Medical Examiner Surveillance of the COVID-19 Pandemic in King County, Washington, USA.

ABSTRACT: The King County Medical Examiner's Office in Seattle, Wash, initiated a surveillance project with a dedicated team and database tracking the spread of severe acute respiratory syndrome coronavirus 2, deaths due to coronavirus disease 2019 (COVID-19), and deaths occurring within 28 days of COVID-19 vaccination. From January 2020 through July 2022, the results of 13,801 nasal/nasopharyngeal swabs from 7606 decedents tested for the virus were assembled in the surveillance database. Generally, 2 samples were collected and tested separately by 2 different laboratories. Positive rates increased from 5.7% in 2020 to 14.3% in 2022. Of 744 decedents positive for the virus, autopsies were performed on 418 (56%); of these, 106 (25%) died of COVID-19 as either the primary or a contributing cause. Comparison of autopsy findings of those dying of COVID-19 with those positive for the virus but dying of other causes demonstrated increased risk for those with preexisting conditions. Of 1035 deaths reported within 28 days of vaccination, the rates of thrombotic complications and myocarditis were no higher than in other decedents. This study provides evidence of the value to public health surveillance of an adequately resourced medical examiner office in tracking viral spread in the community, understanding disease mortality, and assessing vaccine safety.

Patterns of abuse amongst Sri Lankan women returning home after working as domestic maids in the Middle East: An exploratory study of medico-legal referrals.

OBJECTIVE: Migrant worker abuse is well recognised, but poorly characterised within the scientific literature. This study aimed to explore patterns of abuse amongst Sri Lankan women returning home after working as domestic maids. METHODS: Sri Lanka has over 2 million of its citizens employed overseas as international labor migrants. A cross-sectional study was conducted on Sri Lankan female domestic maids returning from the Middle East region who were referred for medico-legal opinion. RESULTS: A total of 20 women were included in the study. Average length of their employment overseas was 14 months. Complaints of physical violence directed mainly through their employers were made by 60% of women. Upon physical examination, two-thirds had evidence of injuries, with a third being subjected to repetitive/systematic violence. Eighty percent suffered some form of psychological trauma. Personal identity papers and travel documents had been confiscated by the employer in 85% of cases, with two thirds indicating they were prevented and/or restricted from leaving their place of work/residence. CONCLUSIONS: Our study demonstrates that female domestic maid abuse manifests through multiple pathways. Violence against such workers span the full spectrum of physical, financial, verbal, emotional abuse and neglect, as defined by the World Health Organization. Findings from this exploratory study cannot be generalized to the large volume of migrant worker outflows. Further research is needed to determine incidence and define patterns in other migrant worker categories such as low-skilled male workers.

Prolonged breastfeeding reduces risk of breast cancer in Sri Lankan women: a case-control study.

GOAL: To assess the association between duration of breastfeeding and the risk of breast cancer in Sri Lankan women. METHODS: We conducted a case-control study in women aged 30-64 years in selected health care facilities in the Western province. A total of 100 recent cases of breast cancer (histologically confirmed) and 203 controls (age and parity matched) were included. Detailed information regarding breastfeeding, menstruation, reproductive factors, passive smoking and other confounders was collected using a structured questionnaire. Adjusted odds ratios and 95% confidence intervals were calculated using multiple logistic regressions. PRINCIPLE RESULTS: Multivariate analysis found that those women who breastfed for > or =24 months during lifetime had significantly lower risk of breast cancer than those who breastfed for less than 24 months (OR=0.40; 95%CI=0.22, 0.73). Compared to 0-11 months of lifetime breastfeeding, there was a 66.3% reduction in breast cancer risk in women who breastfed for 12-23 months, 87.4% reduction in 24-35 months and 94% reduction in 36-47 months categories. The mean duration of breastfeeding per child for > or =12 months was also associated with reduced risk of breast cancer (OR=0.52; 95%CI=0.28, 0.94). The significant factors associated with increased risk of breast cancer were: post-menopausal women (OR=1.74; 95%CI=1.01, 3.01); having an abortion in the past (OR=3.42; 95%CI=1.75, 6.66) and exposure to passive smoking (OR=2.96, 95%CI=1.53, 5.75). MAJOR CONCLUSIONS: Prolonged breastfeeding significantly reduces the risk of breast cancer and this protective effect was supported by a dose-response relationship. Risk due to passive smoking should be emphasized in anti-smoking programmes.