Homicides in Western Norway, 1985-2009, time trends, age and gender differences.

This retrospective study from Western Norway is based on the cases of 196 homicide victims from 1985 to 2009. The median age of the victims was 35 years, in both genders. Within the cases, 113 of the victims were male and 83 female, 28 victims were under the age of 18, and 19 victims were not native Norwegians. Ethanol was detected in the blood of a higher proportion of male compared to female victims, whereas a higher proportion of female compared to male victims had both illegal/legal drugs detected in their blood. Most perpetrators were male. Men were most often killed by an acquaintance, women by their present or former intimate partner. In 14 cases of intimate partner homicide the perpetrator committed suicide after killing their female partner. The dominant scene of crime was private homes. Most victims were killed by blunt force, sharp force or gunshot. The head was the body region most often injured in the homicide victims. Female victims were more often killed by manual strangulation than male victims.

Fatal diving accidents in western Norway 1983-2007.

Despite efforts to reduce their number, fatal diving accidents still occur. The circumstances and post-mortem findings in 40 fatal diving accidents in western Norway from 1983 through 2007 were investigated. Diving experience, medical history and toxicology reports were retrieved. The material consisted of recreational divers, professional saturation divers and professional divers without experience with saturation. In 33 cases the diving equipment was examined as part of the forensic investigation. In 27 cases defects in the diving equipment were found. For six divers such defects were responsible for the fatal accidents. Eighteen divers died on the surface or less than 10 m below surface. Five divers reached below 100 msw, and two of them died at this depth. The fatalities were not season-dependent. However, wave-height and strength of currents were influential factors in some cases. Twelve divers were diving alone. Twenty divers had one buddy, 9 of these divers were alone at the time of death. The cause of death was drowning in 31 out of 40 divers; one of them had a high blood-ethanol concentration, in two other divers ethanol was found in the urine, indicating previous ethanol consumption. Nine divers died from sudden decompression, pulmonary barotraumas, underwater trauma and natural causes. The study shows that most of the fatal diving accidents could be avoided if adequate diving safety procedures had been followed.

Epidemiology of severely and fatally injured patients in western part of Norway.

BACKGROUND AND AIMS: Analysis of the injury mechanism and characteristics of severely and fatally injured patients in the western part of Norway. MATERIAL AND METHODS: We did a prospective registration of all severely injured patients hospitalized during a three-year period. The files of severely injured patients that died at scene or during transport were retrospectively retrieved from the Forensic Department. A total of 558 patients with an Injury Severity Score > 15 were included. RESULTS: Four-hundred-forty-four men (79.6 %) and 114 women (20.4 %) with a median age of 36 and 51.5 years respectively were included. The proportion of female patients older than 80 years were 19.3 % compared to 5.6 % for men. A total of 215 (38.5 %) patients died and 149 (69.3 %) of these patients died on scene or during transport. The incidence of severely injured patients in Hordaland County was 30 per 100,000 inhabitants per year. The incidence was lowest among children below 5 years (7/100,000/year) and highest among persons older than 80 years (95/100,000/year). Men had a 3.8 times greater risk of getting seriously injured compared to women. Road traffic accidents were the cause of the injuries in 235 (42.1 %) patients and 35.8 % of these patients died. A total of 215 (38.5 %) patients were injured due to falls and 30.2 % of these patients died. Patients who had sustained falls were significantly older than patents with other injury mechanisms (p < 0.001, CI = 13.0-20.2). The proportion of patients with penetrating injuries was 7.3 %. CONCLUSION: The incidence of severely injured patients was 30/100000/year. Men and elderly people had a higher risk of getting severely injured. Falls were the dominating injury mechanism among elderly.

[Fatal cases related to medical treatment]. / Dødsfall som følge av uhell under medisinsk behandling.

We have assessed the volume and nature of fatal misadventures related to medical treatment. We have also studied the existing regulations regarding the reporting of such deaths. Autopsy reports from 4,819 forensic cases from 1986 to 1995 were reviewed. 42 deaths were found to be related to medical treatment. The Department of Pathology at the Gade Institute covers a population of approximately 600,000 to 700,000. This constitutes somewhere between 6.0 and 7.0 fatal therapeutic misadventures per million inhabitants per year. Similar numbers have been found in comparable studies from other countries. Traumatic lesions caused by intravascular catheters and by surgery were the most frequent causes of fatal misadventures. 14 of the 42 cases were attributed to negligent conduct. All parties will clearly benefit from increased awareness with regard to therapeutic misadventures. In time, this may lead to a reduction in the number of such deaths.

Abandoning prone sleeping: Effect on the risk of sudden infant death syndrome.

OBJECTIVE: This study was designed to evaluate the long-term effect of a campaign to avoid prone sleeping on the sudden infant death syndrome (SIDS) mortality rate and on parents' choice of sleeping position for young infants. Before the campaign, 64% of infants usually slept prone and the SIDS rate was 3.5 (95% CI, 2.64 to 4.36) per 1000 live births. STUDY DESIGN: Population-based case reference study of infants dying suddenly and unexpectedly at the ages of 1 week to 1 year, and of 493 healthy infants between 2 and 6 months of age, starting 4 years after an intervention program to avoid prone sleeping. RESULTS: The SIDS rate was 0.3 per 1000 live births (95% CI, 0.05 to 0.54). One of five (20%) SIDS victims usually slept prone, three of five (60%) were placed prone for their last sleep, and five of six were found dead in the prone position. Of the reference infants, 1.4% were usually placed prone to sleep, although all had previously accepted a non-prone position. Nearly half of the infants (49.1%) were usually placed supine, 22.7% usually on the side, and 26.8% in variable positions of which 2.0% occasionally included prone. The side position was the least stable position. After the age of 1 week, 59.4% of infants had been found with their heads covered on at least one occasion. CONCLUSIONS: SIDS is rare when prone sleeping is avoided. Infants at the age of particular risk for SIDS may spontaneously turn from the side to the prone position, and they commonly slip under the bedding during sleep.

Fractures of neck structures in suicidal hanging.

A prospective study of hanging deaths was performed, and 80 cases of suicidal hanging were registered. The purpose of the study was to register fractures of the bony structures of the neck. The frequency of such fractures ranges from rare to frequent in the literature. Prospective studies give the highest incidence of fractures. Careful dissection and an X-ray cabinet with ready-made film in envelopes were used to register all fractures. There were 73 per cent men and 27 per cent women. The mean age was 38.7 years. The proportion of fractures seemed to increase with age and possibly also with increasing suspension time. The highest frequency of fractures was found in atypical complete hangings.

[Clozapine and myocarditis]. / Klozapin og myokarditt.

Drugs have different kinds of adverse effects, one of the most serious being myocarditis. This condition is usually reported as an incidental finding, but can also be fatal. The drug clozapine, available on the European market since the 1970s, can cause myocarditis. This report describes the myocardial findings in a patient who died suddenly after taking increasing doses of clozapine. An allergic adverse reaction to clozapine is suspected. The immediate cause of death was an embolus of the central pulmonary artery.

Pleural effusion in drowning.

The factors that determine the amount of pleural effusion in cases of drowning have not been well established. In a series of cases of drowning from the years 1987-1991, several parameters have been registered to determine whether any correlations could be found between these and the amount of pleural fluid in the drowning victims. A statistically significant difference was found between the cases with and those without increased pleural effusion, indicating that the time spent in water is correlated to the production of pleural fluid. A significant difference was also found between saltwater and freshwater drownings, indicating that more pleural fluid is produced in saltwater than in freshwater drownings.

Sleeping position and sudden infant death syndrome (SIDS): effect of an intervention programme to avoid prone sleeping.

The proportion of prone sleeping among sudden infant death syndrome (SIDS) victims and infants in general, and the rate of SIDS were prospectively studied in the county of Hordaland, Norway, three years before (1987-89) and three years after (1990-92) a campaign to discourage prone sleeping. Before the campaign, 64% of random reference infants were put prone versus 8% after (p < 0.0001). Concurrently, the rate of SIDS decreased from 3.5 to 1.6 per 1000 live births (63 infants before and 30 after the campaign, p = 0.0002). Prone sleeping was not considered a statistically significant risk factor for SIDS before (OR 2.0, 95% CI 0.8-4.5), but was highly significant (OR 11.3, 95% CI 3.6-36.5) after the campaign. Prone sleeping is an important risk factor for SIDS, but the association may be missed in epidemiological studies if prone is the predominant sleeping position. Behaviour with regard to sleeping position may be changed rapidly by means of a simple campaign.

A histopathologic and immunocytochemical study of the spinal cord in amateur and professional divers.

To clarify the influence of diving activity on the central nervous system, we studied 10 amateur and 10 professional deceased divers with emphasis on the presence of subacute or chronic pathologic changes in the spinal cord. Of the 10 professional divers (median age 38 yr; range 29-52; median experience in excess of 13 yr), 7 were experienced saturation divers. Five had dived to a maximum depth of 150 meters of seawater, the 2 others to 300 and 500 msw, respectively. Five of the professional divers had experienced decompression sickness. The experience of the amateur divers (median age 29 yr; range 17-51) varied from a few dives to many years of recreational diving. The spinal cords were formalin-fixated and routinely processed for neuropathologic examination, which included light microscopy after immunostaining for glial fibrillary acidic protein and monocyte-macrophage-microglial markers. The microscopic examination did not reveal previous spinal cord damage. Thus, diving activity, saturation diving to extreme depths included, does not in itself seem to lead to necrosis, degeneration, or scar formation in the human spinal cord.

Secular trends of sudden infant death syndrome in Norway 1967-1988: application of a method of case identification to Norwegian registry data.

In Norway, towards the end of the 1980s, sudden infant death syndrome (SIDS) was the most frequent cause of infant death. Both SIDS and the total post-perinatal mortality rates had increased. This paper presents a procedure for identifying SIDS from death certificates. Supplemented with additional information, a database was established to evaluate secular trends of SIDS and for further analytical research. The Medical Birth Registry of Norway comprises 1.3 million births from 1967 to 1988. Of these, 5447 infants died in the post-perinatal period. The cause of death was reviewed by an expert panel and 1984 cases of SIDS were retrieved. Low maternal age, higher birth order, male gender, and lower birth-weight were confirmed as risk factors for SIDS. In 1988, the rate for SIDS and for total post-perinatal deaths reached 2.69 and 5.02 per 1000 infants at risk. The incidence of SIDS increased 2.2 times from the period 1967-1971 to the period 1987-1988. Adjusted for maternal age, birth order, and birthweight, the odds ratio was 3.1. The increase is due to factors not yet accounted for. Adjusted mortality rates for the other post-perinatal deaths were not different from the crude rates.

A neuropathologic study of the ependymoventricular surface in diver brains.

Interference with the dynamics of cerebrospinal fluid may lead to loss of ependymal lining in the ventricles of the brain. The ependymal loss of the lateral ventricles under the corpus callosum at the level of the commisura anterior was measured in 21 diver brains and in a control material of 15 neurologic and non-neurologic brains. The divers were sport divers and professional divers with and without saturation exposure. The different groups were compared with respect to the mean loss of ependymal cells (in percentage). A statistically significant higher loss of ependyma was found in the total number of divers than in the controls. There was no significant difference between the group of sport divers and the control group. The largest loss of ependymal cells was found in the professional divers without saturation experience. Statistically, this loss was significantly larger than the loss of ependymal cells in the controls.

[Suicide among alcoholics]. / Selvmord blant alkoholikere.

During the five year period 1987-1991, 377 deaths among alcoholics were examined at The University of Bergen, The Gade Institute, Department of Forensic Medicine. There were 70 cases where suicide was considered the mode of death. Male alcoholics dominated the material. Relatively few suicides were seen among the very young and the old. Intoxication was the most frequent cause of death. The accessibility to drugs among alcoholics is considered to be an important factor. Factors of use in predicting suicide are discussed.

Traffic deaths in western Norway. A study from the county of Hordaland 1986-1990.

A series of 133 deaths in traffic in Western Norway has been analysed. There were 116 deaths from accidents, 14 natural deaths and 3 suicides. Ischemic heart disease was the predominant cause of natural death behind the wheel. Single vehicular accidents was the predominating accident type and young males were the most common victims. Influence of alcohol contributed to a substantial number of the accidents. Injuries were classified according to the Injury Severity Scale; the higher age victims had a lower ISS score than the young.

[Causes of death among alcoholics]. / Dødsårsaker blant alkoholikere.

During the five year period 1987-91, 377 deaths among alcoholics were examined at the Gade Institute, Department of Forensic Medicine, University of Bergen. The material was dominated by male alcoholics. More than half the cases were regarded as natural deaths. Among these, the dominating cause of death was cardiovascular disease. The rest of the material, where death was attributed to non-natural causes, was dominated by lethal intoxications. A large number of the deaths were suicides.

Bone strength in infants.

The results from a study of bone strength in normal infants is presented. The fibular bones of infants dying from SIDS were tested mechanically by a three-point bending test and the behaviour of the bony structure determined by measuring several variables. Correlations between these variables and infant age, length, weight and length of fibular bones were found and base-line values for bone strength established.

[Reliability of Norwegian suicide statistics]. / Påliteligheten av den norske selvmordsstatistikken.

New laws have radically changed the registration procedure of suicides in Norway, and a new Death Certificate Form makes it more difficult for doctors to cover up a suicide. The changes in the registration procedure may be responsible for a substantial part of the alarming rise in the Norwegian suicide rate from the 60's to the 80's. The Norwegian and the Danish suicide rates from the early 60's are not at all comparable. Neither are the Norwegian rates of the 60's comparable to those of the 80's. A comparison between suicide rates in different countries is near to worthless without an intimate knowledge of the basis for the diagnosis of suicide in the countries concerned.

Venous and neural invasion as predictors of recurrence in rectal adenocarcinoma.

After radical surgery for rectal adenocarcinoma, the presence of venous and neural invasion of tumor cells was correlated with the pattern of treatment failure, local in the pelvis or distant. Of 128 operation specimens, venous and neural invasion was demonstrated in 22 percent and 32 percent, respectively. A significant decrease of the distant recurrence-free 5-year survival (Kaplan-Meier method) was seen when venous invasion was demonstrated (32.9 percent vs. 84.3 percent; P less than 0.0001), whereas more local failures were registered in patients with neural invasion. The local recurrence-free 5-year survival in patients with neural invasion was 64.3 percent, compared with 81.1 percent when neural invasion was not demonstrated (P = 0.03). Their prognostic value was then studied in a Cox regression model including stage and grade. Neural invasion had the strongest association with local recurrences, whereas venous invasion was found to be the third strongest independent predictor of metastasis, after lymph node status and extent of local tumor infiltration. We conclude that examining for the presence of venous and neural invasion gives reliable prediction of recurrences after radical resection of rectal cancer. Recording of tumor recurrence pattern may lead to a better selection of patients for adjuvant therapy after surgery.