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CORK Bibliography: Mortality

111 citations. January 2007 to present

Prepared: March 2008

Albalate D. Lowering blood alcohol content levels to save lives: The European experience. Journal of Policy Analysis and Management 27(1): 20-39, 2008. (52 refs.)

Road safety is of increasing concern in developed countries because of the significant number of deaths and large economic losses. One tool commonly used by governments to deal with road accidents is the enactment of stricter policies and regulations. Drunk driving is one of the leading concerns in this field and several European countries have decided to lower their illegal Blood Alcohol Content levels to 0.5 mg/ml over the last decade. This study uses European panel-based data (CAPE) for the period 1991-2003 for the first time to evaluate the effectiveness of this transition by applying the differences-in-differences method in a fixed effects estimation that allows for any pattern of con-elation (Cluster-Robust). The results show positive policy impacts, particularly on certain groups of victims, such as young males in urban zones. However, there are reasons to expect a short lag in that effectiveness.

Anderson JF. Screening and brief intervention for hazardous alcohol use within indigenous populations: Potential solution or impossible dream? Addiction Research & Theory 15(5): 439-448, 2007. (37 refs.)

Despite the increasing popularity of screening and brief intervention (SBI) for hazardous drinking within the wider population, there is a paucity of SBI research directed at Indigenous populations. In Canada, Aboriginal drinkers are less than half as likely to drink on a weekly/daily basis but more than twice as likely to binge drink compared to the general drinking population. As a result, there is a high rate of alcohol related deaths and hospitalisations compared to the non-Aboriginal population. Modification of these patterns and levels of hazardous drinking - especially binge drinking - among Aboriginal drinkers should markedly improve health outcomes. Although the efficacy of SBI has been demonstrated across a range of health care settings and sociocultural groups, there are potential systemic and cultural barriers to implementation of SBI for Aboriginal hazardous drinkers including the historic impact of alcohol on Aboriginal communities. Implementation of SBI must address these barriers and be sensitive to the historic relationship between Aboriginals and alcohol.

Arve S; Savikko N; Lavonius S; Lehtonen A; Isoaho H. Physical functioning, health and survival: A ten-year follow-up study. Aging. Clinical and Experimental Research 18(5): 367-373, 2006. (33 refs.)

Background and aims: Cutbacks in human resources are putting home care personnel under increasing pressure in their work. Home health care personnel need to know how they can prevent undesirable conditions and support older people towards successful aging. The aim of this ten-year follow-up study was to identify factors associated with increased mortality among 70-year-old subjects living in the community. Methods: Data were collected in 1991 by a postal questionnaire sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Results: Many health-related factors, such as smoking, poor subjective health, and mobility, were related to an increased level of mortality. In addition, several diseases (e.g., diabetes, angina pectoris, cancer) at age 70 were associated with increased mortality over ten years. Difficulties in daily activities at age 70 also increased the risk of mortality. Conclusions: The findings offer useful clues for planning health care services and preventive interventions provided by home health care personnel. Home health care personnel should give special attention to older people who feel ill or very ill.

Baglietto L; English DR; Hopper JL; Powles J; Giles GG. Average volume of alcohol consumed, type of beverage, drinking pattern and the risk of death from all causes. Alcohol and Alcoholism 41(6): 664-671, 2006. (38 refs.)

Background: The objective was to investigate associations between average volume of alcohol consumption, type of beverage and drinking pattern and all-cause mortality in the Melbourne Collaborative Cohort Study. Methods: Average consumption, including type of beverage, was estimated from beverage-specific questions on quantity and frequency of consumption. Pattern of consumption was estimated from a 7-day diary. During an average of 10.5 years of follow-up of 36 984 participants, 1971 deaths occurred. Results: For both men and women, mortality curves were J-shaped (nadir at 9-12 g/day of alcohol consumption; upper protective dose of 42-76 g/day). Wine consumption was associated with lower mortality (for men, minimum hazard ratio (HR) at 20-39 g/day of wine consumption: 0.69; 95% confidence interval (CI): 0.54-0.87; for women, minimum HR at 1-19 g/day: 0.82; 95% CI: 0.70-0.98). Beer was associated with an increased risk for men (test for trend, P = 0.05), but not for women. After adjustment for total amount of alcohol consumed, the number of drinking-days was inversely associated with the risk of dying in men (P-trend = 0.04). Conclusions: These results confirm previous findings about the effect of average volume of alcohol and type of beverage and suggest that drinking pattern is an independent risk factor for all-cause mortality.

Bajanowski T; Brinkmann B; Mitchell EA; Vennemann MM; Leukel HW; Larsch KP et al. Nicotine and cotinine in infants dying from sudden infant death syndrome. International Journal of Legal Medicine 122(1): 23-28, 2008. (31 refs.)

The aim of this component of the German Study on Sudden Infant Death was to determine (1) nicotine concentrations in hair (NCH), as a marker of long standing exposure to tobacco, (2) cotinine concentrations in pericardial fluid (CCP) and (3) cotinine concentrations in liquor cerebrospinalis (CCL), the latter measures being markers of recent exposure to tobacco in the last few hours of life. The results obtained were compared with data on parental smoking revealed from interviews. In 100 cases of sudden infant death syndrome, material was taken at autopsy to determine NCH. In 41 cases, NCH and CCP, and in 70 cases, NCH and CCL were determined. Infants of mothers who stated having smoked during pregnancy had higher NCH than infants of non-smoking mothers (p=0.008). Furthermore, there was a weak but statistically significant relationship between NCH's and the daily cigarette consumption of the mother during pregnancy (n=64, r=0.24, p=0.05). In 43% of infants, nicotine could be detected in their hair, although the mothers had said at the interview that they did not smoke during pregnancy. On the other hand, in 33% of infants whose mother stated they had smoked during pregnancy nicotine was not detectable in the infant's hair. CCP's were strongly correlated with CCL's (r=0.62, p=0.0027). For this reason, both parameters were treated as equivalent for the detection of tobacco smoke exposure in the last hours before death. The influence of breast-feeding was evaluated by comparison of the nicotine concentrations in breast fed and non-breast-fed infants from smokers and non-smokers. Fivefold higher nicotine concentrations were determined in non-breast-fed infants of parents who smoked as compared to all other groups. It can be concluded that nicotine intake by passive smoking is much more important than by breast-feeding. We conclude that both interview data and biochemical measures should be sought to understand the true exposure to tobacco smoke.

Battersby C. What killed Alexander the Great? (editorial). ANZ Journal of Surgery 77(1/2): 85-87, 2007. (13 refs.)

The cause of the death of the Macedonian King, Alexander the Great, at Babylon in 323 BC has excited interest and conjecture throughout the ages. The information available in the surviving ancient sources, none of which is contemporaneous, has been reviewed and compared with modern knowledge as set out in several well-known recent surgical texts. The ancient sources record epic drinking by the Macedonian nobility since at least the time of Phillip II, Alexander's father. Alexander's sudden illness and death is likely to have resulted from a surgical complication of acute alcoholic excess.

Bau PFD; Bau CHD; Rosito GA; Manfroi WC; Fuchs FD. Alcohol consumption, cardiovascular health, and endothelial function markers. (review). Alcohol 41(7): 479-488, 2007. (108 refs.)

Cardiovascular diseases are among the worldwide leading causes of shorter life expectancy and loss of quality of life. Thus, any influence of diet or life habits on the cardiovascular system may have important implications for public health. Most world populations consume alcoholic beverages. Since alcohol may have both protective and harmful effects on cardiovascular health, the identification of biochemical mechanisms that could explain such paradoxical effects is warranted. The vascular endothelium is the target of important mediating pathways of differential ethanol concentrations, such as oxidative stress, lipoproteins, and insulin resistance. Alcohol-induced endothelial damage or protection may be related to the synthesis or action of several markers, such as nitric oxide, cortisol, endothelin-1, adhesion molecules, tumor necrosis factor alpha, interleukin-6, C-reactive protein, and haemostatic factors. The expression of these markers is consistent with the J-shaped curve between alcohol consumption and cardiovascular health. However, there is genetic and phenotypic heterogeneity in alcohol response, and despite the apparent beneficial biochemical effects of low doses of ethanol, there is not enough clinical and epidemiological evidence to allow the recommendation to consume alcoholic beverages for abstemious individuals. Considering the potential for addiction of alcoholic beverage consumption and other negative consequences of alcohol, it would be worthwhile to identify substances able to mimic the beneficial effects of low doses of ethanol without its adverse effects.

Bernstein KT; Bucciarelli A; Piper TM; Gross C; Tardiff K; Galea S. Cocaine- and opiate-related fatal overdose in New York City, 1990-2000. BMC Public Health 7: article 31, 2007. (49 refs.)

Background: In New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths. We assessed trends and correlates of cocaine- and opiate-related overdose deaths in NYC during 1990-2000. Methods: Data were collected from the NYC Office of the Chief Medical Examiner (OCME) on all fatal drug overdoses involving cocaine and/or opiates that occurred between 1990-2000 (n = 8,774) and classified into three mutually exclusive groups (cocaine only; opiates-only; cocaine and opiates). Risk factors for accidental overdose were examined in the three groups and compared using multinomial logistic regression. Results: Overall, among decedents ages 15-64, 2,392 (27.3%) were attributed to cocaine only and 2,825 (32.2%) were attributed to opiates-only. During the interval studied, the percentage of drug overdose deaths attributed to cocaine only fell from 29.2% to 23.6% while the percentage of overdose deaths attributed to opiates-only rose from 30.6% to 40.1%. Compared to New Yorkers who fatally overdosed from opiates-only, fatal overdose attributed to cocaine-only was associated with being male (OR = 0.71, 95% CI 0.62-0.82), Black (OR = 4.73, 95% CI 4.08-5.49) or Hispanic (OR = 1.51, 95% CI 1.29-1.76), an overdose outside of a residence or building (OR = 1.34, 95% CI 1.06-1.68), having alcohol detected at autopsy (OR = 0.50, 95% CI 0.44-0.56) and older age (55 64) (OR = 2.53 95% CI 1.70-3.75). Conclusion: As interventions to prevent fatal overdose become more targeted and drug specific, understanding the different populations at risk for different drug-related overdoses will become more critical.

Beynon CM; Bellis MA; Church E; Neely S. When is a drug-related death not a drug-related death? Implications for current drug-related death policies in the UK and Europe. Substance Abuse Treatment, Prevention, and Policy 2: article 25, 2007. (11 refs.)

Background: Drug-related death (DRD) figures, published by the national performance management framework, are used to monitor the performance of Drug (and Alcohol) Action Teams (D[A]ATs) in England and Wales with respect to reducing DRDs among drug abusers. To date, no investigation has been made into the types of death included in these figures, the demographic and drug profile of those who died, nor the likelihood of individuals included in DRD figures interacting with services designed to assist drug abusers. The aim of this work was to examine the characteristics of deaths classified as drug-related and to explore their applicability to performance-monitor drug-related services. Liverpool was chosen because it was reported by the national DRD monitoring system to have the highest number of DRDs in 2004. Methods: Information was retrieved from the Liverpool coroner's records and established monitoring systems on individuals reported by the national performance monitoring system as a DRD between 1st January 2004 and 30th June 2005 (n = 70). Analyses assessed differences between those categorised by the national performance monitoring system as 'drug abusers/dependents' and 'non-drug abusers/dependents' using ?2, Fisher's exact test and Mann-Whitney U. Results: Non-drug abusers were significantly older (median age 53.59 vs. 38.23), had no recent contact with drug-related agencies (cv. 31.6% of abusers who had treatment contact) and had different post mortem drug profiles than drug abusers. A significantly greater proportion of non-drug abusers died from drug toxicity - predominantly through anti-depressants, anti-psychotics and analgesics. Conclusion: Our findings suggest that the national DRD performance monitoring system includes deaths of people who are not drug abusers - individuals who are not the current focus of drug prevention, treatment or harm minimisation services. This raises concerns regarding the applicability of these figures to performance monitor D(A)ATs. Furthermore, using the more compact definitions used to monitor trends in DRDs across England, Wales and Europe fails to include a proportion of deaths attributable to drug misuse - such as those attributable blood-borne viruses. Current definitions used to monitor DRDs locally, nationally and across Europe fail to capture the true burden of drug-related mortality.

Braithwaite RS; Conigliaro J; Roberts MS; Shechter S; Schaefer A; McGinnis K et al. Estimating the impact of alcohol consumption on survival for HIV plus individuals. AIDS Care 19(4): 459-466, 2007. (38 refs.)

Alcohol consumption is associated with decreased antiretroviral adherence, and decreased adherence results in poorer outcomes. However the magnitude of alcohol's impact on survival is unknown. Our objective was to use a calibrated and validated simulation of HIV disease to estimate the impact of alcohol on survival. We incorporated clinical data describing the temporal and dose- response relationships between alcohol consumption and adherence in a large observational cohort (N = 2,702). Individuals were categorized as nondrinkers (no alcohol consumption), hazardous drinkers (consume >= 5 standard drinks on drinking days), and nonhazardous drinkers (consume <5 standard drinks on drinking days). Our results showed that nonhazardous alcohol consumption decreased survival by more than 1 year if the frequency of consumption was once per week or greater, and by 3.3 years (from 21.7 years to 18.4 years) with daily consumption. Hazardous alcohol consumption decreased overall survival by more than 3 years if frequency of consumption was once per week or greater, and by 6.4 years (From 16.1 years to 9.7 years) with daily consumption. Our results suggest that alcohol is an underappreciated yet modifiable risk factor for poor survival among individuals with HIV.

Carrieri MP; Amass L; Lucas GM; Vlahov D; Wodak A; Woody GE. Buprenorphine use: The international experience. Clinical Infectious Diseases 43(Supplement 4): s197-s215, 2006. (185 refs.)

The confluence of the heroin injection epidemic and the human immunodeficiency virus (HIV) infection epidemic has increased the call for expanded access to effective treatments for both conditions. Buprenorphine and methadone are now listed on the World Health Organization's Model Essential Drugs List. In France, which has the most extensive experience, buprenorphine has been associated with a dramatic decrease in deaths due to overdose, and buprenorphine diversion appears to be associated with inadequate dosage, social vulnerability, and prescriptions from multiple providers. Other treatment models (in the United States, Australia, Germany, and Italy) and buprenorphine use in specific populations are also reviewed in the present article. In countries experiencing a dual epidemic of heroin use and HIV infection, such as former states of the Soviet Union and other eastern European and Asian countries, access to buprenorphine and methadone may be one potential tool for reducing the spread of HIV infection among injection drug users and for better engaging them in medical care.

Centers for Disease Control and Prevention; Arant T; Henry C; Clifford W; Horton DK; Rossiter S. Anhydrous ammonia thefts and releses associated with illicit methamphetamine production - 16 states, January 2000 - June 2004. MMWR. Morbidity and Mortality Weekly Report 54(14): 359-361, 2005. (9 refs.)

Anhydrous ammonia, a colorless gas with a pungent, suffocating fumes, is used primarily as an agricultural fertilizer and industrial refrigerant. It is also a key ingredient for illicit methamphetamine (meth) production in makeshift laboratories. Exposure to anhydrous ammonia can be immediately dangerous to life or health. Anhydrous ammonia generally is not available for sale to the public; states require a license for purchase. Because of this, many illicit meth producers (i.e., "cookers") resort to stealing anhydrous ammonia. If released into the environment, anhydrous ammonia can cause acute injuries to emergency responders, the public, and the cookers themselves. In addition, when handled improperly, anhydrous ammonia can be explosive and deadly. As liquid anhydrous ammonia is released into ambient air, it expands substantially, forming large vapor clouds that behave as a dense gas. This dense gas can travel along the ground instead of immediately rising into the air and dispersing, thereby increasing the potential for exposure to humans. Symptoms of anhydrous ammonia exposure include eye, nose, and throat irritation; dyspnea; wheezing; chest pain; pulmonary edema; pink frothy sputum; skin burns; vesiculation; and frostbite. Exposure can be fatal at high concentrations. Farmers and merchants often are unaware of an anhydrous ammonia theft unless a large-scale release occurs . Nearly half of these HSEES events occurred during agricultural season. In addition, 38% occurred during early morning hours, and 19% occurred on Sundays, when commercial establishments usually are closed. Furthermore, the amount of anhydrous ammonia stolen in each event was small compared with the total volume of the tank. Several additives are being developed and used to help curb anhydrous ammonia thefts and releases, such as one that when mixed into the ammonia, would rendering it useless for meth production. This report describes examples of anhydrous ammonia thefts associated with illicit meth production, summarizes ammonia theft events reported to the Agency for Toxic Substances and Disease Registry (ATSDR), and suggests injury. The information in this report is based on events reported to Hazardous Substances Emergency Events Surveillance (HSEES) system to collect and analyze data about the public health consequences (i.e., morbidity, mortality from 16 state health departments� during January 1, 2000--June 30, 2004. The 85 persons injured (victims) had 110 reported injuries, most frequently respiratory irritation (68 [62%]) and eye irritation (19 [17%]). Of the 1,791 meth events, at least 164 (9%) were known to have been caused by anhydrous ammonia theft with the intention of meth production. These ammonia theft events were reported in 10 of the 16 HSEES states, with Iowa (64 [39%]) and Missouri (57 [35%]) reporting the most events. The most common locations of ammonia theft events were commercial (88 [52%]) and agricultural areas. Of the 164 ammonia theft events, 36 (22%) resulted in a total of 85 injured persons. Persons most frequently injured were members of the general public (38 [45%]) and police officers (27 [32%]).Most (48 [56%]) victims were treated at a hospital but not admitted, and 18 (21%) were treated on the scene. No deaths occurred.

Public Domain

Centers for Disease Control and Prevention; Eaton DK; Kann L; Kinchen S; Ross J; Hawkins J; Harris WA et al. Youth Risk Behavior Surveillance -- United Sates, 2005. MMWR. Morbidity and Mortality Weekly Report 55(No. SS-5): 1-108, 2006. (18 refs.)

Problem: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable. Reporting Period Covered: October 2004--January 2006. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults, including behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infections; unhealthy dietary behaviors; and physical inactivity. In addition, the YRBSS monitors general health status and the prevalence of overweight and asthma. YRBSS includes a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education and health agencies. This report summarizes results from the national survey, 40 state surveys, and 21 local surveys conducted among students in grades 9--12 during October 2004--January 2006. Results: In the United States, 71% of all deaths among persons aged 10--24 years result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that, during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these four causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol; 18.5% had carried a weapon; 43.3% had drunk alcohol; and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and STDs, including HIV infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse; 37.2% of sexually active high school students had not used a condom at last sexual intercourse; and 2.1% had ever injected an illegal drug. Among adults aged >25 years, 61% of all deaths result from two causes: cardiovascular disease and cancer. Results from the 2005 national YRBS indicated that risk behaviors associated with these two causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey; 79.9% had not eaten >5 times/day of fruits and vegetables during the 7 days preceding the survey; 67.0% did not attend physical education classes daily; and 13.1% were overweight. Interpretation: Since 1991, the prevalence of many health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of mortality and morbidity. The prevalence of many health-risk behaviors varies across cities and states.The data is summarized in 73 tables.

Public Domain

Centers for Disease Control and Prevention; Kaplan J; Paulozzi L. Alcohol and drug use in fatal vehicle crashes -- West Virginia. MMWR. Morbidity and Mortality Weekly Report 55(48): 1293-1296, 2006. (10 refs.)

In 2005, approximately 39% of all traffic fatalities in the United States were alcohol related. Evidence of driver impairment from use of drugs other than alcohol is less definitive. In 2005, an estimated 4.3% of persons in the United States reported driving under the influence of a drug used recreationally during the preceding year, and an unknown percentage drove while impaired by drugs being used for medical reasons. To measure the prevalence of alcohol and drug use among persons killed in motor-vehicle crashes in West Virginia (where test results were available for >80% of fatalities), CDC analyzed 2004 and 2005 data reported by the West Virginia Office of the Chief Medical Examiner (OCME) to the Fatality Analysis Reporting System. This report summarizes the results of that analysis, which determined that the prevalence of drug use (25.8%) was similar to the prevalence of a blood alcohol concentration (BAC) >0.08 g/dL (27.7%) among persons killed in motor-vehicle crashes. These results suggest that drug use contributes substantially to driver impairment in West Virginia. In 2004 and 2005, a total of 784 motor-vehicle fatalities resulted from crashes on public roads in West Virginia. Of these, 663 (84.6%) had alcohol test results, 660 (84.2%) had drug test results, and 658 (83.9%) had both. Alcohol was detected in 32.5% of decedents tested for both alcohol and drugs. Illegal BACs (>0.08 g/dL) were detected in 27.7% of decedents, and BACs ranging from 0.01 to 0.07 g/dL were detected in 4.9%. The prevalence of detectable blood alcohol was higher in males and highest among persons aged 16--34 years. Drivers were more likely to have detectable blood alcohol levels than passengers. Detectable levels of at least one drug were reported for 170 (25.8%) decedents. The prevalence of detectable drug levels was higher in males and highest among persons aged 35--54 years. Drivers were more likely to have detectable drug levels than passengers. Among women and persons aged >55 years, drugs were more prevalent than alcohol. Nearly half (47.3%) of all decedents had alcohol or drugs in their bodies; 11.1% had both. Among decedents with detectable blood alcohol levels, 34.1% tested positive for drugs. Among decedents with no detectable blood alcohol levels, 21.8% tested positive for drugs. Opioid analgesics and depressants were each found in 7.3% of tested decedents. The three most common opioid analgesics were hydrocodone, oxycodone, and methadone. The depressants reported were sedatives and muscle relaxants, of which benzodiazepines accounted for 83.3%. The most common benzodiazepines were diazepam and alprazolam. Methamphetamines were involved in four of the five amphetamine reports. Overall, 7.6% of decedents and 9.0% of drivers had two or more of the five different types of drugs in their bodies.

Public Domain

Centers for Disease Control. Annual smoking-attributable mortality, years of potential life lost and productivity losses -- United States, 1997-2001. MMWR. Morbidity and Mortality Weekly Report 54: 2625-2685, 2005. (10 refs.)

Smoking harms nearly every organ of the body, causing many diseases and reducing quality of life and life expectancy. This report assesses the health consequences and productivity losses attributable to smoking in the United States during 1997--2001. The findings indicate that, during 1997--2001, cigarette smoking and exposure to tobacco smoke resulted in approximately 438,000 premature deaths in the United States, 5.5 million YPLL, and $92 billion in productivity losses annually. an estimated annual average of 259,494 deaths among men and 178,408 deaths among women in the United States. Among adults, 158,529 (39.8%) of these deaths were attributed to cancer, 137,979 (34.7%) to cardiovascular diseases, and 101,454 (25.5%) to respiratory diseases. The three leading specific causes of smoking-attributable death are lung cancer (123,836), chronic obstructive pulmonary disease (COPD)� (90,582), and ischemic heart disease (86,801). Smoking during pregnancy resulted in an estimated 910 infant deaths annually for 1997--2001. An estimated 38,112 lung cancer and heart disease deaths annually were attributable to exposure to secondhand smoke. The average annual smoking mortality estimates also include 918 deaths from smoking-attributable fires. In additon, during 1997--2001, smoking accounted for an estimated 3.3 million years of potential life lost (YPLL) for men and 2.2 million YPLL for women annually, excluding burn deaths and adult deaths from secondhand smoke. Estimates for average annual smoking-attributable productivity losses were approximately $61.9 billion for men and $30.5 billion for women during this period.

Public Domain

Centers for Disease Control. Unintentional deaths from drug poisoning by urbanization of area -- New Mexico, 1994-2003. MMWR. Morbidity and Mortality Weekly Report 54(35): 870-873, 2005. (9 refs.)

New Mexico experienced an increase in poisoning deaths during the 1990s and in 2002 was the state with the highest death rate (14.1 per 100,000 population) from unintentional poisoning, more than twice the national rate (6.1). The majority of these unintentional poisoning deaths were caused by ingestion of drugs, including illicit, prescription, and over-the-counter drugs. New Mexico is geographically diverse, with communities ranging from urban centers to sparsely populated counties. Data from the New Mexico Medical Examiner was reviewed for 1994-2003, to ascertain any differences by the nature of the community. The analysis showed that deaths from illicit-drug poisoning were twice as likely to occur in metropolitan areas than nonmetropolitan areas. However, deaths from prescription-drug poisoning were most likely to occur in micropolitan areas. Decedent characteristics (e.g., sex, race/ethnicity, and drugs causing death) were analyzed, and age-adjusted drug-poisoning death rates per 100,000 population by urbanization of area were calculated for 1994--2003. Drugs causing death were categorized as illicit drugs (i.e., heroin, cocaine, or methamphetamine), over-the-counter drugs, or prescription drugs (i.e., methadone, other opioid painkiller, tranquilizer/muscle relaxant, antidepressant, barbiturate, or other prescription drug. During 1994--2003, a total of 1,982 drug-poisoning deaths were identified in New Mexico; data on four deaths did not include county of decedent residence. Statewide, 71.3% of decedents resided in metropolitan areas, 25.3% in micropolitan areas, and 3.4% rural. Compared with decedents from micropolitan and nonstatistical areas, a significantly larger proportion from metropolitan areas died from heroin overdose (52.6% versus 48.8% and 35.3%, respectively). However, a larger proportion from rural areas died from any prescription drug (50.0% versus 37.2% and 40.2%) or from opioid painkillers other than methadone (38.2% versus 19.6% and 22.8%). Illicit drug poisonings had the highest death rate (8.1 per 100,000 population), with a higher poisoning death rate from heroin than from cocaine or methamphetamine (5.8 versus 4.4 and 0.6). The death rate from any prescription drug was 4.4, with the highest rate among prescription drugs from opioid painkillers other than methadone (2.4). Metropolitan areas had the highest rates for all drug-poisoning deaths (12.6 versus 9.5 for micropolitan areas and 7.4 for nonstatistical areas), any illicit drug (9.0 versus 6.8 for micropolitan areas and 4.4 for nonstatistical areas), heroin (6.6 versus 4.7 for micropolitan areas and 2.6 for nonstatistical areas), and cocaine (4.8 versus 3.7 for micropolitan areas and 2.4 for nonstatistical areas). Metropolitan areas also had the highest death rates from methadone (1.6) and over-the-counter drugs (1.0). rural areas had the highest death rate from opioid painkillers other than methadone (2.8); micropolitan areas had the highest death rate from alcohol and drug cointoxication (3.7).

Public Domain

Chung CW; Wang JD; Yu CF; Yang MC. Lifetime medical expenditure and life expectancy lost attributable to smoking through major smoking related diseases in Taiwan. Tobacco Control 16(6): 394-399, 2007. (18 refs.)

Objective: To estimate the lifetime financial burden on Taiwan's national health insurance (NHI) system, life expectancy and years of life expectancy lost (YLEL) attributable to smoking from major smoking related diseases. Methods: 10 major smoking related diseases (seven cancers, stroke, acute myocardial infarction and chronic obstructive pulmonary disease) were selected for this study. A survival analysis was conducted on linked cohorts from the National Death Registry database and the National Cancer Registry (NCR) and patients at the National Taiwan University Hospital (NTUH). Estimation of the smoking attributable fraction (SAF) for the study diseases was undertaken by combining the relative risks of smokers against non-smokers and the prevalence of smoking in Taiwan. The YLEL attributable to smoking was calculated for the study diseases by combining the survival analysis results, the SAF and the annual incidences of each disease. The lifetime medical expenditure for the study diseases was estimated by integrating the survival curve and the mean annual medical costs calculated from NHI reimbursement records. Results: There were 241 280 incidents of the 10 study diseases in 2001, of which about 53 648 cases (22.2%) were attributable to smoking, with a total YLEL of 191 313 at an average of about 3.6 YLEL per case. For each case, the average survival time was about 10.2 years. Under two different annual discount rates, the total lifetime financial burden on the NHI was estimated at between $ 291 million (pound 147 million; epsilon 216 million) (3% discount) and $ 336 million (1% discount) for all diseases attributable to smoking in 2001, accounting for about 24.6% of the total estimated lifetime medical expenditure for all incidents of the 10 study diseases. Conclusions: Smoking places tremendous financial and health burdens upon both society and individuals. A much more stringent tobacco control strategy is needed to curb the damage from smoking.

Coffin PO. Mortality after release from prison. (letter). New England Journal of Medicine 356(17): 1785-1785, 2007. (5 refs.)

Commission of the European Communities. An EU Strategy to Support Member States in Reducing Alcohol Related Harm. Communication for the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. Brussels: Commission of the European Communitites, 2006. (0 refs.)

In 2001, the Council requested a comprehensive strategy to reduce alcohol-related harm in Europe. This report represents a response to that request. Following an introduction the report sets forth a mandate for action, followed by a case for action. The process of consultation and assessment used in creating these recommendations is then described. This is followed by a description of the five priority themes and the relevant good practices to underpin the implementation. The first of these is Protection of young people, children and the unborn child. The specific aims for accomplishing this are Aim 1: To curb under-age drinking, reduce hazardous and harmful drinking among young people. Aim 2: To reduce the harm suffered by children in families with alcohol problems. Aim 3: To reduce exposure to alcohol during pregnancy, thereby reducing the number of children born with Foetal Alcohol Disorders. The rationale for action is that young people are often unfairly depicted as the perpetrators of alcohol problems rather than the victims. Alcohol is estimated to be a causal factor in 16% of cases of child abuse and neglect. Harmful alcohol consumption among young people has been shown to have a negative impact not only on health and social wellbeing, but also on educational attainment. . There is an increasing trend of �binge-drinking� by young people in many parts of the EU. This is exacerbated by the continued availability of alcoholic beverages to under-age consumers. The Second Theme is to reduce injuries and deaths from alcohol-related road traffic accidents. Aim 4: To contribute to reducing alcohol-related road fatalities and injuries. In setting forth the rationale it is noted that approximately one accident in four can be linked to alcohol consumption, and at least 10,000 people are killed in alcohol-related road accidents in the EU each year. Young people aged 18 to 24 are particularly in danger of having an accident. 35% to 45% of fatalities of this age group are due to traffic accidents. For young people, traffic accidents are the most common cause of death (47% ). For drink-driving accidents, two thirds of the people involved were between 15 and 34 years, and 96% were male. The Third Theme is the prevention of alcohol-related harm among adults and reduce the negative impact on. the workplace. The related aims are Aim 5: To decrease alcohol-related chronic physical and mental disorders; Aim 6: To decrease the number of alcohol related deaths.; Aim 7: To provide information to consumers to make informed choices; Aim 8: To contribute to the reduction of alcohol-related harm at the workplace, and promote workplace related actions. The rationale is that while 85% of adult individuals consume alcohol in a moderate and responsible manner, most of the time, harmful and hazardous alcohol consumption is one of the main causes of premature death and avoidable disease and furthermore has a negative impact on working capacity. While 266 million adults drink alcohol up to 20g (women) or 40g (men) per day, over 58 million adults (15%) consume above this level, with 20 million of these (6%) drinking at over 40g (women) or 60g per day (men). Looking at addiction rather than drinking levels, it is also estimated that 23 million Europeans (5% of men, 1% of women) are dependent on alcohol in any one year. The Fourth Theme is to inform, educate and raise awareness on the impact of harmful and hazardous alcohol consumption, and on appropriate consumption patterns, incorporated in Aim 9. The Fifth Theme is to develop, support and maintain a common evidence base. Aim 10: To obtain comparable information on alcohol consumption, especially on young people; definitions on harmful and hazardous consumption, on drinking patterns, on the social and health effects of alcohol; and information on the impact of alcohol policy measures and of alcohol consumption on productivity and economic development. Aim 11: To evaluate the impact of initiatives taken on the basis of this Communication.

Connor J. The life and times of the J-shaped curve. (editorial). Alcohol and Alcoholism 41(6): 583-584, 2006. (15 refs.)

da Silva EA; Noto AR; Formigoni MLOS. Death by drug overdose: Impact on families. Journal of Psychoactive Drugs 39(3): 301-306, 2007. (20 refs.)

Death by overdose is loaded with social/moral stigmas, in addition to strong feelings of anger, helplessness, guilt and shame in the families. The objective of this study was to analyze the impact of these feelings on families facing death by overdose. Qualitative methodology was used to study six families with a history of death by overdose of one of their members. The interview was open, and guided by the question '"What did you feel with the death of your family member by overdose and what was the impact of this death on your family as a whole?" The families were grouped into two categories: families who knew about the drug use of their family member, and families who were not aware of it. The reports show that secrecy regarding drug use followed by death by overdose arouses feelings of anger, guilt, helplessness, and deprives the family members of information that could allow them to take action. As regards families that were aware of the drug use, there seems to be a "veiled preparation" for a possible death by overdose, bringing about ambivalent situations of grief and relief. The report stresses how disturbing it is to lose a family member by overdose, and points to the need for psychological support for those families.

Darke S. From the can to the coffin: Deaths among recently released prisoners. (editorial). Addiction 103(2): 256-257, 2008. (13 refs.)

Daula M; Hanzlick R. Evaluation of certifier practices regarding alcohol-related deaths - Fulton County Medical Examiner's Center, Atlanta, Georgia, 2004. American Journal of Forensic Medicine and Pathology 27(4): 355-358, 2006. (8 refs.)

Context: Alcohol can contribute to various manners of death by acute intoxication that places a person at risk for fatal injury, acute fatal alcohol poisoning, or the various fatal complications of chronic abuse with or without superimposed acute intoxication. The reporting of alcohol use on the death certificate may vary with office policy or procedure, certifier judgment, and the timing of information received during investigation. Objective: To determine the number of deaths including mention of alcohol use in the investigative case file, the number of death certificates on which alcohol use is reported, the number of discrepancies between the 2, and the possible reasons for observed discrepancies. Design, Setting, and Participants: Retrospective case review of all deaths where alcohol use was mentioned in the investigative case file and/or on the death certificate for deaths investigated by the Fulton County Medical Examiner in Atlanta, Georgia, during a 1-year period between January 1, 2004, and December 31, 2004. Main Outcome Measures: Percentage of deaths with alcohol use reported on the death certificate, tabulation of where and how alcohol use is reported on the death certificate, and tabulation of the differences between the investigative case file and death certificate regarding alcohol's possible role in causing death. Results: Among the 1324 deaths certified by the office, 105 (8%) had alcohol use reported on the death certificate. The majority (67%) of these cases were natural deaths. Sixty-nine (5%) deaths had mention of alcohol use in the investigative case notes but did not include it on the death certificate. Twenty-five (2%) deaths had mention of alcohol on the death certificate but did not have mention of it in the investigative case file based on our search criteria. However, subsequent review of additional case follow-up information disclosed a history of alcohol use or acute intoxication in each case. Conclusions: The data show that more natural deaths are considered to be directly caused by alcohol than other manners of death. For the unnatural manners of death (excluding acute alcohol poisoning), alcohol use is often viewed by medical examiners as an incidental, associated finding or risk factor surrounding the circumstances of death rather than being an actual cause of death. In such cases, alcohol use is often omitted from the death certificate. For deaths directly caused by alcohol, the proportion of cases involving possible underreporting or overreporting of alcohol involvement was relatively small and usually involved the omission of chronic alcohol use from the death certificate. Researchers need to be aware of potential limitations of death certificate data for studying alcohol-related deaths.

Davoli M; Bargagli AM; Perucci CA; Schifano P; Belleudi V; Hickman M; VEdeTTE Study Group. Risk of fatal overdose during and after specialist drug treatment: the VEdeTTE study, a national multi-site prospective cohort study. Addiction 102(12): 1954-1959, 2007. (27 refs.)

Background: Specialist drug treatment is critical to overdose prevention; methadone maintenance is effective, but we lack evidence for other modalities. We evaluate the impact of a range of treatments for opiate dependence on overdose mortality. Methods: Prospective cohort study of 10 454 heroin users entering treatment 1998-2001 in Italy followed-up for 10,208 person-years in treatment and 2,914 person-years out of treatment. Standardized overall mortality ratios (SMR) estimate excess mortality risk for heroin users in and out of treatment compared to the general population. Cox models compare the hazard ratio (HR) of overdose between heroin users in treatment and out of treatment. Results: There were 41 overdose deaths, 10 during treatment and 31 out of treatment, generating annual mortality rates of 0.1% and 1.1% and SMRs of 3.9 [95% confidence interval (CI) 2.8-5.4] and 21.4 (16.7-27.4), respectively. Retention in any treatment was protective against overdose mortality (HR 0.09 95% CI 0.04-0.19) compared to the risk of mortality out of treatment, independent of treatment type and potential confounders. The risk of a fatal overdose was 2.3% in the month immediately after treatment and 0.77% in the subsequent period; compared to the risk of overdose during treatment the HR was 26.6 (95% CI 11.6-61.1) in the month immediately following treatment and 7.3 (3.3-16.2) in the subsequent period. Conclusions: We demonstrate that a range of treatments for heroin dependence reduces overdose mortality risk. However, the considerable excess mortality risk in the month following treatment indicates the need for greater health education of drug users and implementation of relapse and overdose death prevention programmes. Further investigation is needed to measure and weigh the potential benefits and harms of short-term therapies for opiate use.

De Letter EA; Lambert WE; Bouche MPLA; Cordonnier JACM; Van Bocxlaer JF; Piette MHA. Postmortem distribution of 3,4-methylenedioxy-N,N-dimethyl-amphetamine (MDDM or MDDA) in a fatal MDMA overdose. International Journal of Legal Medicine 121(4): 303-307, 2007. (27 refs.)

In this manuscript, a newly identified compound, 3,4-methylenedioxy-N,N-dimethylamphetamine (MDDM or also called MDDA), was quantified. The substance was identified in the biological specimens of a 31-year-old man who died following a massive 3,4-methylenedioxymethamphetamine (MDMA) overdose. In addition, the postmortem distribution of the identified substance in various body fluids and tissues was evaluated. For MDDM quantitation, a formerly reported and validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method was adapted. The following quantitative results of the MDDM quantitation were obtained: Femoral blood, aorta ascendens, and right atrial blood contained 2.5, 21.7, and 11.6 ng MDDM/ml, respectively. In left and right pleural fluid and pericardial fluid, concentrations of 47.0, 21.7, and 31.9 ng/ml, respectively, were found. MDDM levels in urine, bile, and stomach contents were 42.4, 1,101, and 1,113 ng/ml, respectively. MDDM concentrations in lungs, liver, kidney, and left cardiac muscle ranged from 12.8 to 39.8 ng/g, whereas these levels were below the limit of quantitation (< LOQ) in right cardiac and iliopsoas muscle. In conclusion, for the first time, MDDM was unambiguously identified in a fatal MDMA overdose. MDDM was probably present as a synthesis by-product or impurity in the MDMA tablets, which were taken in a huge amount by the victim, or MDDM was ingested separately and prior to the MDMA overdose. A third option, i.e., the eventual formation of MDDM as a result of postmortem methylation of MDMA by formaldehyde, produced by putrefaction processes or during storage under frozen conditions, is also discussed. The MDDM levels, substantiated in various body fluids and tissues, are in line with the distribution established for other amphetamine derivatives and confirm that peripheral blood sampling, such as that of femoral blood, remains the "golden standard".

Di Castelnuovo A; Costanzo S; Bagnardi V; Donati MB; Iacoviello L; de Gaetano G. Alcohol dosing and total mortality in men and women: An updated meta-analysis of 34 prospective studies. (review). Archives of Internal Medicine 166(22): 2437-2445, 2006. (58 refs.)

Background: Moderate consumption of alcohol is inversely related with coronary disease, but its association with mortality is controversial. We performed a meta-analysis of prospective studies on alcohol dosing and total mortality. Methods: We searched PubMed for articles available until December 2005, supplemented by references from the selected articles. Thirty-four studies on men and women, for a total of 1,015 835 subjects and 94,533 deaths, were selected. Data were pooled with a weighed regression analysis of fractional polynomials. Results: AJ-shaped relationship between alcohol and total mortality was confirmed in adjusted studies, in both men and women. Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality, maximum protection being 18% in women (99% confidence interval, 13%-22%) and 17% in men (99% confidence interval, 15%-19%). Higher doses of alcohol were associated with increased mortality. The inverse association in women disappeared at doses lower than in men. When adjusted and unadjusted data were compared, the maximum protection was only reduced from 19% to 16%. The degree of association in men was lower in the United States than in Europe. Conclusions: Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women. Our findings, while confirming the hazards of excess drinking, indicate potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival.

Dietze P; Laslett A-M; Rumbold G. The epidemiology of Australian drug use. IN: Hamilton M; KIng T; Ritter A, eds. Drug Use in Australia: Preventing Harm, 2nd Ed.. Oxford: Oxford University Press, 2004. pp. 33-52. (320 book refs.)

This chapter presents data on drug use patterns in Australia. There is discussion of licit drug use -- tobacco, alcohol, and pharmaceuticals -- as well as illict drug use. Data is also presented on problems attendent to drug use, in terms of the numbers of those in drug treatment and mortality related to drug use.

Drummer OH. Post-mortem toxicology. Forensic Science International 165(2-3): 199-203, 2007. (38 refs.)

Studies examining post-mortem processes are difficult to conduct since changes will have already occurred when the body arrives at the mortuary. While control of collection site for blood can minimize changes in concentration it is very difficult to conduct experiments in humans aimed at understanding the mechanisms and determining the extent of such changes. The use of appropriate animal models can be useful in this regard providing the species and conditions are carefully chosen. Pharmacokinetic studies in humans are also very useful for understanding the changes in drug concentration with time in blood (and other fluids) and also for improving our understanding of drug effects. Unfortunately, doses of illicit drugs that can be given are relatively low to guarantee safety hence extrapolations are made to real life situations. Individual case studies can be useful to describe an unusual or particularly interesting circumstances but little useful information can be obtained when trying to ascertain the role of competing factors, e.g. role of individual drugs when multiple drugs are present, varying toxicity between route of administration, and the role of age or natural disease when drugs are also present. Epidemiological approaches by reviewing large numbers of related cases are the most powerful tool to obtain this information. All of these studies need to operate under the ethical and legal framework appropriate for a jurisdiction. This paper discusses the relative merits of scientific approaches to research in post-mortem toxicology and provides guidance on the most appropriate techniques for future studies.

Dyer MR; Renner WA; Bachmann MF. A second vaccine revolution for the new epidemics of the 21st century. (review). Drug Discovery Today 11(21-24): 1028-1033, 2006. (41 refs.)

Non-communicable, chronic diseases are currently the major cause of death and disability worldwide, and many of these maladies have reached epidemic proportions. According to the World Health Organization (WHO) these disorders, including cardiovascular and respiratory diseases, diabetes, obesity and cancer, now account for about half of the global disease burden as well as deaths worldwide. The WHO identifies comparatively few risk factors, namely smoking, alcohol abuse, obesity, high cholesterol and high blood pressure, as the cause of many of these chronic conditions. A new class of medicines, based on vaccine approaches, are now in clinical trials and hold significant promise to treat both risk factors and their associated chronic diseases.

Ekberg-Aronsson M; Nilsson PM; Nilsson JA; Lofdahl CG; Lofdahl K. Mortality risks among heavy-smokers with special reference to women: A long-term follow-up of an urban population. European Journal of Epidemiology 22(5): 301-309, 2007. (32 refs.)

Increased mortality risks associated with smoking are well established among men. There are very few population-based studies comprising a sufficient number of heavily smoking women, measuring the direct effect of smoking on mortality risks. Between 1974 and 1992, 8,499 women and 13,888 men attended a health screening programme including reporting of smoking habits. Individuals were followed for total mortality until 2005. All-cause, cancer, cardiovascular, lung cancer and respiratory mortality were calculated in smoking categories < 10 g per day, 10-19 g per day, and >= 20 g per day with never-smokers as a reference group and with adjustments for co-morbidities, socio-economic and marital status. For respiratory mortality and lung cancer adjustments for FEV1, socio-economic and marital status were performed. Smoking was associated with a two to almost threefold increased mortality risk among women and men. The relative risk (RR) with 95% confidence interval, (CI) for women who smoked 10-19 g per day was 2.44 (2.07-2.87), and for those who smoked 20 g per day or more the RR (95% CI) was 2.42 (2.00-2.92). Smoking was a strong risk factor for cardiovascular mortality among women, the RR (95% CI) for women who smoked 10-19 g per day was 4.52 (3.07-6.64). Ex-smoking women showed increased risks of all-cause mortality; RR (95% CI) 1.26 (1.04-1.52) cancer (excluding lung cancer); RR (95% CI) 1.42 (1.07-1.88) and lung cancer RR (95% CI) 2.71 (1.02-7.23) mortality. However, the cardiovascular; RR (95% CI) 1.18 (0.69-2.00) and respiratory; RR (95% CI) 0.79 (0.16-3.84) mortality risks were not statistically significant. This study confirms that as for men, middle-aged heavily smoking women have a two to threefold increased mortality risk. Adjustments for co-morbidity, socio-economic and marital status did not change these results.

Fanton L; Bevalot F; Schoendorff P; Le Meur C; Gaillard Y; Malicier D. Fatal mephenesin intoxication. Journal of Forensic Sciences 52(1): 221-223, 2007. (12 refs.)

This report describes a death related to the abuse of and intoxication by mephenesin. To the best of our knowledge, this is the first report case of lethal intoxication involving solely mephenesin and reporting mephenesin blood concentrations. The victim was a 48-year-old woman found unconscious at home. Resuscitation was unsuccessful. Toxicological analysis was performed on a blood sample collected during resuscitation. The results being negative, the body was exhumed for an autopsy, which revealed bronchial inhalation syndrome. Analysis in a second laboratory has revealed the presence of mephenesin in samples collected during autopsy. No other drug/toxin was found, and alcohol was negative. Reanalysis of the peripheral blood collected during resuscitation found a mephenesin concentration of 15.81 mu g/mL (15-fold greater that the maximum concentration that would result from a single intake of a 500 mg formulation). The pathologist has concluded on a bronchial inhalation syndrome consecutive to a mephenesin overdose as the cause of death. The manner of this death is discussed in the light of the toxicological hair analysis and the medical past of the victim.

Farrell M; Marsden J. Acute risk of drug-related death among newly released prisoners in England and Wales. Addiction 103(2): 251-255, 2008. (18 refs.)

Aims: To investigate drug-related deaths among newly released prisoners in England and Wales. Design Database linkage study. Participants National sample of 48 771 male and female sentenced prisoners released during 1998-2000 with all recorded deaths included to November 2003. Findings There were 442 recorded deaths, of which 261 (59%) were drug-related. In the year following index release, the drug-related mortality rate was 5.2 per 1000 among men and 5.9 per 1000 among women. All-cause mortality in the first and second weeks following release for men was 37 and 26 deaths per 1000 per annum, respectively (95% of which were drug-related). There were 47 and 38 deaths per 1000 per annum, respectively, among women, all of which were drug-related. In the first year after prison release, there were 342 male deaths (45.8 were expected in the general population) and there were 100 female deaths (8.3 expected in the general population). Drug-related deaths were attributed mainly to substance use disorders and drug overdose. Coronial records cited the involvement of opioids in 95% of deaths, benzodiazepines in 20%, cocaine in 14% and tricyclic antidepressants in 10%. Drug-related deaths among men were more likely to involve heroin and deaths among women were more likely to involve benzodiazepines, cocaine and tricyclic antidepressants. Conclusions: Newly released male and female prisoners are at acute risk of drug-related death. Appropriate prevention measures include overdose awareness education, opioid maintenance pharmacotherapy, planned referral to community-based treatment services and a community overdose-response using opioid antagonists.

Gan Q; Smith KR; Hammond SK; Hu TW. Disease burden of adult lung cancer and ischaemic heart disease from passive tobacco smoking in China. Tobacco Control 16(6): 417-422, 2007. (41 refs.)

Objective: To address the health hazards tobacco smoking imposes upon non-smokers in China, this paper estimates the burden of diseases in adults from passive tobacco smoking for two major diseases-lung cancer and ischaemic heart disease (IHD). Methods: The disease burden was estimated in terms of both premature mortality and disability adjusted life years (DALYs), a measure that accounts for both the age at death and the severity of the morbidity. Results: Passive smoking caused more than 22 000 lung cancer deaths in 2002 according to these estimates. When the toll of disability is added to that of mortality, passive smoking was responsible for the loss of nearly 230 000 years of healthy life from lung cancer. Using the evidence from other countries that links IHD to passive smoking, we estimated that approximately 33 800 IHD deaths could be attributable to passive smoking in China in 2002. Passive smoking is also responsible for the loss of more than one quarter of a million years of healthy life from IHD. Although most of the disease burden caused by active smoking occurs among men, women bear nearly 80% of the total burden from passive smoking. The number of deaths among women caused by passive smoking is about two-thirds of that caused by smoking for the two diseases we examined. Conclusion: Even without considering the passive smoking risks for other diseases and among children that have been documented in other countries, passive smoking poses serious health hazards for non-smokers, especially for adult female non-smokers in China, adding more urgency to the need for measures to be taken immediately to protect the health of non-smokers and curb the nation's tobacco epidemic.

Gentilello LM. Alcohol and the intensive care unit: It's not just an antiseptic. (editorial). Critical Care Medicine 35(2): 627-628, 2006. (10 refs.)

All patients admitted to the intensive care unit (ICU) undergo a complete medical history that includes drugs taken, dosages, and dosing frequency. For a large segment of the ICU population, the most commonly used drug is alcohol. However, there are more publications in the recent intensive care literature on alcohol as a hand-washing disinfectant than as a drug that may influence complications and overall outcome. This editorial emphasizes the importance of being informed about complications associated with chronic use. it comments upon an article in this issue by O'Brien that documents a strong association between alcohol dependence and sepsis, septic shock, and mortality. It is also emphasized that while dependent patients have the highest risk of medical complications, most alcohol-related problems occur in patients who are not dependent, since such patients make up the largest portion of the problem drinking population. A large number of people at moderate risk give rise to more health problems than a small number of patients who are at high risk. For example, more coronary artery disease is caused by cholesterol levels between 200 and 250 mg/dL than by levels higher than 300 mg/dL because levels between 200 and 250 mg/dL are more common. Similarly, alcohol-related medical conditions in ICU patients are more likely to be associated with drinkers who do not meet criteria for dependence. By restricting the analysis of alcohol-related complications to dependent patients, this study probably underestimated the magnitude of the effect of alcohol on complication rates.

Guy P; Holloway M. Drug-related deaths and the 'special deaths' of late modernity. Sociology 41(1): 83-96, 2007. (36 refs.)

The literature on dying and bereavement has long recognized that the features of some deaths make them especially difficult to grieve. The defining features of such deaths and bereavement are that there is often a high level of trauma, they may be socially stigmatizing or existentially problematic, and the grief is frequently 'disenfranchized'. These deaths are special because they occur outside of attempts to create ontological security that have been suggested as a central feature of late modernity. In this article we argue that drug-related deaths represent one example of special deaths. Our argument is illustrated through three case studies taken from a small scale empirical study conducted by one of the authors. From this, a beginning typology for the 'special deaths' of late modernity is suggested. It is argued that better understanding of these deaths is a necessary feature of the theoretical revision of death in late modernity.

Henley SJ; Connell CJ; Richter P; Husten C; Pechacek T; Calle EE et al. Tobacco-related disease mortality among men who switched from cigarettes to spit tobacco. Tobacco Control 16(1): 22-28, 2007. (34 refs.)

Background: Although several epidemiological studies have examined the mortality among users of spit tobacco, none have compared mortality of former cigarette smokers who substitute spit tobacco for cigarette smoking ("switchers'') and smokers who quit using tobacco entirely. Methods: A cohort of 116 395 men were identified as switchers ( n = 4443) or cigarette smokers who quit using tobacco entirely ( n = 111,952) when enrolled in the ongoing US American Cancer Society Cancer Prevention Study II. From 1982 to 31 December 2002, 44,374 of these men died. The mortality hazard ratios ( HR) of tobacco- related diseases, including lung cancer, coronary heart disease, stroke and chronic obstructive pulmonary disease, were estimated using Cox proportional hazards regression modelling adjusted for age and other demographic variables, as well as variables associated with smoking history, including number of years smoked, number of cigarettes smoked and age at quitting. Results: After 20 years of follow-up, switchers had a higher rate of death from any cause ( HR 1.08, 95% confidence interval ( CI) 1.01 to 1.15), lung cancer ( HR 1.46, 95% CI 1.24 to 1.73), coronary heart disease ( HR 1.13, 95% CI 1.00 to 1.29) and stroke ( HR 1.24, 95% CI 1.01 to 1.53) than those who quit using tobacco entirely. Conclusion: The risks of dying from major tobacco- related diseases were higher among former cigarette smokers who switched to spit tobacco after they stopped smoking than among those who quit using tobacco entirely.

Herttua K; Makela P; Martikainen P. Differential trends in alcohol-related mortality: A register-based follow-up study in Finland in 1987-2003. Alcohol and Alcoholism 42(5): 456-464, 2007. (46 refs.)

Aims: To assess to what extent alcohol-related mortality has changed by age, sex and education in Finland in 1987-2003, a period which saw two periods of economic growth, separated by a severe depression (1991-1995). Methods: A register-based follow-up study of all over 15-year-old Finnish men and women. Age, sex and education of the participants were measured at the time of the 1985, 1990, 1995 and 2000 censuses. Follow-up for mortality was for 1987--2003. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. Results: Among men and women aged 45 years and over, the trends in alcohol-related mortality were associated with economic cycles. Among those aged less than 45 years, alcohol-related mortality decreased from the early 1990s, but intoxication-related accidents and violence still contributed largely to premature mortality. The unfavourable trend for older men resulted from an increase in mortality due to directly alcohol-attributable diseases, alcohol-related diseases of the circulatory system and accidents and violence, and for older women from an increase due to intoxication-related accidents and violence, and alcohol-attributable diseases. Alcohol-related mortality was higher in lower educational groups, and among women the educational gap widened towards the end of the study period. Conclusion: This study shows that trends in both economic conditions and per capita consumption of alcohol are not associated with trends in alcohol-related mortality in all population subgroups. In health policy more attention should be paid to divergent trends in gender, age and education specific alcohol-related mortality.

Heuschmann PU; Heidrich J; Wellmann J; Kraywinkel K; Keil U. Stroke mortality and morbidity attributable to passive smoking in Germany. European Journal of Cardiovascular Prevention & Rehabilitation 14(6): 793-795, 2007. (17 refs.)

Background Passive smoking is an established risk factor for coronary heart disease (CHD). Epidemiological studies suggest that passive smoking may also be associated with an increased risk of stroke. We estimate the burden of stroke due to passive smoking in Germany. Methods Frequency of passive smoking was derived from the German national health survey. Nonsmokers who reported exposure to environmental tobacco smoke (ETS) at home were considered for analyses. The relative risk for stroke and passive smoking was derived by means of a meta-analysis from available cohort studies. We computed attributable risks for passive smoking and used data from official statistics to estimate stroke mortality due to ETS. Attributable stroke morbidity was calculated using the WHO-Global-Burden-of-Disease approach. Results Passive smoking may account for 774 stroke-related deaths and 1837 incident first ever strokes in Germany every year. More strokes owing to passive smoking occur among women (1248) than among men (589). The majority of strokes attributable to ETS happen at the age of 65-84 years. Conclusion ETS is a common exposure and stroke is a frequent disease. Though the relative risk of passive smoking on stroke mortality and morbidity is small, the impact on population health is substantial.

Hijmering ML; de Lange DW; Lorsheyd A; Kraaijenhagen RJ; de Wiel AV. Binge drinking causes endothelial dysfunction, which is not prevented by wine polyphenols: a small trial in healthy volunteers. Netherlands Journal of Medicine 65(1): 29-35, 2007. (27 refs.)

Background: Binge drinking (the consumption of large quantities (> 5 units) of alcohol in a short period) is associated with increased cardiovascular mortality. Wine polyphenols are considered to be protective against cardiovascular diseases. We conducted an experimental study to evaluate the acute effects of alcohol consumption on flow-mediated vasodilation and general cardiovascular parameters, using beverages with high polyphenolic content (HPC) and low polyphenolic content (LPC). Methods: Two groups of ten volunteers were asked to drink two different kinds of beverages. In 45 minutes, three units of red wine or an alcoholic beverage with a low polyphenolic count were consumed. Then 45 minutes were allowed for complete uptake of the alcohol or polyphenolic compounds. Next, all volunteers underwent blood pressure readings, ECG and flow-mediated vasodilation. Blood samples were taken at the same time for routine chemistry, inflammation parameters and lipids. Then the entire cycle was repeated once (in total six units of alcohol in 180 minutes). Results: No differences were found between the two drinks. Alcohol itself dose-dependently increased forearm blood flow by vasodilation of both arterioles and distribution arteries. However, flow-mediated vasodilation (FMD) for the LPC group (n=10) decreased from 7-31 +/- 4-78 (% +/- SD) to 2.82 +/- 2.9 after three drinks and 1.21 +/- 3.25 after six drinks. The FMD values for the HPC group (n=10) decreased from 8.61 +/- 1.78 to 1.78 +/- 3.71 and 1.19 +/- 2.6. There were no significant changes between the LPC and the HPC group at the three time points. Conclusion: Although ethanol produces vasodilation at the level of the distribution artery as well as at an arteriolar level, it causes a decrease in flow-mediated vasodilation. This endothelial dysfunction is not corrected by the polyphenols present in wine.

Hser YI; Huang D; Chou CP; Anglin MD. Trajectories of heroin addiction: Growth mixture modeling results based on a 33-year follow-up study. Evaluation Review 31(6): 548-563, 2007. (39 refs.)

This study investigates trajectories of heroin use and subsequent consequences in a sample of 471 male heroin addicts who were admitted to the California Civil Addiction Program in 1964-1965 and followed over 33 years. Applying a two-part growth mixture modeling strategy to heroin use level during the first 16 years of the addiction careers since first heroin use, the authors identified three groups with distinctive profiles: stably high-level heroin users (n = 278), late decelerated users (n = 149), and early quitters (n = 44). Study findings empirically demonstrate the chronic nature of heroin addiction and subsequent adverse consequences including mortality, mental health, and employment.

Hsue PY; McManus D; Selby V; Ren XS; Pillutla P; Younes N et al. Cardiac arrest in patients who smoke crack cocaine. American Journal of Cardiology 99(6): 822-824, 2007. (15 refs.)

The aim of the study is to determine the clinical features and outcomes of cocaine users admitted to the hospital after cardiac arrest and compare them with nonusers. Cocaine is associated with cardiovascular complications, including ventricular arrhythmias; however, resuscitated cardiac arrest in relation to cocaine use is not a well-defined clinical entity. We reviewed available hospital charts at San Francisco General Hospital with the International Classification of Diseases, Ninth Revision diagnosis of cardiac arrest and cocaine use from 1994 to 2006. Clinical features and outcomes of cocaine users were compared with those of randomly selected control patients and age-matched controls with resuscitated cardiac arrest without cocaine use. We identified 22 patients with resuscitated cardiac arrest in the setting of cocaine use. Their average age was 42 +/- 10 years, > 20 years younger than nonusers (68 +/- 16 years, p < 0.01). After cardiac arrest, 12 of 22 patients (55%) who used cocaine had complete neurologic recovery in contrast to only 3 of 20 unmatched controls (15%, p < 0.01) and 7 of 41 age-matched controls (17%, p < 0.01). Only 10 of 22 cocaine users (46%) died compared with 15 of 20 unmatched controls (75%, p = 0.05) and 32 of 41 age-matched controls (78%, p < 0.01). In a combined analysis of all patients, cocaine use was the only significant predictor of neurologic recovery (p < 0.01) and survival (p < 0.01). In conclusion, cocaine use is associated with cardiac arrest. In patients with cardiac arrest, cocaine users are younger than nonusers and more likely to survive with neurologic recovery, even compared with age-matched controls with cardiac arrest.

Hull MJ; Juhascik M; Mazur F; Flomenbaum MA; Behonick GS. Fatalities associated with fentanyl and co-administered cocaine or opiates. Journal of Forensic Sciences 52(6): 1383-1388, 2007. (19 refs.)

Fatalities associated with fentanyl hydrochloride are increasingly seen in Massachusetts. Between September 2005 and November 2006, 5009 medicolegal investigations associated 107 deaths with licit or illicit fentanyl use, along with a co-detection of an opiate/opioid or cocaine/benzoylecognine, or both. Deaths associated with illicit fentanyl use occur in younger people (39.4 vs. 61.5 years) with higher fentanyl (17.1 ng/mL vs. 4.4 ng/mL) and lower morphine (76.9 ng/mL vs. 284.2 ng/mL) postmortem blood concentrations, and more frequent cocaine co-intoxication (65% vs. 3%), than deaths associated with licit fentanyl use. A wide range of postmortem blood concentrations of fentanyl was detected (trace-280 ng/mL), with a minimum concentration of 7 ng/mL of fentanyl strongly associated with illicit use of fentanyl in poly-drug cases. The most commonly detected opiates/opioids in illicit fentanyl users were: morphine (29%), oxycodone (14.5%), and methadone (14.5%). Ethanol, cannabinoids, diazepam, citalopram, and diphenhydramine were each detected in greater than 10% of the illicit fentanyl cases. Most fentanyl abusers died at their own home and their deaths were most often classified as accidental. Mapping of primary residences of decedents revealed conspicuous clustering of the illicit fentanyl use cases, as opposed to the random pattern in licit use cases. Fentanyl misuse is a public health problem in Massachusetts.

Huttunen R; Laine J; Lumio J; Vuento R; Syrjanen J. Obesity and smoking are factors associated with poor prognosis in patients with bacteraemia. BMC Infectious Diseases 7: article 13, 2007. (34 refs.)

Background: Bacteraemia is still a major cause of case fatality in all age groups. Our aim was to identify the major underlying conditions constituting risk factors for case fatality in bacteraemia patients. Methods: The study involved 149 patients (79 male and 70 female) with bacteraemia caused by Staphylococcus aureus (S. aureus) (41 patients), Streptococcus pneumoniae (Str. pneumoniae) (42 patients), beta-hemolytic streptococcae (beta-hml str.) (23 patients) and Eschericia coli (E. coli) (43 patients). Underlying diseases, alcohol and tobacco consumption and body mass index (BMI) were registered. Laboratory findings and clinical data were registered on admission and 6 consecutive days and on day 10-14. Case fatality was studied within 30 days after positive blood culture. Associations between underlying conditions and case fatality were studied in univariate analysis and in a multivariate model. Results: Nineteen patients (12.8%) died of bacteraemia. We found obesity (p = 0.002, RR 9.8; 95% CI 2.3 to 41.3), smoking (p < 0.001, RR 16.9; 95% CI 2.1 to 133.5), alcohol abuse (p = 0.008, RR 3.9; 95% CI 1.3 to 11.28), COPD (p = 0.01, RR 8.4; 95% CI 1.9 to 37.1) and rheumatoid arthritis (p = 0.045, RR 5.9; 95% CI 1.2 to 28.8) to be significantly associated with case fatality in bacteraemia in univariate model. The median BMI was significantly higher among those who died compared to survivors (33 vs. 26, p = 0.003). Obesity and smoking also remained independent risk factors for case fatality when their effect was studied together in a multivariate model adjusted with the effect of alcohol abuse, age (continuos variable), sex and causative organism. Conclusion: Our results indicate that obesity and smoking are prominent risk factors for case fatality in bacteraemic patients. Identification of risk factors underlying fatal outcome in bacteraemia may allow targeting of preventive efforts to individuals likely to derive greatest potential benefit.

Huxley R; Jamrozik K; Lam TH; Barzi F; Ansary-Moghaddam A; Jiang CQ; Asia Pacific Cohort. Impact of smoking and smoking cessation on lung cancer mortality in the Asia-Pacific region. American Journal of Epidemiology 165(11): 1280-1286, 2007. (23 refs.)

Cigarette smoking is becoming increasingly common in Asia while quitting remains rare, in part because of a lack of knowledge about the risks of smoking. This study compared the risk of death from lung cancer associated with smoking habits in Australia and New Zealand and in Asia by using data from the Asia Pacific Cohort Studies Collaboration: 31 studies involving 480,125 individuals. Cox regression models were used. The hazard ratios for lung cancer mortality associated with current smoking were, for men, 2.48 (95% confidence interval (CI): 1.99, 3.11) in Asia versus 9.87 (95% CI: 6.04, 16.12) in Australia and New Zealand; p for homogeneity < 0.0001. For women, the corresponding estimates were 2.35 (95% CI: 1.29, 4.28) in Asia versus 19.33 (95% CI: 10.0, 37.3) in Australia and New Zealand; p for homogeneity < 0.0001. Quitting was beneficial in both regions; the hazard ratios for former compared with current smokers were 0.69 (95% CI: 0.53, 0.92) in Asia and 0.30 (95% CI: 0.22, 0.41) in Australia and New Zealand. The lesser effect in Asia was partly explained by the fewer number of cigarettes smoked and the shorter duration of follow-up in Asian studies. These results suggest that tobacco control policies in Asia should not solely concentrate on preventing the uptake of smoking but also attend to cessation.

Janszky I; Ljung R; Ahnve S; Hallqvist J; Bennet AM; Mukamal KJ. Alcohol and long-term prognosis after a first acute myocardial infarction: the SHEEP study. European Heart Journal 29(1): 45-53, 2008. (48 refs.)

Context Few studies have investigated the relation between alcohol consumption, former drinking, and prognosis after an acute myocardial infarction (AMI), particularly for non-fatal outcomes. Objective To investigate the prognostic importance of drinking habits among patients surviving a first AMI. Design, settings, and patients A total of 1346 consecutive patients between 45-70 years with a first non-fatal AMI underwent a standardized clinical examination and were followed for over 8 years. Main outcome measures: Total and cardiac mortality and hospitalization for non-fatal cardiovascular disease in relation to individual alcoholic beverage consumption at the time of AMI and 5 years before inclusion, assessed by a standardized questionnaire administered during hospitalization. Results: We recorded 267 deaths, and 145 deaths from cardiac causes, during the follow-up period. After adjustment for several potential confounders, hazard ratios for total and cardiac mortality were 0.77 (0.51-1.15) and 0.61 (0.36-1.02) for those drinking > 0-< 5 g per day, 0.77 (0.50-1.18) and 0.62 (0.36-1.07) for those drinking 5-20 g per day, and 0.89 (0.56-1.40) and 0.69 (0.38-1.25) for those drinking over 20 g per day. Risk of hospitalization for recurrent non-fatal AMI, stroke, or heart failure generally showed a similar pattern to that of total and cardiac mortality. Recent quitters at the time of AMI had a hazard ratio of 4.55 (2.03-10.20) for total mortality. Measures of insulin sensitivity appeared to be the strongest mediators of this association. Moderate alcohol drinking might have beneficial effects on several aspects of long-term prognosis after an AMI. Our findings also highlight that former drinkers should be examined separately from long-term abstainers. The potential mechanisms that underlie this association still need to be elucidated.

Kim JK; Kim S; Ulfarsson GF; Porrello LA. Bicyclist injury severities in bicycle-motor vehicle accidents. Accident Analysis and Prevention 39(2): 238-251, 2007. (56 refs.)

This research explores the factors contributing to the injury severity of bicyclists in bicycle-motor vehicle accidents using a multinomial logit model. The model predicts the probability of four injury severity outcomes: fatal, incapacitating, non-incapacitating, and possible or no injury. The analysis is based on police-reported accident data between 1997 and 2002 from North Carolina, USA. The results show several factors which more than double the probability of a bicyclist suffering a fatal injury in an accident, all other things being kept constant. Notably, inclement weather, darkness with no streetlights, a.m. peak (06:00 a.m. to 09:59 a.m.), head-on collision, speeding-involved, vehicle speeds above 48.3 km/h (30 mph), truck involved, intoxicated driver, bicyclist age 55 or over, and intoxicated bicyclist. The largest effect is caused when estimated vehicle speed prior to impact is greater than 80.5 km/h (50 mph), where the probability of fatal injury increases more than 16-fold. Speed also shows a threshold effect at 32.2 km/h (20 mph), which supports the commonly used 30 km/h speed limit in residential neighborhoods. The results also imply that bicyclist fault is more closely correlated with greater bicyclist injury severity than driver fault.

Klatsky AL; Udaltsova N. Alcohol drinking and total mortality risk. Annals of Epidemiology 17(5, Supplement S): S63-S67, 2007. (19 refs.)

To evaluate further the relation between alcohol consumption and total mortality, we have carried out new Cox proportional hazards model analyses of 21,535 deaths through 2002 in the Kaiser Permanente study. This follow-up includes 2,618,523 person-years of observation, with a mean follow-up of 20.6 years. We adjusted for age, sex, ethnicity, body mass index, marital status, education, and smoking. New methodology was used to stratify light-moderate drinkers into groups felt more or less likely to include under-reporters. The analysis reconfirms that the relation of alcohol drinking to total mortality is J-shaped, with reduced risk (mainly because of less cardiovascular disease) for lighter drinkers and increased risk for persons reporting more than 3 drinks per day. Infrequent (occasional) drinkers have risk similar to that of lifelong abstainers, while former drinkers are at increased risk, especially for noncardiac death. The general shape of the relation of alcohol to mortality is similar for men and women. Age differences are substantial, with the apparent benefit from light-moderate drinking not seen before middle life. Our data indicate further that the apparent magnitude of benefit of lighter drinking is probably reduced by systematic underreporting.

Knight M. Stimulant-drug therapy for attention-deficit disorder (with or without hyperactivity) and sudden cardiac death. (editorial). Pediatrics 119(1): 154-155, 2007. (6 refs.)

Kondziella D; Danielsen ER; Arlien-Soeborg P. Fatal encephalopathy after an isolated overdose of cocaine. (editorial). Journal of Neurology, Neurosurgery, and Psychiatry 78(4): 437-438, 2007. (5 refs.)

Koski A; Siren R; Vuori E; Poikolainen K. Alcohol tax cuts and increase in alcohol-positive sudden deaths: A time-series intervention analysis. Addiction 102(3): 362-368, 2007. (20 refs.)

Aim: The impact of alcohol regulation changes in Finland during 2004 on alcohol-positive sudden deaths was analysed, focusing on: (1) removal of traveller's allowance quotas on alcohol imports from other European Union (EU) countries, (2) lowering of Finnish alcohol excise duty rates and (3) Estonia joining the EU. Design: The impact of these changes was estimated using an autoregressive integrated moving average (ARIMA) analytical technique. Post-mortem forensic toxicology data were analysed over a 15-year period to account for seasonal and long-term variation. In all, the data comprised a weekly series of 33 782 alcohol-positive cases (at least 0.20 mg/g alcohol in blood) and a control series of 37 617 alcohol-negative cases. Setting: Finland in 1990-2004. Findings: The liberation of traveller's allowances had no material impact on alcohol-positive sudden deaths, but the impact of alcohol tax cuts in March 2004 was significant, resulting in an estimated eight additional alcohol-positive deaths per week, which is a 17% increase compared with the weekly average of 2003. The impact associated with Estonia joining the EU was not statistically significant. In the models applied to the control series of alcohol-negative deaths, none of the impact coefficients was statistically significant. Conclusions: Alcohol tax cuts were associated with an increase in the number of sudden deaths involving alcohol. This parallels the reported increases in alcohol consumption and alcohol-related causes of death in 2004 in Finland.

Lalonde BR; Wallage HR. Postmortem blood ketamine distribution in two fatalities. Journal of Analytical Toxicology 28(1): 71-74, 2004

Despite the reported increased use of ketamine as a recreational drug, relatively few fatalities attributed to ketamine poisoning have been documented. Two recent fatalities in which ketamine was detected are described and compared with cases previously reported in the scientific literature. Concentrations of ketamine were measured in the heart and femoral blood samples using gas chromatography with nitrogen phosphorus detection. Ketamine concentrations in a 26-year-old man whose death was attributed to ketamine intoxication were 6.9 and 1.8 mg/L in heart and femoral blood, respectively. In this case, the ketamine concentration detected in the heart blood is in agreement with the lowest concentration reported in the literature, in which ketamine intoxication was ruled as the cause of death and no other drugs were present. Ketamine concentrations in a 20-year-old man, whose death was attributed to asthma and ketamine was considered an incidental finding, were 1.6 and 0.6 mg/L in heart and femoral blood, respectively. Marked differences between heart and femoral blood ketamine concentrations were observed in both of the reported cases. This may be indicative of incomplete distribution prior to death and/or postmortem redistribution of ketamine.

Lam TH; Li ZB; Ho SY; Chan WM; Ho KS; Tham MK et al. Smoking, quitting and mortality in an elderly cohort of 56,000 Hong Kong Chinese. Tobacco Control 16(3): 182-189, 2007. (30 refs.)

Background: Although the harms of smoking are well established, it is unclear how they extend into old age in the Chinese. Aim: To examine the relationship of smoking with all-cause and major cause-specific mortality in elderly Chinese men and women, respectively, in Hong Kong. Methods: Mortality by smoking status was examined in a prospective cohort study of 56 167 (18 749 men, 37 416 women) Chinese aged >= 65 years enrolled from 1998 to 2000 at all the 18 elderly health centres of the Hong Kong Government Department of Health. Results: After a mean follow-up of 4.1 years, 1848 male and 2035 female deaths occured among 54 214 subjects (96.5% successful follow-up). At baseline, more men than women were current smokers (20.3% vs 4.0%) and former smokers (40.8% vs 7.9%). The adjusted RRs (95% CI) for all-cause mortality in former and current smokers, compared with never smokers, were 1.39 (1.23 to 1.56) and 1.75 (1.53 to 2.00) in men and 1.43 (1.25 to 1.64) and 1.38 (1.14 to 1.68) in women, respectively. For current smokers, the RRs (95% CI) for all-cause mortality were 1.59 ( 1.39 to 1.82), 1.72 (1.48 to 2.00) and 1.84 (1.43 to 2.35) for daily consumption of 1-9, 10-20 and > 21 cigarettes, respectively (p for trend < 0.001). RRs (95% CI) were 1.49 (1.30 to 1.72) and 2.20 (1.88 to 2.57) in former and current smokers for all deaths from cancer, and 1.24 (1.04 to 1.47) and 1.57 (1.28 to 1.94) for all cardiovascular deaths, respectively. Quitters had significantly lower risks of death than current smokers from all causes, lung cancer, all cancers, stroke and all cardiovascular diseases. Conclusions: In old age, smoking continues to be a major cause of death, and quitting is beneficial. Smoking cessation is urgently needed in rapidly ageing populations in the East.

Lang I; Guralnik J; Wallace RB; Melzer D. What level of alcohol consumption is hazardous for older people? Functioning and mortality in US and English national cohorts. Journal of the American Geriatrics Society 55(1): 49-57, 2007. (49 refs.)

OBJECTIVES: To estimate disability plus mortality risks in older people according to level of alcohol intake. DESIGN: Two population-based cohort studies. SETTING: The Health and Retirement Study (United States) and the English Longitudinal Study of Aging (England). PARTICIPANTS: Thirteen thousand three hundred thirty-three individuals aged 65 and older followed for 4 to 5 years. MEASUREMENTS: Difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality. RESULTS: One-tenth (10.8%) of U.S. men, 28.6% of English men, 2.9% of U.S. women, and 10.3% of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95% confidence interval (CI)=0.8-1.2) for ADL problems, 0.7 (95% CI=0.6-1.0) for IADL problems, and 0.8 (95% CI=0.6-1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women. CONCLUSION: Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.

Leon DA; Saburova L; Tomkins S; Andreev E; Kiryanov N; Mckee M et al. Hazardous alcohol drinking and premature mortality in Russia: A population based case-control study. Lancet 369(9578): 2001-2009, 2007. (35 refs.)

Background: The reason for the low life expectancy in Russian men and large fluctuations in mortality are unknown. We investigated the contribution of alcohol, and hazardous drinking in particular, to male mortality in a typical Russian city. Methods: Cases were all deaths in men aged 25-54 years living in Izhevsk occurring between Oct 20, 2003, to Oct 3, 2005. Controls were selected at random from the city population and were frequency matched to deaths by age. Interviews with proxy informants living in the same household as cases were done between Dec 11, 2003, and Nov, 16 2005, and were obtained for 62% (1750/2835) of cases and 57% (1750/3078) of controls. We ascertained frequency and usual amount of beer, wine, and spirits consumed and frequency of consumption of manufactured ethanol-based liquids not intended to be drunk (non-beverage alcohol), and markers of problem drinking. Complete information on markers of problem drinking, frequency of alcohol consumption, education, and smoking was available for 1468 cases and 1496 controls. Findings: 751 (51%) cases were classed as problem drinkers or drank non-beverage alcohol, compared with 192 (13%) controls. The mortality odds ratio (OR) for these men, compared with those who either abstained or were non-problematic beverage drinkers, was 6.0 (95% CI 5.0-7-3) after adjustment for smoking and education. The mortality ORs for drinking non-beverage alcohol in the past year (yes vs no) was 9.2 (7.2-11.7) after adjustment for age. Adjustment for volume of ethanol consumed from beverages lowered the OR to 8.3 (6.5-10.7), and further adjustment for education and smoking reduced it to 7.0 (5.5-9.0). A strong direct gradient with mortality was seen for frequency of non-beverage alcohol drinking independent of volume of beverage ethanol consumed. 43% of mortality was attributable to hazardous drinking (problem drinking or non-beverage alcohol consumption, or both) adjusted for smoking and education. Interpretation Almost half of all deaths in working age men in a typical Russian city may be accounted for by hazardous drinking. Our analyses provide indirect support for the contention that the sharp fluctuations seen in Russian mortality in the early 1990s could be related to hazardous drinking as indicated by consumption of non-beverage alcohol.

Lie JAS; Andersen A; Kjaerheim K. Cancer risk among 43,000 Norwegian nurses. Scandinavian Journal of Work, Environment & Health 33(1): 66-73, 2007. (41 refs.)

Objectives: This study evaluated the influence of occupational exposure on cancer risk among female Norwegian nurses. Methods: A historical prospective cohort study was performed. The cohort was established from the Norwegian Board of Health's registry of nurses and included women who graduated from a nursing school before 1985. The cohort (N=43 316) was linked to the Cancer Registry of Norway. The observed number of cases was compared with the expected number on the basis of national rates. Time since first employment, period of first employment, and duration of employment were used as indicators of exposure. Poisson regression analyses were used for internal comparisons, adjusting for age, period, and fertility. Results: The nurses were followed over 1473,931 person-years. During the follow-up (1953-2002), 6193 cancer cases were observed. The standardized incidence ratio (SIR) for all cancers combined was close to unity. Significantly lower risks were found for cancers with a known association with alcohol and tobacco consumption and sexual activity. A significantly increased risk was found for breast cancer (SIR 1.14, 95% confidence interval (95% CI) 1.09-1.19), ovarian cancer (SIR 1.14, 95% CI 1.04-1.25), malignant melanoma (SIR 1.15, 95% CI 1.04-1.28), and borderline significant risk appeared for other skin cancer (SIR 1.12, 95% CI 0.98-1.29). A positive trend for increasing time since first exposure was found for breast cancer and malignant melanoma. Conclusions The results indicate an association between working as a nurse and an increased risk of breast cancer and malignant melanoma. Decreased risks, found for several cancers, indicate favorable lifestyle habits among nurses.

Liu RH; Liu HC; Lin DL. Distribution of methylenedioxymethamphetamine (MDMA) and methylenedioxyamphetamine (MDA) in postmortem and antemortem specimens. Journal of Analytical Toxicology 30(8): 545-550, 2006. (15 refs.)

With increasing requests for the analysis of various specimens related to fatal and non-fatal abuse of methylenedioxymethamphetamine (ecstasy, MDMA), the toxicology laboratory of the Institute of Forensic Medicine has established protocols for the analysis of MDMA and related compounds in hair, urine, and various postmortem specimens. Analytical protocols include extraction, derivatization, and gas chromatographic-mass spectrometric analysis adapting deuterated analogs of the analytes as internal standards. Data resulting from these analyses and hereby reported include postmortem distribution of MDMA and methylenedioxyamphetamine (MDA) in heart blood, gastric content, urine, and bile specimens from 20 fatal cases; other drugs found in the heart blood from these 20 cases; and the distribution of MDMA and MDA in 25 antemortem urine and 6 hair specimens. The MDA/MDMA concentration ratio observed in a limited number of hair specimens (n=6) are consistent and appear to be higher than those found in other specimens. Compared to other commonly abused drugs (e.g., cocaine and heroin), the "drug/metabolite" concentration ratio (MDMA/MDA) in hair is not significantly different from the ratios derived from other specimens, such as urine and blood. This observation is consistent with the relative drug/metabolite incorporation rates reported for cocaine/benzoylecgonine, tetrahydrocannabinol/tetrahydrocannabinoic acid, and MDMA/MDA.

Lopez MJ; Perez-Rios M; Schiaffino A; Nebot M; Montes A; Ariza C et al. Mortality attributable to passive smoking in Spain, 2002. Tobacco Control 16(6): 373-377, 2007. (28 refs.)

Objective: Exposure to environmental tobacco smoke (ETS) is associated with a variety of health effects, including lung cancer and ischaemic heart disease. The objective of this study was to estimate the number of deaths caused by exposure to ETS among non-smokers in Spain during the year 2002. Methods: Prevalence of ETS exposure among never smokers was gathered from three region based health interview surveys. The relative risks of lung cancer and ichaemic heart diseases were selected from three meta-analyses. Population attributable risk (PAR) was computed using a range of prevalences (minimummaximum). The number of deaths attributable to ETS was calculated by applying PARs to mortality not attributable to active smoking in 2002. The analyses were stratified by sex, age and source of exposure (home, workplace and both combined). In addition, a sensitivity analysis was performed for different scenarios. Results: Among men, deaths attributable to ETS ranged from 408 to 1703. From 247 to 1434 of these deaths would be caused by the exposure only at home, 136-196 by exposure only in the workplace and 25-73 by exposure at both home and the workplace. Among women, the number of attributable deaths ranged from 820 to 1534. Between 807 and 1477 of these deaths would be caused by exposure only at home, 9-32 by exposure only in the workplace and 4-25 by exposure both at home and in the workplace. Conclusion: Exposure to ETS at home and at work in Spain could be responsible for 1228-3237 of deaths from lung cancer and ischaemic heart disease. These data confirm that passive smoking is an important public health problem in Spain that needs urgent attention.

Lundborg P. Smoking, information sources, and risk perceptions: New results on Swedish data. Journal of Risk and Uncertainty 34(3): 217-240, 2007. (35 refs.)

Using data on Swedish adolescents, this study examines (1) perceptions of the addictiveness and mortality risk of smoking, (2) the effects of these perceptions on smoking behaviour, and (3) the role of various smoking risk information sources. The average respondent believed that 46 out of 100 smokers would die from diseases caused by their smoking. As to addictiveness perceptions, the average respondent believed that 68 out of 100 smokers trying to quit would not succeed. Both a higher perceived addictiveness and a higher perceived mortality risk were negatively related to smoking participation. The results showed substantial variation in the weight that the teenagers attached to the various information sources.

Marks NF; Jun H; Song J. Death of parents and adult psychological and physical well-being - A prospective US national study. Journal of Family Issues 28(12): 1611-1638, 2007. (78 refs.)

Guided by a life course perspective, attachment theory, and gender theory, this study aims to examine the impact of death of a father, a mother, or both parents, as well as continuously living with one or both parents dead (in contrast to having two parents alive) on multiple dimensions of psychological well-being (depressive symptoms, happiness, self-esteem, mastery, and psychological wellness), alcohol abuse (binge drinking), and physical health (self-assessed health). Analyses of longitudinal data from 8,865 adults in the National Survey of Families and Households 1987-1993 reveal that a father's death leads to more negative effects for sons than daughters and a mother's death leads to more negative effects for daughters than sons. Problematic effects of parent loss are reflected more in men's physical health reports than women's. This study's results suggest that family researchers and practitioners working with aging families should not underestimate the impact of filial bereavement on adult well-being.

Martin TL; Chiasson DA; Kish SJ. Does hyperthyroidism increase risk of death due to the ingestion of ecstasy? (review). Journal of Forensic Sciences 52(4): 951-953, 2007. (17 refs.)

Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is a psychoactive amphetamine derivative widely used for recreational purposes. Deaths caused by acute drug intoxication with MDMA are rare but can often involve a severe hyperthermic episode. The factors underlying the increased risk of some ecstasy users to a fatal drug reaction are not known. We present a case report of a 24-year-old woman who developed fatal hyperthermia with multi-organ complications following MDMA use and was found at autopsy to have diffuse thyroid hyperplasia (Graves' disease). An antemortem blood MDMA concentration of 0.68 mg/L was measured in a sample obtained on admission to hospital. Although a cause and effect cannot be established, as the thyroid hormone is a major regulator of thermogenesis, we suggest that hyperthyroidism predisposed the subject to ecstasy-induced hyperthermia and that a pre-existing defect affecting temperature status could be one factor in explaining some ecstasy intoxication deaths.

Mathers CD; Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3(11): article e-442, 2006. (38 refs.)

Background: Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. Methods and Findings: Relatively simple models were used to project future health trends under three scenarios baseline, optimistic, and pessimistic - based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015. Conclusions These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.

McCloskey J; Bailes J. When Winning Costs Too Much: Steroids, Supplements, and Scandal in Today's Sports. Lanham MD: Taylor Trade, 2005

This book co-authored by a sports writer and physician who has consulted with professional sports teams, covers the problems related to performace-enhancing drugs being used by athletes, among professional athletes, and increasingly among college and high school ages. It covers the use of steroids, designer drugs, and supplements which are largely unregulated and an increasing economic boom. Medical and health roblems related to the use of performance-enhancing drugs is reviewed. Seprate chapters are devoted to heat stroke, brain injury, and unexplained deaths among athletes. A consistent theme throughout the book is the costs to athletes, the undue emphasis on winning, the absence of traditional views of sportsmanship.

Miller C; Kerr T; Strathdee S; Li K; Wood E. Factors associated with premature mortality among young injection drug users in Vancouver. Harm Reduction Journal 4(article 1), 2007. (32 refs.)

Background: Young injection drug users (IDUs) may be at increased risk of premature mortality due to the health risks associated with injection drug use including overdoses and infections. However, there has been little research conducted on mortality causes, rates and associations among this population. We undertook this study to investigate patterns of premature mortality, prior to age 30 years, among young IDUs. Methods: Since 1996, 572 young (�29 years) IDUs have been enrolled in the Vancouver Injection Drug Users Study (VIDUS). Semi-annually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for HIV and hepatitis C (HCV). Mortality data have been continually updated through linkages with the Provincial Coroner's Office. Crude and age-specific mortality rates, standardized mortality ratios, and life expectancy measures were calculated using person-time methods. Predictors of mortality were identified using Cox regression analyses. Findings: Twenty-two participants died prior to age 30 years during the follow-up period for an overall crude mortality rate of 1,368 per 100,000 person-years. Overall, young IDUs were 16.4 times (95% confidence interval [CI]; 9.1-27.1) more likely to die; young women IDUs were 54.1 times (95%CI; 29.6-90.8) and young men IDUs were 12.9 times (95%CI; 5.5, 25.3) more likely to die when compared to the Canadian non-IDU population of the same age. The leading observed cause of death among females was: homicide (N = 9); and among males: suicide (N = 3) and overdose (N = 3). In Cox regression analyses, factors associated with mortality were, HIV infection (Hazard Ratio [HR]: 4.55; CI: 1.92-10.80) and sex work (HR: 2.76; CI: 1.16-6.56). Interpretation: Premature mortality was 13 and 54 times higher among young men and women who use injection drugs in Vancouver than among the general population in Canada. The majority of deaths among the women were attributable to homicide, suggesting that interventions should occur not only through harm reduction services but also through structural interventions at the legal and policy level.

Miller JW; Naimi TS; Brewer RD; Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 119(1): 76-85, 2007. (61 refs.)

OBJECTIVES. Underage drinking contributes to the 3 leading causes of death (unintentional injury, homicide, and suicide) among persons aged 12 to 20 years. Most adverse health effects from underage drinking stem from acute intoxication resulting from binge drinking. Although binge drinking, typically defined as consuming >= 5 drinks on an occasion, is a common pattern of alcohol consumption among youth, few population-based studies have focused specifically on the characteristics of underage binge drinkers and their associated health risk behaviors. METHODS. We analyzed data on current drinking, binge drinking, and other health risk behaviors from the 2003 National Youth Risk Behavior Survey. Prevalence estimates and 95% confidence intervals were calculated by using SAS and SUDAAN statistical software. Logistic regression was used to examine the associations between different patterns of alcohol consumption and health risk behaviors. RESULTS. Overall, 44.9% of high school students reported drinking alcohol during the past 30 days (28.8% binge drank and 16.1% drank alcohol but did not binge drink). Although girls reported more current drinking with no binge drinking, binge-drinking rates were similar among boys and girls. Binge-drinking rates increased with age and school grade. Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs. A strong dose-response relationship was found between the frequency of binge drinking and the prevalence of other health risk behaviors. CONCLUSIONS. Binge drinking is the most common pattern of alcohol consumption among high school youth who drink alcohol and is strongly associated with a wide range of other health risk behaviors. Effective intervention strategies (eg, enforcement of the minimum legal drinking age, screening and brief intervention, and increasing alcohol taxes) should be implemented to prevent underage alcohol consumption and adverse health and social consequences resulting from this behavior.

O'Brien JM Jr; Lu B; Ali NA; Martin GS; Aberegg SK; Marsh CB et al. Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Critical Care Medicine 35(2): 345-350, 2006. (32 refs.)

Objective: To determine the association between alcohol dependence (alcoholism not in remission and/or alcohol withdrawal) and sepsis, septic shock, and hospital mortality among intensive care unit (ICU) patients. Design: Retrospective cohort study. Setting: Two ICUs in an urban hospital. Patients: Patients included 11,651 adult admissions to Denver Health Medical Center from January 1, 1999, to December 31, 2004, with >=1 ICU day. nterventions: None. Measurements and Main Results: Of first admissions appearing in the data set (n = 9,981), 1,222 (12.2%) had a diagnosis consistent with alcohol dependence. These patients had higher rates of sepsis (12.9% vs. 7.6%, p < .001), organ failure (67.3% vs. 45.8%, p < .001), septic shock (3.6% vs. 2.1%, p = .001), and hospital mortality (9.4% vs. 7.5%, p = .022) on unadjusted analyses. Patients with alcohol dependence also had fewer hospital-free days. After adjustment for factors with known association with sepsis, alcohol dependence was associated with sepsis. This association was modified if the patient received (adjusted odds ratio, 0.92; 95% confidence interval, 0.65-1.31) or did not receive (adjusted odds ratio, 1.91; 95% confidence interval, 1.49-2.44) red cell transfusions. A general predisposition to infections mediated some, but not all, of this association. Results were similar when repeat admissions were included in the analysis. Alcohol dependence was also associated with septic shock and hospital mortality in multivariable analyses. Among those with liver disease and sepsis, alcohol dependence was associated with more than two-fold increased risk-adjusted odds of hospital mortality (adjusted odds ration, 2.31; 95% confidence interval, 1.26-4.24). Similarly, sepsis and liver disease carried higher odds of death for alcohol-dependent patients than for those without alcohol dependence. Conclusions: Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among ICU patients. The underlying mechanisms of this association require exploration, as an increased rate of infections mediated some, but not all, of this association.

Odegard E; Amundsen EJ; Kielland KB. Fatal overdoses and deaths by other causes in a cohort of Norwegian drug abusers: A competing risk approach. Drug and Alcohol Dependence 89(2/3): 176-182, 2007. (21 refs.)

Objective: To identify causes of death among Norwegian drug abusers and to investigate the risk factors for fatal overdose and other causes of death, with specific attention to ageing and duration of abuse. Methods: In a cohort of 501 drug abusers admitted to treatment in the period 1981-1991, mortality has been calculated as incidence rates. The analyses of time to death were conducted as proportional hazard regression models using a competing risk approach. Results: Crude incidence rates for all deaths and overdose deaths did not vary with age. For non-overdose deaths, however, the incidence was significantly higher after the age of 40. Explanatory factors associated with age at fatal overdoses are also associated with age at death by other causes. At every age the risk of death was higher with a long-term abuse of drugs, and more so for fatal overdose than for death by other causes. Conclusions: With respect to fatal overdose duration of abuse, but not ageing, is found to be a risk factor. With respect to death by other causes both ageing and duration of abuse are factors associated with such death.

Office of Applied Studies. Drug Abuse Warning Network, 2003: Area Profiles of Drug-Related Mortality. DAWN Series D-27. Rockville MD: Office of Applied Studies, Substance Abuse and Mental Health Administration, 2005

This is the first publication of mortality data from the New Drug Abuse Warning Network. This Report profiles drug-related deaths report to the DAWN participating medical examines and coroners. (Note: Mortality data from this revised system are not comparable to previous reports.) For 2003, 122 jurisdictions in 35 metropolitan area and 6 States, these states new to DAWN are Maine, Maryland, New Hampshire, New Mexico, Utah, and Vermont. Following the Highlights and introduction, the Report provides metropolitan area profiles for communities, State, and abbreviated profiles, as well as area spotlights. Among the highlights are that among the decedents, males are disproportionately represented, ranging from 52% to 77% in reporting metropolitan areas. The patterns for the state level data ranged from 2:1 to 3:1. The age group with the highest proportion of deaths is the 35-54 age group, falling below half of deaths in only two metropolitan areas. Deaths typically occur at home. More drug misuse deaths involved an opiate than any other drug. Alcohol is also commonly identified. Multiple drugs can be identified for a single death. Typically it is only about a quarter of deaths that involve only one substance. For two drug combinations, the major combinations are cocaine and opiates, and alcohol with either opiates, cocaine, or cocaine and opiates. Drug-related suicide deaths are more divers than drug misuse deaths in terms of gender and age. Drug-related suicides among children and adolescents are less common, and the lowest age group in all of the states and all but two of the metropolitan areas. Illicit drugs are involved, on average with less than 20% of drug-related suicides.

Office of Applied Studies. The New DAWN Report. Opiate-related Drug Misuse Deaths in Six States: 2003. Issue 19. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (3 refs.)

The 2004 National Survey on Drug and Use and Health found that an estimated 4.4 miilion people aged 12 or older had used opiate pain medications nonmedically in the prior month. In 2004, an estimated 158,281 emergency department visits were related to opiate prescription pain medications. This report examines the involvement of opiates in deaths resulting from drug misuse in six states: Maine, New Hamphsire, Vermont, Maryland, Utah, and New Mexico. These states vary in population and portion of the population living in metropolitan versus rural areas. Among the major findings are that the rates of opiate-related drug misuse deaths in 2003 ranged from 7.2 per 100,000 population (New Hampshire) to 11.6 persons per 100,000 in New Mexico. In each of these states, most opiate-related drug misuse deaths involved multiple drugs. In five of the six states, the age group with the highest rate of opiate-related deaths was among those ages 35-54. In the remaining state (Maine), the highest rate was for adults ages 21-34. States varied in respect to which opiate medication was involved in deaths. Oxycodone was involved in 30% of deaths in Vermont, but less than half of that in Maryland (14%) and New Mexico (13%). Hydrocodone involvement ranged from 3% (Maryland) to 17% Utah). In all states but Vermont, methadone deaths outnumbered deaths associated with oxycodone or hydocodone. Information is also provided in respect to demographic characteristics, death rates per age group, and poly- versus single drug involvement.

Ojanpera I; Gergov M; Rasanen I; Lunetta P; Toivonen S; Tiainen E et al. Blood levels of 3-methylfentanyl in 3 fatal poisoning cases. American Journal of Forensic Medicine and Pathology 27(4): 328-331, 2006. (17 refs.)

Three fatal poisoning cases due to 3-methylfentanyl are described. In each case, the death was accidental and occurred after injection of the opioid combined with amphetamine, heroin, or other drugs. The victims' ages, ranging from 30 to 41 years, were higher than those typically found in heroin poisonings in Finland. The blood concentrations of cis-3-methylfentanyl, measured here for the first time by a specific tandem mass spectrometric method, ranged from 0.3 to 0.9 mu g/L (mean 0.5 mu g/L). These values are significantly lower than the levels reported for a-methylfentanyl and fentanyl in fatal poisonings. Repeated seizures of fentanyl and its analogs have been reported in Europe close to the Russian border.

Oyelese Y; Ananth CV. Placental abruption. Obstetrics and Gynecology 108(4): 1005-1016, 2006. (48 refs.)

Placental abruption complicates about 1% of pregnancies and is a leading cause of vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal mortality and morbidity. The maternal effect of abruption depends primarily on its severity, whereas its effect on the fetus is determined both by its severity and the gestational age at which it occurs. Risk factors for abruption include prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of the membranes, intrauterine infections, and hydramnios. Abruption involving more than 50% of the placenta is frequently associated with fetal death. The diagnosis of abruption is a clinical one, and ultrasonography and the Kleihauer-Betke test are of limited value. The management of abruption should be individualized on a case-by-case basis depending on the severity of the abruption and the gestational age at which it occurs. In cases where fetal demise has occurred, vaginal delivery is preferable. Disseminated intravascular coagulopathy should be managed aggressively. When abruption occurs at or near term and maternal and fetal status are reassuring, conserva