Epidemiological trends of suicide and attempted suicide by poisoning in the US: 2000–2008

In the US the suicide rate on a population basis has risen and fallen over time between approximately 10 and 12 per 100,000 population. The recent trend toward an increased rate has been paralleled by an increase in emergency department visits for attempted suicide. The purpose of this study was to examine trends in suspected suicide (SS) cases reported to the National Poison Data System (NPDS), over a 9-year period (2000–2008).MethodsData were obtained from NPDS, for all human patients between the years 2000 and 2008 with the reason for poisoning exposure recorded as “Intentional – Suspected Suicide” (ISS). Additionally, population sizes were obtained from the US Census Bureau as single annual counts by age and sex bands for the 2000–2008.ResultsThere were 1,672,324 human exposures reported to substances with the reason of SS. Sixty-five percent (1,084,669) were female. The average age of a patient was 30 years with the age groups 13–19 and 20–29 years reporting the highest SS events, 26.4% and 25.7%, respectively. From 2000 to 2008, the estimated rate of SS increased from 72.6 to 82.8 per 1000 human exposure cases. On a population basis, the estimated rate of SS increased from 55.8 to 67.9 per 100,000 population (p for trend <0.001). The relative risk of human exposures for reason of SS compared to human exposures for any other reason being reported to the NPDS is 1.13 (95% CI: [1.122–1.135], p < 0.001) for every 10 years. The relative risk for females vs. males was 1.82 for having SS as a reason for exposure (p < 0.001). However, females were also 0.82 times less likely to experience a severe medical outcome (SMO) compared to males (95% CI: [0.81–0.83], p < 0.001). We noted an increasing risk of a SMO or fatality increasing with age.ConclusionsBased on the total human exposure cases reported to the NPDS, there was a suggested trend of an increase in SS rates of 13% in the next 10 years. There was a greater incidence of SS in females and younger age groups. However, the odds of a SMO or fatality were higher for males and increased with increasing age.     

Head injury trends and helmet use in skiers and snowboarders in Western Canada, 2008–2009 to 2012–2013: an ecological study

This research explored associations between helmet use and head injuries in snowsports by investigating reported snowsport injuries in Western Canada from 2008–2009 to 2012–2013. The key finding was that increased helmet use (from 69% to 80%) was not associated with a reduction in reported head injuries. Over the study period, the average rate of reported head injuries was 0.2/1000 skier visits, with a statistically significant variation (P < 0.001). The line of best fit showed an non-significant upward trend (P = 0.13). Lacerations were the only subcategory of head injuries that decreased significantly with helmet use. A higher proportion of people who reported a head injury were wearing a helmet than for injuries other than to the head. Skiers were more likely to report a head injury when wearing a helmet than snowboarders (P < 0.001 cf. P = 0.22). There were significant differences in characteristics of helmet and non-helmet wearers. Helmet wearers were more likely to be: young adults (P < 0.001); beginner/novices (P = 0.004); and snowboarders (P < 0.001), but helmet wearing was not associated with gender (P = 0.191). Further research is needed to explore the possible reasons for the failure of helmets to reduce head injuries, for example, increased reporting of head injuries and increased risk-taking combined with over-rating of the helmets' protection.     

A demographic study of homicide–suicide in the Pretoria region over a 5 year period

A study was undertaken to research the occurrence of homicide–suicide events in the Pretoria region from January 1997 until October 2001. It is important to attempt understanding this tragic phenomenon from psychiatric and forensic perspectives. This uncommon phenomenon has attracted widespread and sensational media coverage, but little is known about the causal factors and demographic profile of perpetrators and victims, and possible sites of intervention. Case files of the Pretoria Medico-Legal Laboratory (where all cases of unnatural death in Pretoria are investigated) were reviewed and information collected from relevant investigating officers of the South African Police Services.The average annual incidence of homicide–suicide in Pretoria over the period studied was found to be 1 per 100,000 of the population. Two profiles of typical perpetrators seem to emerge: a younger, single, black male shooting his girlfriend and himself at home; and an older, married, Caucasian male shooting his wife and himself at home.Employment in peace forces and unemployment are shown to play significant roles, suggesting need for the availability of psychological support systems to members of peace forces and for intervention regarding unemployment.     

Mortality from cancers of the extra-thoracic airways in relation to radon progeny in the Wismut cohort, 1946–2008

Abstract

Purpose: Inhalation of radon progeny can cause high lung and respiratory tract radiation doses. The aim of this paper was to examine the relationship between radon progeny and cancers of the extra-thoracic airways in the German uranium miner cohort for an extended follow-up through 2008.

Methods: The cohort included 58,690 workers employed between 1946 and 1989 at the Wismut company. Exposure to radon progeny in Working Level Months (WLM) was determined from a comprehensive job-exposure matrix. The mean (max) cumulative exposure to radon among exposed cohort members (86%) was 280 WLM (3,224 WLM). Internal Poisson regression models were applied to estimate the linear Excess Relative Risk (ERR) per unit of cumulative exposure to radon.

Results: A small increase in the mortality from all cancers of the extra-thoracic airways combined with increasing cumulative exposure to radon was found (ERR/100 WLM = 0.036, p = 0.12), based on 234 deaths. The estimated ERR per 100 WLM for relevant cancer sub-groups were: 0.017 (p > 0.5) larynx (n = 94); 0.077 (p = 0.20) pharynx (n = 74); and 0.030 (p > 0.5) tongue and mouth (n = 55).

Conclusion: Results indicated a small but not statistically significant increase in mortality from cancers of the extra-thoracic airways in relation to radon. Low statistical power and uncontrolled confounding were limitations of this study.     

SDH and EDH in children up to 18 years of age—a clinical collective in the view of forensic considerations

International Journal of Legal Medicine - Providing concise proof of child abuse relies heavily on clinical findings, such as certain patterns of injury or otherwise not plausibly explainable...     

Survey of computed tomography techniques and absorbed dose in Italian hospitals: a comparison between two methods to estimate the dose–length product and the effective dose and to verify fulfilment of the diagnostic reference levels

The aim of this study was the production of the first Italian survey of radiation dose in computed tomography (CT) prior to the widespread adoption of multislice CT, in order to have a reference point to facilitate later investigation of dose exposure changes brought by this new CT modality. The collected dose data were compared with diagnostic reference levels (DRLs). The agreement between experimental dose evaluation and Monte Carlo (MC) simulations was investigated. The survey was carried out in 29 Italian hospitals, covered 48 CT scanners and 232 examinations. The dose–length product (DLP) and effective dose (E) values were estimated based on MC simulations for seven clinical protocols using the CT-Dose program. Statistical analysis showed a significant difference (p<0.01) in the DLP between the two methods, with MC values being greater than the experimental ones. For E, the MC values were greater in routine head (8.2%), cervical spine (2.7%) and lumbar spine (2.9%) studies. The weighted CT dose index, the DLP and E were always below the DRLs set by the European Community. This dose survey gives a good but incomplete picture of the Italian CT dose situation and may be useful as a reference baseline for defining clinical multislice protocols in the near future.     

Discussion of the features of suicide trends in 1994–1995 and 2019–2020: The need for different contents in suicide prevention measures for both periods in Japan from the viewpoint of the present

Japan is a country that is prone to natural disasters. This study compared the characteristics of suicide trends before and after the Great Hanshin-Awaji Earthquake, and during the current COVID-19 pandemic 25 years later.In the present study, we examined the annual number of suicides, the number of suicides by age group, and the reason for suicide during the period associated with the earthquake (1994–1995) and the period associated with the pandemic (2019–2020). This study used statistical analyses to compare the two periods. Our findings suggest that research needs to be conducted from the perspective of legal medicine and social medicine to devise current and future measures to prevent suicides.During the first period, suicides increased in 1995 compared to 1994. Suicide due to economic and life problems increased significantly. During the second period, suicides increased in 2020 compared to 2019. Suicides by males decreased significantly and those by females increased significantly; suicides by individuals aged 19 or under and by those aged 20–29 increased significantly, while suicides by individuals aged 60–69 decreased significantly; and suicides due to “other problems” increased significantly, while suicides due to economic and life problems decreased significantly.Ongoing studies of detailed trends in suicides due to the effects of COVID-19 need to be conducted in the future, and it is important to determine suicide risk due to the effects of COVID-19. Legal medicine and social medicine are fields that conduct such studies and that can offer science-based responses to these trends.     

Immunohistochemistry of catecholamines in the hypothalamic–pituitary–adrenal system with special regard to fatal hypothermia and hyperthermia

Catecholamines are involved in various stress responses. Previous studies have suggested applicability of the postmortem blood levels to investigations of physical stress responses or toxic/hyperthermic neuronal dysfunction during death process. The present study investigated cellular immunopositivity for adrenaline (Adr), noradrenaline (Nad) and dopamine (DA) in the hypothalamus, adenohypophysis and adrenal medulla with special regard to fatal hypothermia (cold exposure) and hyperthermia (heat stroke) to examine forensic pathological significance. Medicolegal autopsy cases (n = 290, within 3 days postmortem) were examined. The proportions of catecholamine (Adr, Nad and DA)-positive cells (% positivity) in each tissue were quantitatively estimated using immunostaining. Hyperthermia cases (n = 12) showed a lower neuronal DA-immunopositivity in the hypothalamus than hypothermia cases (n = 20), while Nad- and DA-immunopositivities in the adrenal medulla were higher for hyperthermia than for hypothermia. Rates of Nad-immunopositivity in the adrenal medulla were very low for hypothermia. No such difference between hypothermia and hyperthermia was seen in the adenohypophysis. In hypothermia cases, cellular Nad-immunopositivity in the adrenal medulla correlated with the Nad level in cerebrospinal fluid (r = 0.591, p < 0.01). These observations suggest a characteristic immunohistochemical pattern of systemic stress response to fatal hypothermia and hyperthermia, involving the hypothalamus and adrenal medulla.     

18F–FDG PET/CT in solitary plasmacytoma: metabolic behavior and progression to multiple myeloma

Purpose

Solitary plasmacytoma (SP) is a rare plasma-cell neoplasm, which can develop both in skeletal and/or soft tissue and frequently progresses to multiple myeloma (MM). Our aim was to study the metabolic behavior of SP and the role of 18F–FDG-PET/CT in predicting progression to MM.

Materials and methods

Sixty-two patients with SP who underwent 18F–FDG-PET/CT before any treatment were included. PET images were qualitatively and semiquantitatively analyzed by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and compared with age, sex, site of primary disease, and tumor size.

Results

Fifty-one patients had positive 18F–FDG-PET/CT (average SUVbw was 8.3 ± 4.7; SUVlbm 5.8 ± 2.6; SUVbsa 2 ± 1; MTV 45.4 ± 37; TLG 227 ± 114); the remaining 11 were not 18F–FDG-avid. Tumor size was significantly higher in patients avid lesions compared to FDG not avid; no other features are associated with FDG-avidity. Progression to MM occurred in 29 patients with an average of 18.3 months; MM was more likely to develop in patients with bone plasmacytoma and in patients with 18F–FDG avid lesion. Time to transformation in MM (TTMM) was significantly shorter in patients with osseous SP, in 18F–FDG avid lesion, for SUVlbm > 5.2 and SUVbsa > 1.7.

Conclusions

18F–FDG pathological uptake in SP occurred in most cases, being independently associated with tumor size. PET/CT seemed to be correlated to a higher risk of transformation in MM, in particular for 18F–FDG avid plasmacytoma and SBP. Among semiquantitative features, SUVlbm > 5.2 and SUVbsa > 1.7 were significantly correlated with TTMM.

     

Development of a preparation method to produce a single sample that can be applied to both LC–MS/MS and GC–MS for the screening of postmortem specimens

Simple and efficient extraction methods have been developed for the screening of a wide array of drugs in postmortem autopsy specimens. Acidic and basic compounds were targeted with two extraction methods that can be applied to both GC–MS and LC–MS/MS instrumentation. The extractions were achieved by utilizing lipid-removal and solid-phase extraction cartridges while carefully monitoring the pH of the samples to ensure the adequate removal of interfering substances like lipids and amino acid derivatives. These methods were applied to actual autopsy cases, with 94 and 124 compounds detected by GC–MS and LC–MS/MS, respectively. The developed methods could easily be incorporated into a forensic laboratory’s daily routine for screening many different compounds from postmortem samples.     

Are dual-phase 18F-FDG PET scans necessary in nasopharyngeal carcinoma to assess the primary tumour and loco-regional nodes?

Purpose This prospective study aimed to investigate the efficacy of dual-phase positron emission tomography (PET) in evaluating the loco-regional status of nasopharyngeal carcinoma (NPC).Methods Eighty-four patients with newly diagnosed NPC and a fasting serum glucose level of <200 mg/dl were enrolled. [¹⁸F]fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET studies (at 40 min and 3 h after injection of 370 MBq ¹⁸F-FDG) and head and neck magnetic resonance imaging (MRI) were performed within 1 week. Diagnostic criteria for NPC comprised the histopathological findings, the joint judgments of the research team and the post-treatment outcome. Each lesions maximum standardised uptake value (SUV) and retention index were obtained. SUV data were evaluated using a paired t test. Receiver operating characteristic curves and calculation of the area under the curve (AUC) determined the discriminative power.Results ¹⁸F-FDG PET was significantly superior to MRI in identifying lower neck NPC nodal metastasis (AUC: 1 vs 0. 972, P=0.046) and overall loco-regional metastases (AUC: 0.985 vs 0.958, P=0.036). However, ¹⁸F-FDG PET was similar to MRI in detecting primary tumour, as well as retropharyngeal, upper neck and supraclavicular nodal metastases. There was no significant difference between early phase (40 min) and delayed phase (3 h) ¹⁸F-FDG PET in the detection of primary tumours (accuracy: 100% vs 100%) or loco-regional nodal metastasis (AUC: 0.984 vs 0.985, P=0.834).Conclusion ¹⁸F-FDG PET is superior to MRI in identifying lower neck nodal metastasis of NPC. Additional 3-h ¹⁸F-FDG PET contributes no further information in the detection of primary tumours or loco-regional metastatic nodes in untreated NPC patients.     

Individual differences in self-reported heat tolerance. Is there a link to the cardiocirculatory, thermoregulatory and hormonal response to endurance exercise in heat?

AIM: Tolerance to exercise in heat exhibits great interindividual variability. We questioned whether individual differences in self-reported heat tolerance within a group of endurance trained athletes are linked to the cardiocirculatory, thermoregulatory and hormonal response to endurance exercise in heat. METHODS: Using a rating scale to assess the individual degree of tolerance to exercise in heat we allocated 12 non-heat-acclimated trained runners into two groups of 5 highly heat tolerant (HHT) and 7 less heat tolerant (LHT) athletes. Both groups performed a 60-min treadmill run (velocity 90% of individual anaerobic threshold, room temperature and humidity 28 inverted exclamation mark C and 50%, respectively). RESULTS: Sweating rate did not differ between HHT (mean +/- SEM: 0.44+/-0.02) and LHT (0.40+/-0.02 ml x kg(-1) x min(-1)). Compared to LHT, exercise-induced rises in core temperature (39.3+/-0.2/40.0+/-0.2 inverted exclamation mark C), heart rate, plasma norepinephrine and cortisol were significantly lower in HHT, while epinephrine did not exhibit differences between the groups. In contrast, response of human growth hormone (hGH) was significantly more pronounced in HHT. CONCLUSION: Our initial results, obtained in a small group of endurance-trained runners, show that self-reported tolerance to exercise in heat is associated with an attenuated rise in body core temperature during prolonged exercise under elevated ambient temperatures. This finding in heat tolerant athletes is paralleled by a lower stress response as reflected by lower rises in heart rate and stress hormones such as norepinephrine and cortisol. The functional significance (i.e. with respect to sweating function) of the more pronounced response of hGH in heat tolerant athletes warrants further research.     

Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process?

The CT diagnosis of bowel and mesenteric injuries is difficult and warrants optimal technique and skilled interpretation. We retrospectively reviewed 36 consecutive patients with blunt traumatic injuries to the bowel and mesentery at our regional level I trauma center during the past 3 years. Physical examination, laboratory, Computed tomographic (CT), and intraoperative findings were compared. Surgically proven bowel injuries (13 cases) occurred in the duodenum (three cases), ileum (two cases), jejunum (two cases), colon (three cases), and stomach (three cases). CT findings considered specific of bowel rupture were observed in 5/13 patients including: extraluminal oral contrast or luminal content extravasation (four cases) and discontinuity of hollow viscus wall (one case). In the remaining 8/13 CT findings considered suggestive of bowel injury consisted of: pneumoperitoneum (six), gas bubbles close to the injured hollow viscus (three), thickened (>4-5mm) bowel wall (five), bowel wall hematoma (three), intraperitoneal fluid of unknown source (three). Mesenteric injury (23 cases) were surgically observed at the level of the mesenteric vessels (17 cases), legament of Treitz (two cases), gastro-duodenal artery (one case), transverse (one case) and sigmoid mesocolon (one case). CT finding considered specific of mesenteric laceration was active extravasation of contrast material from the mesenteric vessels (10 cases). CT findings suggestive of mesenteric injury (13 cases) consisted of: mesenteric hematoma (five) and/or high attenuation fluid collections, within the mesenteric root (eight) and folds (four). Helical CT is sensitive in the identification of bowel and mesenteric injury after blunt trauma providing a wide spectrum of findings. However, CT cannot be used as the sole indicator in cases with isolated thichened bowel wall, mesenteric hematoma, bowel hematoma, pneumoperitoneum or gas bubbles. Persistent, active extravasation of intravenous constrast medium from the mesenteric vessels, in isolation or associated with further injuries, requires immediate exploration and repair; disruption of bowel wall and extravasation of oral contrast are definite signs of bowel rupture. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.     

Detainees in police custody in the Paris,France area: medical data and high-risk situations (a prospective study over 1 year)

Background and objective

The annual number of detainees held in police custody in France is approximately 700,000. Medical data regarding arrestees are scarce across countries. We present the medical characteristics of detainees kept in police custody, including addictive behaviours and high-risk medical situations.

Methods

We conducted a prospective study over 1 year in a suburban area near Paris.

Results

A total of 19,098 medical examinations were performed on 13,317 individuals. The examinations mainly concerned male subjects (18,116 of 19,098, 95 %). Median age was 24 years (range 13–83). Medical examination was requested by the detainee in 6,638 of 16,801 cases (40 %). Assaults were reported in 4,052 of 17,312 cases (23 %) and occurred at the time of arrest in most cases (2,243, 13 %). A total of 2,394 of 13,317 detainees (18 %) had at least one chronic somatic disorder including asthma (603, 5 %), diabetes (263, 2 %) and arterial hypertension (205, 2 %). A history of psychiatric disorder was reported by 6 % of individuals (674 of 11,787). Regular alcohol drinking was reported by 58 % of detainees. Illicit drug use mainly involved cannabis (4,021 cases, 30 %). In 14,661 of 19,098 cases (77 %), detainees were considered to be unconditionally fit for detention in custody, and 274 detainees (1 %) were declared unfit to be detained.

Conclusion

The present study showed a high frequency of alcohol or substance use and reported assaults or traumatic lesions in arrestees. Attending physicians should pay particular attention to addictive behaviours and traumatic injuries in arrestees, both for immediate care and for prevention.     

Does the Addition of a “Black Bone” Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after Traumatic Brain Injury in Children?

BACKGROUND AND PURPOSE:Head CT is the current neuroimaging tool of choice in acute evaluation of pediatric head trauma. The potential cancer risks of CT-related ionizing radiation should limit its use in children. We evaluated the role of MR imaging, including a “black bone” sequence, compared with CT in detecting skull fractures and intracranial hemorrhages in children with acute head trauma.MATERIALS AND METHODS:We performed a retrospective evaluation of 2D head CT and brain MR imaging studies including the black bone sequence of children with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Another pediatric neuroradiologist blinded to the diagnosis evaluated brain MR images and head CT images in 2 separate sessions. The presence of skull fractures and intracranial posttraumatic hemorrhages was evaluated. We calculated the sensitivity and specificity of CT and MR imaging with the black bone sequence in the diagnosis of skull fractures and intracranial hemorrhages.RESULTS:Twenty-eight children (24 boys; mean age, 4.89 years; range, 0–15.5 years) with head trauma were included. MR imaging with the black bone sequence revealed lower sensitivity (66.7% versus 100%) and specificity (87.5% versus 100%) in identifying skull fractures. Four of 6 incorrectly interpreted black bone MR imaging studies showed cranial sutures being misinterpreted as skull fractures and vice versa.CONCLUSIONS:Our preliminary results show that brain MR imaging complemented by a black bone sequence is a promising nonionizing alternative to head CT for the assessment of skull fractures in children. However, accuracy in the detection of linear fractures in young children and fractures of aerated bone remains limited.

CT is the initial neuroimaging technique of choice for the acute evaluation of pediatric head trauma due to its wider availability, lower cost, and short acquisition time. In addition, CT identifyies most traumatic injuries that require urgent treatment and correlates well with clinical scales and outcome.¹ However, CT-related ionizing radiation involves the potential risk of patients developing cancer and strongly argues in favor of alternative neuroimaging techniques such as MR imaging.² The lifetime cancer mortality risk attributable to the radiation from a single CT scan of the head in a 1-year-old child has been estimated as 0.07%. This small risk translates into a large population-level risk, especially because head trauma in children from 0 to 14 years of age accounts for nearly half a million emergency department visits in the United States annually.^3,4MR imaging is a nonionizing technique that provides superior contrast resolution and has a higher sensitivity and specificity for parenchymal lesions compared with CT.^3,4 Especially, advanced MR imaging techniques (DWI, SWI) provide additional information that correlates well with outcome.^5,6 Nonhemorrhagic shear injuries and subtle microhemorrhages are typically seen with higher sensitivity by MR imaging compared with CT. Nevertheless, the role of MR imaging in the acute diagnostic work-up of head trauma in children is still limited.^2,7,8 This limitation may be partially explained by longer acquisition times and the subsequent need for sedation as well as the low sensitivity of MR imaging for skull fractures.^2,8 Recently, black bone MR images have been introduced as a new sequence for the evaluation of structural bony abnormalities such as craniosynostosis.⁹On the basis of the inherent diagnostic quality of the black bone sequence, we aimed to determine whether a trauma brain MR imaging protocol with an included black bone MR image could be an alternative to head CT in the acute work-up of children with head trauma. To address our goal, we compared the diagnostic accuracy of brain MR imaging including the black bone sequence with CT for the detection of skull fractures after traumatic brain injury in children. Images were also studied for coexisting intracranial lesions.