Epidemiology Of Death Research Articles

Ten-Year Trends in Mortality with Symptomatic Gallstone Disease and Emergency Cholecystectomy in New Jersey

Introduction: The epidemiology of death from symptomatic gallstone disease (SGD) may offer insight into current shortcomings of surgical and non-surgical therapy for SGD. Our aim was to explore in New Jersey (NJ) secular trends in mortality with SGD overall and mortality after emergency cholecystectomy. Methods: National Center for Health Statistics Restricted Mortality Data and Healthcare Cost and Utilization Project (HCUP) State Inpatient Data were used to examine NJ trends in calendar years 2009 to 2018. Outcomes were any death with SGD and inpatient death after emergency cholecystectomy. Death count and calendar year data were fit using simple linear regression. Results: There were 1580 deaths overall with 644 (40.76%) of those deaths after emergency cholecystectomy. A +2.05% relative change in deaths overall compared with a -57.58% relative change in deaths after emergency cholecystectomy from 2009 to 2018. Deaths overall remained flat [slope estimate -0.90; 95% CI -4.30, 2.51] while a downward linear trend occurred for deaths after emergency cholecystectomy [slope estimate -5.19; 95% CI -7.84, -2.53]. Conclusion: While overall rate of death with SGD in NJ was flat over a decade, substantial decreases were observed in inpatient death after emergency cholecystectomy. This needs to be reproduced in other states. However, any population trends in incidence of emergency vs non-emergency surgery for SGD are largely unknown. Examining medical and procedural treatments of emergency and non-emergency disease in addition to surgery may help to prevent mortality due to SGD.

A clinico epidemiological analysis of dengue deaths in children during outbreaks in the year 2013 and 2017

Background: Majority of published studies have looked at the risk factors for mortality in dengue. There are limited data on critical analysis of the causes of death in children with dengue when they are treated according to the World Health Organization guidelines. This study was conducted to analyze the immediate causes and epidemiology of deaths in children in two different outbreaks of dengue. Subjects and Methods: This was a retrospective observational study conducted at tertiary care teaching hospital during outbreaks in the years 2013 and 2017. All children who died due to Dengue during outbreaks were included in the study. A retrospective chart review was done using predesigned pro forma. Results: A total of 29 children died due to Dengue in two outbreaks. There were Eighteen deaths in the year 2013 and eleven deaths in the year 2017 outbreak. Myocarditis (27%), Encephalitis (24%), Massive hemorrhage (13%), and severe capillary leak (13%) were major immediate causes of death. Myocarditis (45%) was the leading cause of death in 2017 while Dengue encephalitis and massive bleed (23%) each in 2013. Hypoalbuminemia at admission was seen in 26 (89%) patients at admission among all deaths. Aspartate transaminase (AST) >1000 IU/L was seen in 10 (91%) Children and had a sensitivity of 91% and specificity of 50% in diagnosing myocarditis. Conclusions: The primary cause of death in fatal dengue had shown changing epidemiology during two outbreaks. Hypoalbuminemia can predict the beginning of the critical phase better than the defervescence of fever. AST >1000 IU/L may point towards myocarditis.

The epidemiology of hospital death following pediatric severe community acquired pneumonia

BackgroundCommunity acquired pneumonia is the primary cause of pediatric hospitalizations and deaths in children under 5 years of age. But the epidemiology of death in pediatric severe community acquired pneumonia was not well characterized.MethodsThis retrospective observational study was performed at the academic Emergency department and intensive care unit and we investigated the timing, cause, mode and attribution of death in children with severe community acquired pneumonia.ResultsOf 962 subjects with severe community acquired pneumonia, there were 57 non-survivors (5.9% mortality). Median time to death was 7 [IQR 3,16] days from severe community acquired pneumonia recognition. Patients dying ≤7 days were younger, had greater illness severity and higher rate of congenital heart disease, who were more likely to die of a cardiovascular cause. Multiple organ dysfunction syndrome predominated in deaths > 7 days. Unsuccessful cardiopulmonary resuscitation was the most common mode of death at all timepoints. Our findings suggested that in pediatric severe community acquired pneumonia, early deaths were due primarily to cardiovascular dysfunction, while later deaths were more commonly due to multiple organ dysfunction syndrome.ConclusionsDeaths from non-pulmonary factors accounted for a substantial portion of non-survivors. Respiratory dysfunction accounted for only a minority of deaths. Our study highlighted limitations associated with rescuing patients with severe pneumonia from death if extrapulmonary organ dysfunctions could not be simultaneously managed.

Epidemiology of Death and Years of Life Lost (YLL) Due to Accidents in Ardabil Province

Epidemiology of Death and Years of Life Lost (YLL) Due to Accidents in Ardabil Province

Epidemiology of Death Caused by Drug Abuse in Golestan Province during 2010-2015

Epidemiology of Death Caused by Drug Abuse in Golestan Province during 2010-2015

Epidemiology of Cause of Death in Pediatric Acute Respiratory Distress Syndrome.

Investigations of acute respiratory distress syndrome in adults suggest hypoxemia is an uncommon cause of death. However, the epidemiology of death in pediatric acute respiratory distress syndrome is not well characterized. We aimed to describe the cause, mode, and timing of death in pediatric acute respiratory distress syndrome nonsurvivors. We hypothesized that most deaths would be due to nonpulmonary factors, rather than hypoxemia. Retrospective, decedent-only analysis. Two large, academic PICUs. Nonsurvivors with pediatric acute respiratory distress syndrome. None. Of 798 subjects with pediatric acute respiratory distress syndrome, there were 153 nonsurvivors (19% mortality). Median time to death was 6 days (interquartile range, 3-13 d) after pediatric acute respiratory distress syndrome onset. Patients dying less than 7 days after pediatric acute respiratory distress syndrome onset had greater illness severity and worse oxygenation. Patients dying less than 7 days were more likely to die of a neurologic cause, including brain death. Patients dying greater than or equal to 7 days after pediatric acute respiratory distress syndrome onset were more commonly immunocompromised. Multisystem organ failure predominated in deaths greater than or equal to 7 days. Withdrawal of therapy was the most common mode of death at all timepoints, accounting for 66% of all deaths. Organ dysfunction was common at time of death, irrespective of cause of death. Refractory hypoxemia accounted for only a minority of pediatric acute respiratory distress syndrome deaths (20%). In pediatric acute respiratory distress syndrome, early deaths were due primarily to neurologic failure, whereas later deaths were more commonly due to multisystem organ failure. Deaths from neurologic causes accounted for a substantial portion of nonsurvivors. Refractory hypoxemia accounted for only a minority of deaths. Our study highlights limitations associated with using death as an endpoint in therapeutic pediatric acute respiratory distress syndrome trials.

Epidemiological analysis of death cases in pediatric intensive care unit of Children′s Hospital of Fudan University

Objective To determine the epidemiology of death in PICU in the past ten years. Methods Retrospective cohort study was conducted in the PICU of Children′s Hospital of Fudan University from January 2005 to December 2014. Results The overall mortality rate of PICU was 8.5% over a 10-year period from January 2005 to December 2014.Compared with the period from 2005 to 2009, the mortality rate in PICU decreased from 9.7% to 8.0% during the period of 2010 to 2014.A total of 736 patients died over a 10-year period, including 329(44.7%) infants, 191(26.0%) toddlers, 118(16.0%) preschoolers, and 98(13.3%) school-age and adolescence.From 2005 to 2009, there were 269 deaths, of which 65.4% were infants and toddlers.From 2010 to 2014, there were 467 deaths, of which 73.7% were infants and toddlers.Among the diseases causing death, the severe pneumonia was the most common disease(21.6%), followed by malignant tumors(16.3%), sepsis(15.4%), accidental injury(13.7%), and severe encephalitis(8.0%). In different age groups, the distribution of the diseases causing death was different, such as infants mainly with severe pneumonia(34.3%), toddlers mainly with accidental injury(16.8%), preschoolers mainly with accidental injury and malignant tumors(23.7%), school-age and adolescence mainly with malignant tumor(28.6%). From 2005 to 2009, 77.5% deaths were critically and very critically ill patients, and the sep sis was the most common cause of death(27.6%) especially in very critically ill patients.From 2010 to 2014, 83.0% deaths were critically and very critically ill patients, and the accidental injury was the most common cause of death(23.2%) especially in very critically ill patients, followed by sepsis(17.9%). There were 345 deaths(46.9%) occurred within the first week of admission, mainly with accidental injury(20.9%). There were 391 deaths(53.1%) with the PICU stay for 7 or more days, and severe pneumonia(24.3%) was the most common cause of death.Modes of death were categorized as failed cardiopulmonary resuscitation(54.6%) and forgoing life-sustaining treatment(45.4%). Conclusion Compared with the period from 2005 to 2009, the mortality rate in PICU decreased significantly during the period of 2010 to 2014.The younger the patient, the higher the mortality rate.Most deaths were attributed to severe pneumonia, followed by malignant tumors and sepsis.The causes of death also had relations with severity of diseases and length of PICU stay.Failed cardiopulmonary resuscitation and forgoing life-sustaining treatment were still the most common mode of deaths. Key words: Children; Death; Intensive care units; Cardiopulmonary resuscitation

Epidemiology of deaths due to traffic accidents in Kermanshah province (2012)

Background : The increasing trend of traffic accidents is one of the most serious problems of public health. The aim of this paper was to investigate the fatal traffic accidents in Kermanshah province. Method: All research data required were obtained from Legal Medicine Organization and analyzed by Stata-11 software. Traffic statistics available on the Road Maintenance and Transportation Organization website were used to study the death rate per month and day according to traffic level on suburban highways. Results: The incidence rate of age-standardized deaths due to road traffic accidents was 26.1per 100,000 people, and the mean age of the dead was 39.98±21.60 years. The mortality rate was higher in men, those more than 40 years old, married, illiterate and self-employed. Considering the traffic rate on suburban roads, the highest death rate occurred in the warmest months of the year during the day. Furthermore, most deaths were due to collisions and the highest frequency of death was reported for the car occupants. In most cases, head injuries and head traumas were the final cause of death. A significant correlation was reported between the type of vehicle and the cause of death and how the accident occurred (P<0.05). Conclusion: The mortality rate due to traffic accidents in Kermanshah province is high. Surveillance over the suburban roads in hot seasons and male drivers is of particular importance.

Epidemiology of Deaths by Lightning in the State of Sao Paulo-Brazil Years 2000 to 2014, and Impacts of Development and Environmental Factors

Epidemiology of Deaths by Lightning in the State of Sao Paulo-Brazil Years 2000 to 2014, and Impacts of Development and Environmental Factors

Mortality from oral cancer in Aracaju/SE, Brazil: 2000-2009

INTRODUCTION: The incidence of oral cancer varies widely in the world, with two thirds of cases diagnosed in developing countries. OBJECTIVE: To investigate the epidemiology of deaths from oral cancer and the spatial distribution in the city of Aracaju in the state of Sergipe between 2000 and 2009. MATERIAL AND METHOD: Data were collected using the Mortality Information System (MIS) of Aracaju/SE at the DATASUS website and were tabulated using the software TABWIN 3.4. The geographic distribution of deaths by neighborhoods of that city was visualized. RESULT: Of the 78 deaths, 61 (78.2%) were male. The mean age was 64.23 years. Individuals of mixed ethnicity had a higher death frequency (34.6%). Regarding education, the majority of death certificates recorded the option ignored, followed by individuals with 1 to 3 years of study. The anatomical sites most affected were unspecified parts of the mouth (43.6%). The spatial distribution analysis indicated that neighborhoods such as Santos Dumont, Luzia, Atalaia, Santa Maria, Cidade Nova and Industrial had the highest death frequencies. CONCLUSION: Males between the fifth and sixth decades of life of mixed ethnicity, low education and in neighborhoods with low and very low standards of living constitute the epidemiological profile for deaths from oral cancer.

Epidemiology of death in the emergency department of a tertiary health centre south-south of Nigeria

The emergency department (E.D) of any hospital is an important entry point of critically ill patients. The initial management of these patients is often challenging, and for valuable lives to be saved, the in fracture and manpower should be up to date. To analyze the epidemiology of death in our Emergency Department within 72hours after admission, the death rate, and to establish any contributory factors. Demographic data, time of arrival at the ED, physical finding, the Glasgow coma scale(GCS), the injury severity score(ISS), the diagnosis, investigations done, treatment offered, the time of death and the autopsy report, were entered into a Proforma. These data was analyzed using EPI-Info statistical programme version 3.4.3 of 2007. Four thousand and eleven (4,011) patients were seen in the E.D during the period. A total of three hundred and fifty five (355) mortalities were recorded. Their ages ranged from 4-87years, with an average of 34.5years. The male: female ratio was 2.1:1. The overall mortality in the hospital during the period was 859: the E.D mortality figure representing 41.3%. Fifteen patients were brought in dead. The 355 deaths fell into two categories: trauma and non-trauma. One hundred and forty-seven (41.4%) persons died from trauma; road traffic accidents (RTAs) accounting for 118 (80.3%). Two hundred and eight (58.6%) persons died from nontrauma related causes, with chronic cardiovascular disorders been the most frequent cause of death 52[25.0]. Majority of the mortalities were between 26-50 years age range. 86.2% of the mortalities presented late, greater than 6hours after the incidence. Within the 72 hours period, only 129(36.3%) were able to do the requested tests. Out of the 355 deaths, only 4[1.1%] were autopsied. An in-hospital 72hours death rate of 8.6 was recorded. Road traffic accidents and cardiovascular disorders are the common causes of emergency death in UCTH. A recorded death rate of 8.6% is high, suspected contributory factors include systemic deficiencies such as the lack of a trauma system, prehospital care; late presentation, the role of chemist operators, traditional healers, and delayed referral systems.

Epidemiology of death from aneurysmal subarachnoid hemorrhage in New Mexico

BackgroundThe authors report the first retrospective analysis of all reported cases of death from aneurysmal subarachnoid hemorrhage in the state of New Mexico from 1 January 2001 to 31 December...

Does the Taser Cause Electrical Changes in Twelve Lead ECG Monitoring of Human Subjects

Introduction: Previous data from the Police Executive Research Forum (PERF) report that the average time from Taser activation to death in those individuals who died in custody following a Taser activation Methods: This prospective study was performed on 32 healthy volunteer subjects receiving a shock from the Taser X-26. The subjects had a baseline 12 lead ECG performed immediately before and within 1 Results (cont): The average age was 33 and BMI 26.5kg/m2. The average duration of Taser shock was 2.1 (SD=1.0) seconds and ranged from 1 to 5 seconds. Overall, there i ifi t i i h t t Limitations: We were not able to continuously monitor the subjects with a 12 lead monitor before, during and after the Taser activation due to limitations of the was 63 minutes. However, there is concern by some that the Taser activation could have an immediate effect on cardiac conductivity, such as prolonging the QT interval, and placing the individual at risk for a sudden cardiac event. Our preliminary work used a three lead to monitor the heart minute post Taser activation. One minute post Taser activation was considered clinically relevant as most reported deaths following Taser use occur after 1 min, and thus any electrocardiographic changes, such as QT prolongation, should be captured if present. Primary endpoints included was a s gn can ncrease n mean ear ra e (2.4; 95% CI=0.0, 4.9; p<0.05) and decrease PR interval (-6.5; 95% CI=-9.7, -3.3; p<0.001). When stratified by gender, the only significant change was a decrease in PR interval in men (p<0.01). When stratified by BMI, a significant increase in heart rate and decreases in PR and QT intervals are noted monitor. Therefore, we were not able to monitor individuals immediately after the Taser activation. Changes that resolved within the first minute, could have missed by the time we obtained the ECG. However, given the epidemiology of deaths following Taser activations, most occur well beyond th i t i t l th if d h th i before, during and after a Taser activation and demonstrated no dysrhythmias. Attempts to calculate accurate QT, PR and QRS intervals were challenging as the interval durations could not reliably be determined from the single strip monitoring. Thus the present study was designed to evaluation of changes in cardiac rhythm, morphology, and interval duration. Descriptive statistics and paired t-test comparisons are reported (p<0.05) (SPSS). (4.0; 95% CI=1.3, 6.7 for HR, -6.0; 95% CI=11.3, -0.7 for PR interval and -18.8; 95% CI=-33.2, -4.3 for QT Interval) among normals. In all cases, none of the subjects had a QTc preor post Taser activation that exceeded 0.44 seconds. None of the statistically significant differences between *ANOVA results <0.05 e one m nu e n erva , us a ysr y m a was responsible, we feel confident that we would have captured any changes in intervals by the one minute ECG. Additionally our subjects were generally healthy and free from chronic disease, which may not mimic the population of patients who have cardiac arrests after a Taser Results: In all 32 subjects an interpretable 12 lead ECG was obtained prior utilize 12-lead ECG monitoring to determine if a shock exposure from a Taser® X-26 results in changes in cardiac conductionin healthy policevolunteers. ECG measures were clinically relevant.

End-of-Life Content in Treatment Guidelines for Life-Limiting Diseases

Clinical guidelines are systematically developed statements that influence medical practice, education, and funding. Guidelines represent the consensus of leaders, often based on systematic reviews of the literature, regarding the "state of the art." To assess the degree to which end-of-life care is integrated into nationally developed guidelines for chronic, noncurable, life-limiting diseases. Four compendia were reviewed: The Healthcare Standards Directory ECRI, 2001; the Clinical Practice Guidelines Directory, 2000 edition; the National Guidelines Clearinghouse, (guideline.gov); and the National Library of Medicine's MEDLINE database on the OVID platform for guidelines on nine chronic diseases (chronic obstructive pulmonary disease, end-stage liver disease, amyotrophic lateral sclerosis, congestive heart failure, dementia, cerebrovascular accident, end-stage renal disease, cancer [breast, colon, prostate, lung], and human immunodeficiency virus). They were assessed by two reviewers for end-of-life content in 15 domains (e.g., epidemiology of death, symptom management, spiritual, family roles, and settings of care), the presence of eight specific terms dealing with palliative care, integration of palliative care information into the guideline, and descriptive variables. Not available. Each guideline was examined and rated on a 0-2 scale (0, absent content; 1, minimal content; 2, helpful content) using 15 end-of-life content domains. Scores from domains were summed and classified into 3 categories: 4 or less, minimal; 5-12, moderate; and more than 12, significant content. Ten percent of guidelines had significant palliative care content, 64% had minimal content, and 26% had moderate content. The least addressed domains dealt with spirituality, ethics, advocacy and family roles. When guidelines that dealt solely with prevention, acute exacerbations or complications of an illness, or specific treatment modalities were excluded 28% and 16% of these general guidelines (n = 58) had moderate and significant palliative care content, respectively, compared to 24% and 0% of all nongeneral guidelines. Similar results were found when analyzing the data by disease course or treatment focus. Only 14% of guidelines advised physicians to consider palliative care at a specific point in the disease course. Ninety-one percent of the guidelines mentioned death, dying, end of life, mortality, or terminal illness but only 36% mentioned palliation or hospice. Current national guidelines on nine chronic, life-limiting illnesses offer little guidance in end-of-life care issues despite a recent increase in attention to this aspect of medical care.

Statement of the 5th International Consensus Conference in Critical Care Challenges in end-of-life care in the ICU☆Brussels, Belgium, April 2003

Death, previously a private, usually spiritual or religious event involving family and friends is today by contrast, often public and technological. The severity of illness of hospitalised patients has progressively increased over recent decades, whilst sophisticated technological support has allowed such patients to survive longer. At the same time it is increasingly accepted that continued aggressive care might not always be beneficial. Death in the ICU, therefore, now frequently follows limitation of life-supporting therapies. As a result, the mission of intensive care has expanded to encompass the provision of the best possible care to dying patients and their families. The International Consensus Conference was convened to discuss some of the challenges posed by these social and medical changes. On 24–25 April 2003, in Brussels, Belgium, a jury of 10 persons, including an anthropologist and nine intensivists, attended the presentations of 30 experts in the field of end-of-life care, and the subsequent discussions, with the objective to answer five specific questions. (1) Is there a problem with end-of-life care in the ICU? (2) What is the epidemiology of death in the ICU? (3) How does one explain the differences between and within countries and cultures regarding end-of-life care? (4) Who decides to limit life-sustaining treatments in the ICU? (5) What is the optimal care for patients dying in the ICU? The following document is a synthesis of the experts’ opinion, the available literature and 2 days of deliberation by the jury.

Statement of the 5 th International Consensus Conference in Critical Care Challenges in end-of-life care in the ICU : Brussels, Belgium, April 2003

Death, previously a private, usually spiritual or religious event involving family and friends is today by contrast, often public and technological. The severity of illness of hospitalised patients has progressively increased over recent decades, whilst sophisticated technological support has allowed such patients to survive longer. At the same time it is increasingly accepted that continued aggressive care might not always be beneficial. Death in the ICU, therefore, now frequently follows limitation of life-supporting therapies. As a result, the mission of intensive care has expanded to encompass the provision of the best possible care to dying patients and their families. The International Consensus Conference was convened to discuss some of the challenges posed by these social and medical changes. On 24–25 April 2003, in Brussels, Belgium, a jury of 10 persons, including an anthropologist and nine intensivists, attended the presentations of 30 experts in the field of end-of-life care, and the subsequent discussions, with the objective to answer five specific questions. (1) Is there a problem with end-of-life care in the ICU? (2) What is the epidemiology of death in the ICU? (3) How does one explain the differences between and within countries and cultures regarding end-of-life care? (4) Who decides to limit life-sustaining treatments in the ICU? (5) What is the optimal care for patients dying in the ICU? The following document is a synthesis of the experts’ opinion, the available literature and 2 days of deliberation by the jury.

Biopsychosocial Approaches

Epidemiology in General and Special Populations. Suicide trends in Europe, 1984-1990 (D. Wasserman et al. ). The epidemiology of death and suicide symptoms in primary health care (V.G. Mavreas, T.B. Ustun). Suicide in the United States military (E. Cassimatis, J. Rothberg). Suicide in mood disorders (E.T. Isometsa, J. Lonnqvist). Suicide in schizophrenia (A. Roy). The relationship of suicide attempts to licit and illicit drug use (A. Kokkevi, K. Politikou, C. Stefanis). Physical illness and suicide: the facts (C.R. Soldatos). Etiopathogenetic Considerations. Some biological and psychological aspects of suicidal behavior: An attempt to bridge the gap (H.M. van Praag). Neurobiological insights into the pathogenesis of self-mutilation and suicidal behavior (J.J. Mann et al. ). Heredity and suicidality (G.N. Papadimitriou). Suicide and violence: the two-stage model of countervailing forces (R. Plutchik). Suicidal behavior: risk and protective factors (A. Botsis). The psychology of suicide: past and present (N.L. Farberow). Clinical Issues Clinical problems in assessing suicide risk (D.J. Pallis). Parasuicide: is it a distinct phenomenon? (R.F.W. Diekstra) Attempted suicide by violent methods (V.P. Kontaxakis, G.N. Christodoulou). Counseling the suicidal person in the modern age (D. Lester). Suicidal crisis: psychodynamic approaches (B. Buda). Assessment of suicidal behavior in adolescence (S. Beratis). Suicide in children and adolescents (A. Apter). The suicidal patient and the antidepressant drugs (A. Parashos). Conceptual and Ethical Issues The will to die: an international perspective (A.A. Leenaars, R.F.W. Diekstra). Civilisation, suicide, physician-assisted suicide and euthanasia (M. J. Kelleher). Expanding our conceptual horizons on the future of suicide research (R. Plutchik). Index of authors. Keyword index.

Medical Examiner Cases Associated With Previously Undiagnosed Diabetes Mellitus, North Carolina, 1994

Approximately half of the 16 million Americans with diabetes mellitus (DM) are unaware they have the disease; the epidemiology of death from previously undiagnosed DM is unclear. We report medical examiner (ME) cases of death from DM in North Carolina in 1994 to determine the number and characteristics of these cases. Deaths from DM ICD-9 were identified and reviewed. Of the 42 cases ascertained from ME records, 6 had previously undiagnosed DM, 5 had diabetes ketoacidosis, and 1 had nonketotic hyperosmolar hyperglycemia. Mean patient age at death for all cases was 42 years (range, 35 years to 57 years). Four patients felt bad at least 24 hours before death, indicating that they are not technically "sudden deaths." We provide a limited epidemiologic perspective of the phenomenon of death from undiagnosed DM. We suggest further investigation of mortality from previously undiagnosed diabetes.

DEATH IN ADOLESCENTS WITH CARDIOVASCULAR DISEASE: A COMPARISON OF SEQUENTIAL 10-YEAR COHORTS. † 14

Although cardiovascular disease ranks as the 6th leading cause of mortality in adolescents, the etiology and epidemiology of death has not been evaluated systematically. We studied 100 patients with known congenital or acquired heart disease from a university hospital pediatric cardiology service who died between 11 and 21 years of age during the intervals 1974 to 1984 and 1984 to 1994. Sudden death was defined as unexpected, unpredictable, instantaneous death in non-hospitalized patients of presumed cardiac cause. When the activity level at the time of death was known, < 10% of patients were engaged in moderate or strenuous exercise. Table

Deaths from volatile substance abuse in those under 18 years: results from a national epidemiological study.

The epidemiology of deaths from volatile substance abuse (VSA) in those under 18 years that occurred in the UK from 1981-90 is described. The analysis of deaths is based on a national register, which has information obtained from a regular survey of coroners, the Office of Population Censuses and Surveys, and a press clippings agency. Altogether 605 people under 18 died from VSA during this period. Seventy per cent of deaths occurred between the ages of 14 and 16. The largest number of deaths were attributed to butane gas lighter refills. There was a large north-south gradient in age specific mortality ratios (Scotland 180, south east England 87) and nearly four times as many deaths occurred in social class V compared with social class I. Deaths from VSA are an important and preventable cause of deaths in those under 18. Strategies aimed at prevention should include measures to reduce experimentation, intervention to reduce socioeconomic deprivation, and health education campaigns aimed at schools and parents.