Unnatural Causes Of Death Research Articles

Incidence and Risk Profiles for Suicide Mortality in Patients With Schizophrenia Receiving Homecare Case Management in Taiwan.

Case management (CM)-based community therapy for patients with schizophrenia had little effect on reducing suicide mortality. We investigate the long-term suicide mortality outcome and associated risk factors in patients with schizophrenia receiving homecare (CM) in Taiwan. We enrolled a nationwide cohort of patients with schizophrenia who newly received homecare CM intervention (n = 13 317) between January 1, 2001, and December 31, 2015; their data were derived from Taiwan's National Health Insurance Research Database. We calculated the incidence rate of suicide methods. We examined the demographic and medical utilization profile for suicide and then performed a nested case-control study and multivariate regression to identify independent risk factors for suicide mortality. Among the 13 317 patients who received homecare CM intervention, 1766 died during the study period, of whom 213 died by suicide, which is the leading cause of unnatural death. Jumping from a high place, self-poisoning, and hanging were the top 3 suicide methods. Increased medical utilization was noted for both psychiatric and non-psychiatric services within 3 months of suicide mortality. Comorbidities of depressive disorder, nonspecific heart diseases, pneumonia, and gastrointestinal ulcers were identified as independent risk factors for suicide mortality. Suicide was the leading cause of unnatural mortality in patients with schizophrenia receiving homecare CM intervention in Taiwan. We noted the preferred suicide methods, high medical utilization, and comorbidities before suicide. Thus, we suggest that the CM team should assess lethal methods for suicide and ensure that patients adhere to psychiatry treatment for improving the current care model for this specified population.

Cause-specific mortality after hospital discharge for suicide attempt or suicidal ideation: A cohort study in Piedmont Region, Italy

BackgroundSuicide attempters are at higher risk of death than the general population. The present study aims to investigate the excess of all-cause mortality and cause-specific mortality in a cohort of patients who have attempted suicide or had suicidal ideation compared with the general population. MethodThe cohort included 826 patients residing in the Piedmont Region of Northwest Italy who were admitted to a hospital or emergency department for suicide attempts or suicidal ideation between 2010 and 2016. Mortality excesses of the study population compared to the general population were estimated by applying indirect standardization. Standardized Mortality Ratios and 95% Confidence Intervals were calculated for all-cause, and cause-specific, natural, and unnatural causes of death by gender and age. ResultsDuring the 7 years of follow-up, 8.2% of the study sample died. The mortality of suicide attempters and ideators was significantly higher than that of the general population. Mortality was about twice than expected from natural causes, and 30 times than expected from unnatural causes. The mortality due to suicide was 85 times higher than that of the general population, with an excess of 126 times for females. The SMRs for all-cause mortality decreased with increasing age. ConclusionsPatients who access hospitals or emergency departments for suicide attempts or suicidal ideation are a frail group at high risk of dying from natural or unnatural causes. Clinicians should pay special attention to the care of these patients, and public health and prevention professionals should develop and implement appropriate interventions to timely identify individuals at higher risk for suicide attempts and suicidal ideation and provide standardized care and support services.

A Ten Year Retrospective Study of Poisoning Deaths in a Tertiary Care Hospital Situated in Rural Area of Himachal Pradesh

Acute poisoning is an important medical emergency and one of the commonest causes of unnatural deaths. Poisoning occurs when any substance interferes with normal body functions after it is swallowed, inhaled, injected, or absorbed. Toxicology is the science which deals with the properties, actions, toxicity, fatal dose, detection, estimation, treatment and autopsy findings of poisons, drugs and various chemical substances. An autopsy based retrospective study was conducted from January 2009 to December 2018 at the Department of Forensic Medicine and Toxicology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. All cases of deaths due to alleged poisoning brought for medico-legal autopsy were studied. The data obtained was computed and descriptive analysis of baseline characteristics was analysed and summarized. In our study, 24.48% of the total cases autopsied were of deaths occurring due to poisoning. The maximum number of cases 362 (53%) were of males followed by 321(46.99%) cases of females. Aluminium Phosphide was found to be the most commonly used poison. Peak incidence was observed in the age group 41-50 years (72.34%) in males and 21-30 years (54.27%) in females. Based on these findings preventive measures like restriction of sale and strengthening the legislature on the availability of poison, promoting poison treatment and detection centres etc. should be the main aim at this time.

A Postmortem Study of Pattern and Distribution of Intracranial Haemorrhages in Fatal Head Injuries Following Road Traffic Accidents in Basaveshwara Teaching and General Hospital, Gulbarga

Background: The present study was conducted to know, pattern and distribution of intracranial haemorrhage in fatal head injuries in RTAs along with victim’s age and sex and survival period. In addition, an attempt was also made to know the cause of death.Methodology: The present study was both retrospective and prospective study. The study material comprised of 75 victims of RTA cases, who were admitted and died in Basaveshwara teaching and general Hospital, MRMC, Gulbarga and subsequently autopsied, during the 3 year period from May 2011 to April 2014.Results: In this study, males outnumbered females in the ratio 2.9:1. Age group most commonly involved was 21 – 30 years (24%). Most of the victims died < 24 hours following accident (58.66%). Most common victims involved were motor cycle occupants (37.33%). Intracranial haemorrhage was present in maximum number of victims (58.67%), followed by lung injuries (33.33%). Subdural haemorrhage was seen in majority of cases (38.67%). Intracranial injuries alone were responsible for death in 57.33% followed by hemorrhagic shock in 36%.).Conclusion: RTA’s are the penalty paid by us for rapid transportation and have become the commonest cause of unnatural deaths. The rise in the number of fast moving vehicles, semi-skilled drivers, drunken drivers, congested and ill-maintained roads has led to the increase in the number of RTA’s. Intracranial injury was the most common finding in the study. It was observed that in majority of cases, intracranial injury contributed either directly or indirectly to death especially with skull fracture. Hence stricter implementation of traffic rules and promotion of road safety measures by the concerned authority viz. the use of helmets and seatbelts, avoidance of over speeding, using footpaths, etc. is the need of the hour. It also highlights the need of emergency trauma services at site of the occurrence for reducing morbidity and mortality in such cases

Social and psychological profile of pattern of female burn casualties

BackgroundThermal injuries are one of the commonest causes of unnatural deaths in females in developing countries. However, there is a lack of adequate research into the social and psychological aspects that lead to such deaths. The suicidal death due to immolation by fire is a scourge on Indian society that is not being adequately addressed in all its aspects. There is an attempt in this study to bring awareness of the population under risk and to motivate prevention measures.A retrospective cross-sectional study was conducted at the Victoria Hospital Mortuary for a period of 12 months between 2017 and 2018. Medicolegal and psychological autopsies were performed on 120 female burn victims over 15 years of age. The information gathered via medical records, police investigations, interviews with family, and postmortem findings was analyzed and compiled to obtain the following results.ResultsMost of the victims, i.e., 52% of the women, were illiterate. More than half of the victims, i.e., 53% of the women in this study, were found to be in the upper-lower socio-economic. Majority of the female victims (63.3%) were married for more than 7 years. Suicide was the commonest manner of death (52%). There was no alleged history of domestic abuse in most cases (73.3%). Only 2 cases, i.e., 1.7% of cases, were booked under Dowry Prohibition Act. Only 28.3% of cases were investigated by Magistrate’s Inquest. History of mental illnesses was reported only in 14.2% of victims. Alcohol was detected in only 2 of the victims (1.7%).ConclusionsIt is evident that in most cases of deaths in women due to thermal injuries, the entire narrative is not thoroughly investigated and any prior history of domestic abuse, dowry demands/harassment, and even mental illnesses gets under-reported or undocumented. Despite there being a plethora of information regarding the statistics as to how women die due to thermal injuries, very minimal data exists regarding the measures adopted to prevent it. There is a hope that this study inspires the concerned stakeholders to take stock and introduce measures to prevent such potential deaths among the vulnerable female population.

Observational Study of Elderly Suicidal Deaths

Suicide is a self-planed and deliberate termination of one’s own life. Painful experiences suffered during their lifelead to varying degrees of depersonalization and alienation. In the course of defending themselves from onslaughtof negative stimuli, elderly people establish a desire for hastened death. An Observational study of suicides amongelderly age group ≥60 years was conducted in the Department of Forensic Medicine and Toxicology, OsmaniaMedical College and General Hospital, Hyderabad during the period of 2016 to 2020.Police inquests, hospitalrecords, toxicological reports and suicide letters were collected and studied.The total elderly suicidal deathsduring the period of 5 years were 257, more common among 60-64 years aged people. Educated, middle class,joint family and different categories of professional background with physical ailments were common factors inthe study. The methods used for suicide ranged from poisoning, hanging, burns to fall from height. The resultswere analysed and compared with previous research studies and this study matched with results of several otherstudies. This is possibly due to beginning of dependency and stressful life following their retirements. Suicideis the 3rdleading unnatural cause of death among elderly which is not an impulsive act.Intervention in the agedsuicide will be a complex task and should involve changes at different levels of the current aged care system.

Trauma Patients at Risk of In-Hospital Mortality

The trauma incidence in South Africa is significantly high and forms one of the top-five causes of unnatural death. Thus, one of the higher incidences of trauma across the world. Subsequently the in-hospital mortality forms a high burden of disease on the health systems in South African health care facilities. Therefore, analysing the incidence of trauma and the various mechanisms of trauma allows for in-hospital trauma mortalities to assessed. The aim of this study was to analyse the in-hospital mortality distribution factors at a Johannesburg Trauma unit over an eight-year retrospective review from 01 January 2005 –31 December 2012 and Analysis of Trauma Bank data forms at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Looking at demographics, physiological parameters, mechanism of Injury, Injury Severity Score (ISS) and New Injury Severity Score (NISS). Ethics through the Wits Ethics Committee was obtained. The Statistica V8 application was used to analyse the data that was collected and a P value of <0.05 was reported as significant. A total of 18, 087 Priority 1 patients were reviewed in this study. This sample demonstrated the 21-45 years of age group was the most affected trauma group (87.3%). Penetrating injuries (Stab and gunshot wounds) had the highest incidence yet lower mortalities. However, blunt injuries (ranging from Pedestrian- and Motor- vehicle crashes, blunt assaults, falls and burns) had lower incidences and higher mortalities. The highest in-hospital mortality was due to burns patients (22.56%) followed by pedestrian vehicle crashes patients affecting the predominantly young male population. Poor probability of survival was demonstrated amongst Motor Vehicle Crashes (Ps 44%) and Motorbike Crashes (34%), and PVCs.

Effect of comorbid ADHD on mortality in women with borderline personality disorder

BackgroundMany similarities exist between borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD), more so in women than in men. People with comorbid ADHD and BPD represent a subgroup of BPD patients with distinct symptom expression and, consequently, a different prognosis. We used Swedish national high quality registers to assess whether such comorbidity is related to increased mortality risk. The study focused on women with BPD because they are more likely than men to be clinically diagnosed with BPD and present a higher mortality risk, especially for unnatural causes of death, including suicide.FindingsIn a cohort of 15 847 women diagnosed with BPD a subsequent clinical diagnosis of ADHD did not influence the overall risk of mortality, including suicide.ConclusionsWomen with comorbid ADHD and BPD have a similar mortality risk as those only diagnosed with BPD.

Availability of death review of children using death certificates and forensic autopsy results

The Model Project for Child Death Review (CDR) was initiated in Japan, but parental consent is required for detailed investigations. We proposed an alternative method to review child deaths using death certificates and forensic autopsy results when parental consent is not provided. We extracted and reviewed death certificates for the deceased younger than 18 years from among all certificates submitted in Shiga Prefecture between 2015 and 2017. In addition, we analyzed autopsy records in cases that underwent forensic autopsy. The prevalence of each cause of death was compared among age groups. The situation and circumstances of unnatural deaths were analyzed in detail. Of 131 certificates, unnatural deaths accounted for 29.7 %. The prevalence of each cause of death significantly differed among age groups. Malignant disease and suicide were most common in school-aged children and congenital disease was most common in infants. Suicide was the leading cause of unnatural death, followed by suffocation, which was most common in infants. Situations where suffocation was reported included co-sleeping with the mother and breastfeeding. Despite parental consent not being obtained, the trends of regional child deaths and the circumstances of accidental deaths were clarified by the present method. However, the results of detailed investigation were lacking. This study provided basic information for implementing detailed methods and procedures for CDR at the governmental level. To perform optimal CDR, legislation for collecting detailed information without parental consent is required.

Postmortem of traffic accident deaths in Kenya: Indicators of alcohol intoxication

This study sought to establish the magnitude of fatalities resulting from road traffic accidents and their relation to alcohol intoxication to inform public health policy on the need for their prevention. This descriptive prospective study was undertaken at the city Mortuary, Nairobi. This study included all cases of deaths from road traffic accidents for twelve consecutive months. Data was analysed using SPSS. Descriptive statistics using means, medians and modes were used to test for age and gender differences. Road traffic accidents contribute to violent deaths; road traffic accident deaths in Kenya are associated with alcohol intoxication. The male gender is more involved. The study recommends that road safety and alcohol abuse be interrogated more as a cause of unnatural death. Deaths caused by road traffic accidents are a major problem. Public health measures and policies must be implemented to address this malady. Further road traffic accidents show a positive correlation with alcohol intoxication. Males were more prone to road traffic accidents; society should address the plight of the male child.

Difference and Analysis of Evaluating Psychological Monitors' Interview and Classmates' Being Interviewed About Suicide

In recent years, suicide has become the leading cause of unnatural death among college students in China. Psychological monitors, as class cadres who manage affairs related to mental health within their classes, are critical in identifying and intervening in psychological crises among their classmates. In China, however, talking about death is a cultural taboo, and many mental health workers have expressed concern about their implementation of interviews about suicide with others. Generally speaking, interviews with suicidal classmates are usually conducted by professional psychological experts and psychological monitors (psychological monitors are non-professional peer counselors in China). Such classmates that have undergone both the aforementioned types of interviews were investigated in this paper. However, this paper focuses on two issues. Firstly, what are the perceptions of classmates who have been interviewed toward the experience of being interviewed by psychological monitors? Secondly, what are the psychological monitors' perceptions of their implementation of interviews about suicide with classmates? In this study, 1,664 classmates who had been interviewed and 1,320 psychological monitors were surveyed by means of an online questionnaire. The results showed that classmates who have been interviewed perceived their experience of being interviewed by a psychological monitor about suicide more positively than the psychological monitors who viewed their implementation of interviews about suicide with classmates. Among the classmates who have been interviewed, three categories of classmates have more positive perceptions of their experience of being interviewed by a psychological monitor about suicide. Category one is males. Category two is those who were willing to seek help from the psychological monitors. Category three is those who had a more correct attitude toward mental illness. Among the psychological monitors, three categories of psychological monitors have more positive perceptions of their implementation of interviews about suicide with classmates. Category one is those who have the experience of implementing interviews with their classmates. Category two is those who have received training. Category three is those who had a more correct attitude toward mental illness. Psychological monitors can interview classmates confidently, and the training of psychological monitors on mental health knowledge should be strengthened in universities.

Relationship between Alcohol and Homicide, in Nairobi County, Kenya: Autopsy Study.

This study sought to investigate the relationship between alcohol and homicide, in Nairobi County, Kenya. The study was carried out at the city Mortuary, Nairobi. In this study, all cases of violent deaths for a period of twelve consecutive months were included. Alcohol level estimation was done on 400 of all the study subjects. The 400 were selected consecutively as every fifth subject. This was a purposeful sampling frame and size. The data obtained included age and gender distribution, type of accident, when the accident occurred and the alcohol levels of the deceased. This data was analysed using SPSS. The study concludes that homicide is a preventable public health problem and a major contributor to violent deaths. Moderate and heavy intoxication predispose to homicide. Deaths from accidents were largely those caused by burns and drowning; they were positively correlated with alcohol intake and are a preventable public health problem in Kenya. The study recommends that public policy should educate the public on this phenomenon that relates homicide to alcohol intoxication. Violence causing fatal trauma to the body, the commonest cause of unnatural death, is a preventable leading global public health problem. Further, it shows intercountry and intercity variation. Its prevention and control require data on the magnitude and nature of the problem.

Excess mortality in a cohort of Brazilian patients with a median follow-up of 11 years after the first psychiatric hospital admission

PurposeTo estimate the mortality rates of a cohort of Brazilian patients after their first psychiatric admission and determine the possible risk factors associated with excess mortality.MethodsThe study included a cohort of psychiatric patients hospitalised from Jan 1, 2002 to Dec 31, 2007 in the catchment area of Ribeirão Preto, São Paulo state, Brazil. Data were linked to deaths that occurred between Jan 1, 2002 and Dec 31, 2016 from the SEADE Foundation (state data analysis system of São Paulo). The mortality rate (MR), age-sex-standardised mortality ratio (SMR), life expectancy at birth, and years of life lost (YLL) were computed. The factors associated with mortality were analysed by survival analysis using a Cox proportional hazards regression model.ResultsOf 4019 patients admitted (54.76% male), 803 died (69.74% male) during the follow-up (median = 11.25 years). Mortality rates were approximately three-fold higher than expected (SMR = 2.90, 95% CI 2.71–3.11). The highest mortality rate was noted in men with alcohol-related disorders (SMR = 5.50, 95% CI 4.87–6.19). Male sex (adjusted hazard ratio (aHR) = 1.62, 95% CI 1.37–1.92), higher age (aHR = 21.47, 95% CI 13.48–34.17), and unemployment (aHR = 1.22, 95% CI 1.05–1.43) significantly increased the mortality risk from all causes. The average YLL was 27.64 years with the highest YLL noted in nonalcohol substance-related disorders (39.22 years). The life expectancy at birth in this cohort was 47.27 years. Unnatural causes of death were associated with nonwhite skin colour and substance-related disorders.ConclusionAn excess of mortality and a significant reduction in life expectancy of mentally disordered patients who were first admitted to psychiatric beds was noted, particularly patients admitted for substance-related disorders, which should represent a priority in mental health policies.

Preparation of Action plan for elimination of Accident at black spot (A Case Study)

The number of traffic accidents globally is increasing as the world's population expands and cars become more widespread. Improved geometric design, congestion management tactics, and greater driver education and enforcement are all traditional ways to prevent collisions. While these procedures are often beneficial, they are frequently impractical or prohibitively expensive to put in place. Many factors play a role in traffic accidents, and some of them have a significant impact on one another, making it impossible for transportation safety engineers to use just one parameter to adequately explain the severity of traffic accidents. The number of traffic crashes can be reduced by studying parameters involved in traffic crashes utilizing combined contemporary models that include the interplay of input and output variables. Road and traffic accidents are a leading source of death and disability around the world. A collision between a conveyance and another conveyance, a person, or other items is referred to as a road contingency. In rapidly developing metropolitan agglomerations, road traffic accidents are a big concern. There is a substantial body of research literature that sheds light on the scope of the problem and the remedies that are required. Road traffic accidents are the third leading cause of unnatural death among all deaths. Transportation engineers and academics have attempted to construct safe roads that adhere to suitable design standards, yet traffic accidents are inescapable. If an accident occurs, the reasons that caused it must be identified, and suitable corrective measures must be established and implemented as soon as possible. The goal of this study is to gain a better knowledge of the problem of road traffic accidents and identification of black spot-on BG Road in Sivasagar City and ends at Sapekhati and the factors that may contribute to the high accident rates.

Mortality in individuals with childhood ADHD or subthreshold symptoms – a prospective perinatal risk cohort study over 40 years

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is associated with negative life outcomes and recent studies have linked it to increased mortality. These studies have examined nationwide registers or clinic-referred samples and mostly included participants up until the age of 30. No studies have investigated mortality associated with subthreshold levels of ADHD symptoms. Our aim was to analyze mortality in a perinatal risk cohort of 46-year-old adults with childhood ADHD (cADHD) and milder childhood attention problems (including hyperactivity and inattention; cAP) compared with a group with similar birth risks but no or low levels of childhood ADHD symptoms (Non-cAP). Causes of death obtained from a national register were examined.MethodsMortality was analyzed with Cox proportional hazard models for all-cause mortality, cause-specific mortality (natural and unnatural causes), and age-specific mortality (under and over age 30). All models were adjusted with gender. The total n in the study was 839 (cADHD n = 115; cAP n = 216; Non-cAP n = 508).ResultsBy the age of 46, 11 (9.6%) deaths occurred in the cADHD group, 7 (3.2%) in the cAP group, and 20 (3.9%) in the Non-cAP group. The cADHD group had the highest mortality risk (adjusted hazard ratio = 2.15; 95% CI 1.02, 4.54). Mortality was not elevated in the cAP group (adjusted hazard ratio = 0.72; 95% CI .30, 1.72). Mortality in the cADHD group was mainly attributed to unnatural causes of death (adjusted hazard ratio = 2.82; 95% CI 1.12, 7.12). The mortality risk in the cADHD group was sixfold before age 30 (adjusted hazard ratio = 6.20; 95% CI 1.78, 21.57).ConclusionsChildhood ADHD was associated with a twofold risk of premature death by the age of 46 in this prospective longitudinal cohort study. Our results corroborate previous findings and the morbidity of ADHD. Subthreshold levels of childhood ADHD symptoms were not linked to increased mortality. Our results suggest that mortality risk is higher in young than middle adulthood. Future studies should examine mortality associated with ADHD in different ages in adulthood to identify those in greatest risk of premature death.

Causes of Death in Children Aged Under Five Years in Tehran Province, Iran: A Forensic Epidemiological Study of Autopsy Data

Background: Mortality among children under 5 years is an important health indicator. Therefore, determining the most common causes and manners of death according to the postmortem data is necessary for designing intervention programs to reduce mortality. Objectives: This study aimed to evaluate the causes and manners of death in children aged under 5 years old in Tehran, Iran using autopsy findings. Methods: This descriptive cross-sectional study was conducted on the data of all deaths among children aged under 5 years who were referred to the Legal Medicine Organization of Tehran, Iran, during January 2009-December 2019. The data were collected using the checklists of demographic characteristics, autopsy, toxicological findings, pathological findings, hospital records, and judicial documents, which were then analyzed. Results: Among 1750 children aged under 5 years old included in this study, 898 (51.3%) cases were male, and 997 (56.9%) were hospitalized. Most of the mortality cases occurred about two months after birth. The most common causes of death were found as congenital cardiovascular anomalies (14.7%), pneumonia (11.7%), and preterm labor (11%). Moreover, natural death (77.7%), accidental death (17.7%), homicide (2.7%), and unknown death (2%) were the major manners of death in these children. Conclusions: Postmortem examination to determine the causes of unnatural death could help clinicians and policymakers to propose a suitable intervention for reducing the mortality rate in children under 5 years.

Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers

Cancer is a life-altering event causing considerable psychological distress. However, information on the total burden of psychiatric disorders across all common adult cancers and therapy exposures has remained scarce. Here, we estimated the risk of self-harm after incident psychiatric disorder diagnosis in patients with cancer and the risk of unnatural deaths after self-harm in 459,542 individuals. Depression was the most common psychiatric disorder in patients with cancer. Patients who received chemotherapy, radiotherapy and surgery had the highest cumulative burden of psychiatric disorders. Patients treated with alkylating agent chemotherapeutics had the highest burden of psychiatric disorders, whereas those treated with kinase inhibitors had the lowest burden. All mental illnesses were associated with an increased risk of subsequent self-harm, where the highest risk was observed within 12 months of the mental illness diagnosis. Patients who harmed themselves were 6.8 times more likely to die of unnatural causes of death compared with controls within 12 months of self-harm (hazard ratio (HR), 6.8; 95% confidence interval (CI), 4.3–10.7). The risk of unnatural death after 12 months was markedly lower (HR, 2.0; 95% CI, 1.5–2.7). We provide an extensive knowledge base to help inform collaborative cancer-psychiatric care initiatives by prioritizing patients who are most at risk.

The impact of urban design and the built environment on road traffic crashes: A case study of Rawalpindi, Pakistan

Road traffic crashes are one of the biggest causes of unnatural deaths in developing countries. This study identifies urban design factors that can influence road traffic crashes. The factors are categorized under the dimensions of land use, street furniture, buildings, and landscape. Road crashes’ data was collected from 1122 Emergency Services of Punjab, Pakistan, while data regarding built environment factors were collected using field surveys. Kernel density estimation technique was used to identify crash hotspots. Multiple and Tobit regression models were used to determine the impact of these indicators on road traffic crashes. Results have shown that most collisions were along the main highways. Commercial, residential, and recreational land uses positively influenced traffic crashes. Informal stops, traffic sign visibility, road condition, footpath/setback encroachments, and green belt availability also affected accident density. The study highlights the need to consider urban form and design factors for road accident prevention and management.

The Socio-Demographic Profile of Unnatural Death in Bihar

Background- Unnatural deaths place a significant burden on society. The sociodemographic characteristics of these deaths in Bihar is not well-documented in the literature. The goal of the current study was to add to knowledge so that these deaths could be stopped or reduced. Material and Method- A retrospective autopsy analysis of one-year unnatural deaths (421 cases) was done at the Department of Forensic Medicine and Toxicology, Nalanda Medical College & Hospital, Patna & Madhubani Medical College & Hospital, Madhubani, Bihar. RTA was the most common cause of unnatural deaths (126/421 i.e., 29.9%). It was followed by violence death (84/421 i.e., 19.9%), poisoning (74/421 i.e., 17.6%), hanging (34/421 i.e., 8.1%), burn (32/421 i.e., 7.6%), drowning (27/421 i.e., 6.4%), strangulation (20/421 i.e., 4.8%) and others (electrocution, lightning, fall- 24/421 i.e., 5.7%). Victims of most unnatural deaths were male except in burn and strangulation cases (3.5% vs 4.1% & 2.1% vs 2.6%). Cases of unnatural deaths were seen to be higher in younger and working age groups (226/421 i.e., 53.4%) in both males and females in the age group of 16-40 years. There was a slight increase in unnatural deaths in the summer season (40%). Suicide was the most common cause of unnatural deaths (140/421 i.e., 33.2%), followed by RTA (126/421 i.e., 29.9%), homicide (104/421 i.e., 24.7%), and other causes (drowning, electrocution, etc.– 51/421 i.e., 12.2%). Male to female death ratio in suicide, homicide and RTA was 1.7 (88/52), 4.8 (86/18), and 8.6 (113/13) respectively. Conclusion- Unnatural death is one of the indicators of the level of social and mental health. Many studies showed different results regarding different modes of unnatural death. These deaths can be minimized by public awareness, skilled drivers, better road conditions and health system, female education and their social empowerment, sincere effort to solve unemployment, strict rules of law, and regulation on the selling of agrochemicals and other poisons.

Profile of Autopsy Cases at District Hospital, South India in Pandemic Year 2020

Autopsy profile is one of the essential inputs for National Statistics. It gives an insight into the prevailing unnatural causes of death in the vicinity and subsequently helps stake holders take appropriate measures to prevent the same. The present study was conducted in district hospital, South India in the pandemic year, 2020. A total of 808 medico legal autopsies were conducted in Government District Hospital, Tumkur which is high in spite of pandemic and lockdown in place. Among them majority of victims were male constituting 78.85% and females attributing to 21.15% of total cases. Manner of death was analysed and accidental deaths formed the major chunk of cases comprising of 351 cases (43.44%). Suicidal deaths comprised of 35.87 % of cases and homicide deaths accounted for 3.71% of cases. Among males maximum number of cases was recorded in fourth decade with 147 cases. While in females maximum cases fell in third decade of life with 51 cases. Road traffic accident was the prime most cause of death with 241 cases comprising of 30% of total cases. Second most common cause was hanging with 137 cases comprising 17% of total cases. Surprisingly natural deaths constituted third most common cause with 125 cases comprising of 15% of the cases. Majority of cases were reported in middle age group 21-50 years which form the bread winner group. With adequate safety precautions and counselling these unnatural deaths could be prevented.