Suicide and drug toxicity mortality in the first year of the COVID-19 pandemic: use of medical examiner data for public health in Nova Scotia. / Mortalité par suicide et par intoxication aux drogues ou aux médicaments dans la première année de la pandémie de COVID-19 : utilisation des données des médecins légistes à des fins de santé publique en Nouvelle-Écosse.

INTRODUCTION: The COVID-19 pandemic and governmental responses have raised concerns about any corresponding rise in suicide and/or drug toxicity mortality due to exacerbations of mental illness, economic issues, changes to drug supply, ability to access harm reduction services, and other factors. METHODS: Data were obtained from the Nova Scotia Medical Examiner Service. Case definitions were developed, and their performance characteristics assessed. Pre-pandemic trends in monthly suicide and drug toxicity deaths were modelled and the observed numbers of deaths in the pandemic year compared to expected numbers. RESULTS: There was a significant reduction in suicide deaths in the first year of the COVID-19 pandemic in Nova Scotia, with about 21 fewer non-drug toxicity suicide deaths than expected in March 2020 to February 2021 (risk ratio = 0.82). No change in drug toxicity mortality was detected. Case definitions were successfully applied to free-text cause of death statements and cases where cause and manner of death remained under investigation. CONCLUSION: Processes for case classification and monitoring can be implemented in collaboration with medical examiners/coroners for timely, ongoing public health surveillance of suicide and drug toxicity mortality. Medical examiners and coroners are the stewards of a wealth of data that could inform the prevention of further deaths; it is time to engage these systems in public health surveillance.

Secular trends in weight, stature, and body mass index in Nova Scotia, Canada.

OBJECTIVES: The present study aims to investigate the secular trends of weight, stature, and BMI values in a Nova Scotian sample from 1946 to 1999, with particular focus on how these trends may relate to nutrition and the evolving obesity epidemic. METHODS: Data were collected from investigative (autopsy) records of 1645 individuals (1287 males, 358 females) of European descent at the Nova Scotia Medical Examiner Service. Secular trends were evaluated by linear regression of weight, stature, and BMI with respect to the year of birth. Further analysis of this sample was based on five time periods (birth cohorts), in order to determine whether dramatic shifts in diet and nutrition affected weight, stature, and BMI. RESULTS: Overall, the results of this study demonstrate positive secular trends in weight, stature, and BMI from 1946 to 1999 in the Nova Scotian sample. Subsequent analysis among different time periods shows a secular increase in the weight of Nova Scotian males from 1946 to 1979, and a subsequent decrease in weight in after 1980. For Nova Scotian females, the results show a secular increase in weight from 1946 to 1989, and a subsequent decrease in weight after 1990. Such secular increases in weight coincide with the global nutrition transition, while recent decreasing median weight values may reflect economic growth and urbanization in Nova Scotia. CONCLUSIONS: Overall, the results of the present study indicate that temporal trends in nutrition may have contributed to positive secular changes in weight, stature, and BMI in Nova Scotia, Canada between 1946 and 1999.

Metal dust deposition in a shotgun wound associated with barrel modification.

Contact-range gunshot wounds commonly demonstrate deposition of black soot in and around the wound. Deposition of other visible pigments originating from the firearm has not been specifically described. In the current case, an adult male was found dead adjacent to a shotgun fixed in a vice grip with a modified, shortened barrel. A handheld, powered, metal grinding wheel was nearby. Autopsy revealed an intraoral gunshot wound, including soot deposition in and around the mouth and within the wound track. In addition, there was a peculiar, gray, lustrous film on the lips, gingiva, and anterior teeth. The material was concentrated around the most severe areas of injury in the anterior mouth and easily rubbed off with a cotton swab. It was not visualized in the rest of the mouth and not present in the larynx, or the esophagus. Overall, our opinion is that this unique, gray, lustrous film represents deposition of fine metallic dust that accumulated in the barrel of the shotgun during its modification with the grinding wheel. This type of unique pigment deposition should be recognized by forensic pathologists as possibly being related to the discharge of a firearm with a recently modified barrel or other cause for fine metallic dust accumulation within the barrel. Depending on the circumstances of the case, collection of samples of such metal dust deposits could be indicated for subsequent analysis.

Factors associated with not seeking professional help or disclosing intent prior to suicide: a study of medical examiners' records in Nova Scotia.

OBJECTIVE: Individual-level data from clinical settings lack information on people who did not seek professional help prior to suicide. We used records of the Nova Scotia Medical Examiner Service (NSMES) to compare people who had contact with a health professional prior to suicide with those who did not. METHOD: We linked data from the NSMES to routine administrative data of the province. RESULTS: The NSMES recorded 108 suicides in Nova Scotia from January 1, 2006, to December 31, 2006; there were 90 male and 18 female suicide deaths. Mean and median age at death were 44.73 (SD 13.33) and 44 years, respectively. Patients aged 40 to 49 years made up one-third of the cases (n = 35) and this was the decade of life with the highest number of suicides. This was also the group least likely to have suicidal intent recorded in the NSMES files (χ(2) = 3.86, df = 1, P = 0.05). Otherwise, there were no significant differences between people who sought help, or disclosed intent, prior to suicide and people who did not. The samples in all cases were predominately male and single. CONCLUSIONS: People aged 40 to 49 years were the age group with the highest absolute number of suicides, but were the least likely to have suicidal intent recorded in the NSMES files. This finding merits further investigation. Medical examiner or coroner data may provide additional information not obtained elsewhere for the surveillance of suicide.