Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self-poisoning and alcohol-/illicit drug-negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant-positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.
Non-therapeutic use of anabolic androgenic steroids (AAS) has been associated with various adverse effects; one of the most serious being direct cardiovascular effects with unknown long-term consequences. Therefore, large studies of the association between AAS and cardiovascular outcomes are warranted. We investigated cardiovascular morbidity and mortality in individuals who tested positive for AAS.
Between 2002 and 2009, a total of 2013 men were enrolled in a cohort on the date of their first AAS test. Mortality and morbidity after cohort entry was retrieved from national registries. Of the 2013 individuals, 409 (20%) tested positive for AAS. These men had twice the cardiovascular morbidity and mortality rate as those with negative tests (adjusted hazard ratio (aHR) 2.0; 95% confidence interval (CI) 1.2-3.3). Compared to the Swedish population, all tested men had an increased risk of premature death from all causes (standardized mortality ratio for AAS-positive: 19.3, 95% CI 12.4-30.0; for AAS-negative: 8.3, 95% CI 6.1-11.0).
Non-therapeutic exposure to AAS appears to be an independent risk factor for cardiovascular morbidity and premature death.
Valid mortality statistics are important for healthcare planning and research. Suicides and accidents often present a challenge in the classification of the manner of death. The aim of this study was to analyse the reliability of the national suicide statistics by comparing the classification of suicide in the Scandinavian cause of death registers with a reclassification by 8 persons with different medical expertise (psychiatry, forensic pathology and public health) from each of the 3 Scandinavian countries.
The cause of death registers in Norway, Sweden and Denmark retrieved available information on a sample of 600 deaths in 2008 from each country. 200 were classified in the registers as suicides, 200 as accidents or undetermined and 200 as natural deaths. The reclassification comprised an assessment of the manner and cause of death as well as the level of certainty.
In total, 81%, 88% and 90% of deaths registered as suicide in the official mortality statistics were confirmed by experts using the Swedish, Norwegian and Danish data sets, respectively. About 3% of deaths classified as accidents or natural deaths in the cause of death registers were reclassified as suicides. However, after a second reclassification based on additional information, 9% of the natural deaths and accidents were reclassified as suicides in the Norwegian data set, and 21% of the undetermined deaths were reclassified as suicides in the Swedish data set. In total, the levels of certainty of the experts were 87% of suicides in the Norwegian data set, 77% in the Swedish data set and 92% in Danish data set; the uncertainty was highest in poisoning suicides.
A high percentage of reported suicides were confirmed as being suicides. Few accidents and natural deaths were reclassified as suicides. Hence, reclassification did not increase the overall official suicide statistics of the 3 Scandinavian countries.
The use of anabolic androgenic steroids (AASs) has been associated with hypertrophy of the left cardiac ventricle (LVH) as diagnosed by echocardiography. Case reports suggest that AAS-related LVH may lead to sudden death. We performed an investigation of the gross cardiac pathological findings in deceased male AAS users in order to further elucidate the proposed role of AAS in cardiac hypertrophy.
Eighty-seven deceased males who tested positive for AAS at autopsy and 173 age-adjusted control deceased males without suspected AAS use were studied for cardiac hypertrophy. The AAS-positive subjects had been examined at any of the six departments of forensic medicine in Sweden during the period from 1989 to 2009. Data were assessed employing multivariate analyses controlling for body weight, height, age, bleeding after trauma, and the impact of weight training.
The analysis of the logarithm of heart mass by multivariate statistics implied that strong correlations existed between body mass and heart mass (P
Aims: Statistics on drug-related deaths (DRD) provide crucial information on the drug situation. The European Monitoring Centre for Drug and Drug Addiction (EMCDDA) has published a specification for extracting DRD from national mortality registers to be used in international comparisons. However, surprisingly little is known of the accuracy of DRD statistics derived from national mortality registers. This study assesses the accuracy of Swedish data derived from national mortality registers by comparing it with other sources of data. Methods: We compared five Swedish datasets. Three were derived from national mortality registers, two according to a Swedish specification and one according to the EMCDDA specification. A fourth dataset was based on toxicological analyses. We used a fifth dataset, an inventory of DRD in Stockholm, to assess the completeness and coverage of the Swedish datasets. Results: All datasets were extracted from high-quality registers, but still did not capture all DRD, and both the numbers and demographic characteristics varied considerably. However, the time trends were consistent between the selections. In international comparisons, data completeness and investigation procedures may impact even more on stated numbers. Conclusions: Basing international comparisons on numbers or rates of DRDs gives misleading results, but comparing trends is still meaningful.
The purpose of this population-based registry study was to analyze both birth-related femur and humerus shaft fractures and diagnosed later in infancy, as regards incidence, perinatal characteristics, other diagnoses, and reported accidents.
Children born in 1997-2014, diagnosed with a femur or humerus shaft fracture before age 1?year, were identified in the Swedish Health Registries. Rate of birth fractures were estimated by combining femur and humerus shaft fractures coded as birth-related with femur and humerus shaft fractures diagnosed during day 1-7 without registered trauma or abuse. Incidence was computed by comparing infants with femur or humerus shaft fractures to the total at-risk population.
The incidence for birth-related femur shaft fractures was 0.024 per 1000 children (n?=?45) and that for birth-related humerus shaft fractures was 0.101 per 1000 children (n?=?188). The incidence was 0.154 per 1000 children for later femur shaft fractures (n?=?287) and 0.073 per 1000 children for later humerus shaft fractures (n?=?142). Birth-related femur shaft fracture was associated with shoulder dystocia, cesarean, multiple birth, breech, preterm, and small-for-gestational age, while humerus shaft fracture was associated with maternal obesity, dystocic labor, shoulder dystocia, vacuum-assisted delivery, male sex, multiple birth, breech, preterm, large-for-gestational age, birth weight?>?4000?g, and injury of brachial plexus. A bone fragility diagnosis was recorded in 5% of those with birth-related or later femur shaft fractures. Among infants with birth-related humerus shaft fractures, 1% had a bone fragility diagnosis; the figure for later fractures was 6%. Maltreatment diagnosis was associated with later fractures of both types, especially among those aged
There are previous studies that have found associations between specific injury patterns and different victim-offender relationships (VORs) in homicides. We have used quantitative injury severity scores to further investigate this issue. The amount and severity of injuries were assessed in 178 Swedish homicide victims, retrospectively included from the years 2007-2009. We analyzed whether different injury measures could be used to predict the VOR. In addition to a deeper understanding of violent behavior, such associations may be of help to homicide investigators for offender profiling. The victims' injuries were assessed with eleven different methods. The cases with known VORs were divided into four categories: partner, relative, acquaintance, and stranger. The injury severities were then compared between these categories. No relevant differences were found. Thus, the current study does not support the claim that the VOR can be predicted from the injury severity in a general homicide population. These findings are in contrast to the results of some previous studies but confirm those of others.
The hypothesis of this study is that the diagnosis of infant abuse is associated with criteria for shaken baby syndrome (SBS)/abusive head trauma (AHT), and that that changes in incidence of abuse diagnosis in infants may be due to increased awareness of SBS/AHT criteria.
This was a population-based register study. Setting: Register study using the Swedish Patient Register, Medical Birth Register, and Cause of Death Register. The diagnosis of infant abuse was based on the International Classification of Diseases, 9th and 10th revision. Participants: All children born in Sweden during 1987-2014 with a follow-up until 1 year of age (N = 2 868 933). SBS/AHT criteria: subdural haemorrhage, cerebral contusion, skull fracture, convulsions, retinal haemorrhage, fractures rib and long bones. Outcomes: Incidence, rate ratios, aetiologic fractions and Probit regression analysis.
Diagnosis of infant abuse was strongly associated with SBS/AHT criteria, but not risk exposure as region, foreign-born mother, being born preterm, multiple birth and small for gestational age. The incidence of infant abuse has increased tenfold in Sweden since the 1990s and has doubled since 2008, from 12.0 per 100 000 infants during 1997-2007 to 26.5/100 000 during 2008-2014, with pronounced regional disparities.
Diagnosis of infant abuse is related to SBS/AHT criteria. The increase in incidence coincides with increased medical preparedness to make a diagnosis of SBS/AHT. Hidden statistics and a real increase in abuse are less plausible. Whether the increase is due to overdiagnosis cannot be answered with certainty, but the possibility raises ethical and medico-legal concerns.
For the purpose of studying homicidal violence from a victiminologic point of view, we have examined the number and nature of injuries inflicted on homicide victims examined at the Department of Forensic Medicine in Stockholm during the periods 1976-1978, 1986-1988 and 1996-1998. Evaluation of the total number of injuries (both lethal and non-lethal) revealed a break in the earlier trend during the last of these periods, which demonstrated a clear increase in the number of injuries probably caused by intense and prolonged violence. Thus, there were 14 victims with 40 or more injuries (the maximum being 101 injuries) in the 1996-1998 period, whereas there was only one such victim in each of the two earlier periods. Furthermore, the proportion of victims exhibiting multiple lethal injuries was greater during the last period than during the two preceding periods. These findings indicate a general enhancement in the level of aggression exerted by violent offenders, as well as an increase in the number homicide victims with injuries apparently inflicted by acts of aggression characterized by outrage.