2/2019, including immediate cause and location of death and implementation of palliative measures. Information unavailable from the medical record was supplemented by caregivers. RESULTS Data were available for 152 patients (95 men, 57 women; median age at death 61.5 years). Failure to thrive with transition to supportive care (n=117, 77%) was the most common immediate cause of death. Others included infection (19, 13%; with pulmonary (12, 8%), urinary tract (5, 3%), CNS (4, 3%), and GI (2, 1%) sources); seizures (8, 5%); intracerebral hemorrhage (5, 3%); cerebral edema (4, 3%); pulmonary embolism (4, 3%); autonomic failure (2, 1%); hemorrhagic shock (2, 1%); respiratory failure of unknown cause (2, 1%); pulmonary edema (1, 1%); and cardiac arrhythmia (1, 1%). Ten patients had multiple causes of death. Seventy-three patients (48%) died at home with hospice. Other locations were inpatient hospice (40, 26%); acute care hospital (34, 22%) including 27 (18%) with and 7 (5%) without comfort measures; skilled nursing facility (4, 3%) including 3 (2%) with and 1 (1%) without comfort measures; or religious facility (1, 1%) with comfort measures. Acute cardiac and/or pulmonary resuscitation was performed in 20 patients (13%); 8 (5%) died with no comfort measures. CONCLUSIONS Failure to thrive with transition to supportive care was the most common (77%) immediate cause of death followed by infection (13%). Hospice and/or palliative measures were implemented in 95% of patients, though resuscitative efforts were performed in 13%.

Despite 75 to 90 % physician accuracy in determining the underlying cause of death, precision of determination of the immediate cause of death is approximately 40 %. In contrast, two thirds of immediate causes of death in hospitalized patients are correctly diagnosed by postmortem computed tomography (CT). Postmortem CT might provide an alternative approach to verifying the immediate cause of death. To evaluate the effectiveness of postmortem CT as an alternative method to determine the immediate cause of death in hospitalized patients, an autopsy-based prospective study was performed. Of 563 deaths from September 2011 to August 2013, 50 consecutive cadavers undergoing hospital autopsies with consent for additional postmortem CT at the University of Fukui were enrolled. The accuracy of determination of the immediate cause of death by postmortem CT was evaluated in these patients. Diagnostic discrepancy was also compared between radiologists and attending physicians. The immediate cause of death was correctly diagnosed in 37 of 50 subjects using postmortem CT (74 %), concerning 29 cases of respiratory failure, 4 of hemorrhage, 3 of liver failure and 1 of septic shock. Six cases of organ failure involving 13 patients were not identified as the cause of death by postmortem CT. Regarding the immediate cause of death, accuracy of clinical diagnosis was significantly lower than that of postmortem CT (46 vs 74 %, P < 0.01). Postmortem CT may be more useful than clinical diagnosis for identifying the immediate cause of death in hospitalized patients not undergoing autopsy.Electronic supplementary materialThe online version of this article (doi:10.1007/s00428-016-1937-6) contains supplementary material, which is available to authorized users.

Loneliness and mental ill-health are a serious threat to the well-being of young people. It is important to listen to their own voices about how they experience loneliness and mental ill-health, but few studies focus on loneliness related to young people's friends and school. The aim of the study was to examine young people's and young adults’ experiences of loneliness and mental ill-health in relation to friends and school and strategies for alleviating loneliness. A qualitative study with an inductive approach was used as a design. Ten young people aged 19-27 were interviewed. The data were analyzed using qualitative content analysis. The results show that young people's experiences of loneliness may be related to their upbringing and personality traits and may originate in not fitting in, lack of friends, suffering from mental illness, and experiencing exclusion and bullying. Another reason for young people's experiences of loneliness is not having someone close to talk to. Several describe the transition from primary to secondary school as a time when they experienced loneliness. Mental health problems, such as anxiety and panic attacks, can be causes of emotional loneliness. Young people have different strategies for alleviating experiences of loneliness; nature can provide alleviation or they may seek different forms of entertainment as a strategy to relieve their suffering, such as gaming, watching movies or doing exercise. Negative coping strategies include eating disorders, addictions, self-harm, social isolation and an unhealthy lifestyle. One strategy to alleviate the experience of loneliness is to engage with other people in the community. Moreover, young people would like to see early interventions if student loneliness is discovered at school. They would also like to see places for various inexpensive activities and support groups for young people who feel lonely.

Maternal drug-related death and suicide are leading causes of postpartum death in California

Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive lung disease that commonly results in respiratory failure and death. However, the cause of death in these patients has not previously been fully defined. The current study reviews the clinical records and pathological findings of 42 consecutive patients with IPF who underwent a post mortem at the Mayo Clinic (Rochester, MN, USA) over a 9-yr period, from January 1996 to December 2004. The median (range) age at post mortem for the patients was 74 (46-98 yrs) yrs, which included 25 (60%) males. A total of 31 (74%) patients died in the hospital. The immediate causes of death were reported as: respiratory (64%), cardiovascular (21%), or noncardiopulmonary (14%). Acute exacerbation of IPF was the most common immediate cause of death (29%). Pneumonia, aspiration and drug-induced lung disease were identified as other causes of respiratory death. Evidence of pulmonary hypertension was present in the post mortem of 19 (45%) patients and was the immediate cause of death in two of these patients. The immediate cause of death was clinically unsuspected in five (12%) patients and IPF was diagnosed post mortem in nine (21%) patients. The majority of patients with idiopathic pulmonary fibrosis who had undergone a post mortem were found to have died from respiratory causes. Acute exacerbation of idiopathic pulmonary fibrosis was found to be the most common cause of death whilst death from the gradual progression of idiopathic pulmonary fibrosis was found to be less common.

Childhood adversities and quality of sleep in adulthood: A population-based study of 26,000 Finns

To determine the accuracy of National Center for Health Statistics cause-specific infant mortality data. The National Center for Health Statistics compiles these data by applying World Health Organization (WHO) selection rules to death certificate data. The WHO rules arrange medical entities into a hierarchical order and select a single underlying cause of death (ULCD). A comparison was made between ULCD assigned to a cohort of 335 infant death certificates by (1) a neonatologist panel, and (2) application of WHO selection rules by the Florida State Office of Vital Statistics (OVS). Among the 146 infants with birth weights 1500 to 4649 g, agreement between neonatologists and OVS was 88%, while among the 189 infants with birth weights 0 to 1499 g (very low birth weight), agreement was just 41%. Neonatologists selected short gestation as the underlying cause of death for 82% of very low birth weight infant records, vs 25% by OVS. Due to the application of specific WHO selection rules, OVS frequently selected immediate causes of death, such as "cardiac arrest," as the ULCD, even when the medical certifier had indicated short gestation as the ULCD. In vital statistics reports, many of these immediate causes are reported as "other respiratory conditions of newborn," or "all other perinatal conditions." WHO ULCD selection rules should be modified to allow short gestation to have a higher priority over immediate causes of infant death.

The relationship between cause and timing of death in 294 adults who had been hospitalized with community-acquired bacterial meningitis was investigated. For 74 patients with community-acquired bacterial meningitis who died during hospitalization, the underlying and immediate causes of death were identified according to the criteria of the World Health Organization and National Center for Health Statistics. Patients were classified into 3 groups: category I, in which meningitis was the underlying and immediate cause of death (59% of patients; median duration of survival, 5 days); category II, in which meningitis was the underlying but not immediate cause of death (18%; median duration of survival, 10 days); and category III, in which meningitis was neither the underlying nor immediate cause of death (23%; median duration of survival, 32 days). In a substantial proportion of adults hospitalized with community-acquired bacterial meningitis, meningitis was neither the immediate nor the underlying cause of death. A 14-day survival end point discriminated between deaths attributable to meningitis and those with another cause.

Drug related deaths (DRDs) have been increasing in Scotland over at least the past decade. This study aimed to describe the characteristics (gender, age, ICD10 cause of death), toxicology and circumstances of all Scotland's DRDs in 2003 to help inform a national overdose prevention strategy. Coronial files for 300/317 (95%) DRDs registered with the General Register Office for Scotland (GROS) in 2003 were examined retrospectively (in 2004). Characteristics: 241/300 (80%) were male. Mean age at death was 32.8 years (SE 0.63, range 16–82). Route of administration was injecting for 137/268 (51%) who were classifiable. Classified injectors were more likely to be male (91%: 124/137) and younger (mean age of 32 years) than those whose death was by a non-injecting route (male: 87/131 (66%) and mean age of 35 years). Twenty-five to forty-four year olds made up 108/137 DRDs by injecting (79%), but only 62/131 (47%) by non-injecting routes. Cases of intentional self-poisoning (injectors 1; non-injecting 34) and undetermined intent (injectors 14; non-injecting 26) were infrequent among injectors. Of those who died by the injecting route, 108/137 were known intravenous drug users, but so too were 29/131 DRDs by non-injecting routes. Toxicology: overall 38/300 cases of DRD (13%) were negative for opioid drugs–only 2/137 DRDs by injecting (1%) were negative for opioids compared with 33/131 (25%) by non-injecting route. Methadone was present for 15/137 DRDs by injecting route (11%) and for 57/131 DRDs by non-injecting routes (44%, p < 0.001). Presence of dihydrocodeine, and anti-depressants was about three times and six times respectively, more likely in DRDs by non-injecting routes. Irrespective of route, two-thirds of DRDs tested positive for benzodiazepines (202/300 DRDs). Circumstances: time between overdose and death was within the hour for 61/137 DRDs (45%) by injecting, but rarely by non-injecting routes (3%: 4/131). Three out of four DRDs occurred in a house or flat: 98/137 DRDs (72%) by the injecting route and 101/131 (77%) by non-injecting routes. Interpretation: A relatively high proportion of cases died by non-injecting routes. National mortality databases should separate out cases of injecting-related DRD from non-injecting cases, and public health strategies to reduce DRDs should distinguish between these groups. Widespread availability in Scotland of prescribed and illicit benzodiazepines needs attention.

The causes of death for patients with lung cancer are inadequately described. To categorize the immediate and contributing causes of death for patients with lung cancer. The autopsies from 100 patients who died of lung cancer between 1990 and February 2011 were analyzed. Tumor burden was judged the immediate cause of death in 30 cases, including 26 cases of extensive metastases and 4 cases with wholly or primarily lung tumor burden (causing respiratory failure). Infection was the immediate cause of death for 20 patients, including 8 with sepsis and 12 with pneumonia. Complications of metastatic disease were the immediate causes of death in 18 cases, including 6 cases of hemopericardium from pericardial metastases, 3 from myocardial metastases, 3 from liver metastases, and 3 from brain metastases. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (10 cases, 2 tumor emboli), and pulmonary diffuse alveolar damage (7 cases). From a functional (pathophysiologic) perspective, respiratory failure could be regarded as the immediate cause of death (or mechanism of death) in 38 cases, usually because of a combination of lung conditions, including emphysema, airway obstruction, pneumonia, hemorrhage, embolism, resection, and lung injury in addition to the tumor. For 94 of the 100 patients, there were contributing causes of death, with an average of 2.5 contributing causes and up to 6 contributing causes of death. The numerous and complex ways lung cancer kills patients pose a challenge for efforts to extend and improve their lives.

Predictors of new-onset depressive disorders – Results from the longitudinal Finnish Health 2011 Study