An analysis and report of custodial deaths in Nebraska, USA: Part II.

All medico-legal cases investigated by the Nebraska Institute of Forensic Sciences, Inc. in Lincoln, Nebraska, USA, between 2003 and 2009, were reviewed for deaths which occurred in custody (n = 38). The causes of death, in ranked order, were natural causes 37% (14/38), followed by homicide 21% (8/38), accident 21% (8/38), and suicide 21% (8/38). Each cause of death was then subdivided by age, race, and sex. The findings of this investigation are a continuation of a previous study of the same population from 1991 to 1996 (n = 51). This article also provided five case studies: two natural deaths, two suicides, and one homicide.

Forensic epidemiology of childhood deaths in Nebraska, USA.

In a 7-year period (April 1, 2003-March 31, 2010), all medico-legal childhood deaths aged 0-18 years investigated by the Lancaster County Coroner's Office under the auspices of Nebraska Institute of Forensic Sciences, Inc. (NIFS), were retrospectively reviewed (n = 140). This number of cases represents 10.9% of the 1287 forensic autopsies performed during the same period. Age, race, gender, cause and manner of deaths were analyzed for all victims categorized into five age groups: 0-1 year, 1-4 years, 5-9 years, 10-14 years, and 15-18 years. Male victims predominated with 98 cases (70%) versus 42 cases (30%) for females giving a male to female ratio of 2.3: 1. The mean age of the children was 7.6 years. The racial composition was 86.4% white, 10.7% Hispanic, 0.7% American Indian, 1.4% African American, and 0.7% Asian American. The majority of deaths occurred in the 0-1 age group (50 cases), followed in rank order by the 15-18 age group (40 cases), the 1-4 age group (23 cases), the 10-14 age group (17 cases), and the 5-9 age group (10 cases). The most common manner of death was accident, followed by natural, suicide, homicide, and undetermined. Accidents accounted for 71 cases (50.7%) of all the deaths and are amenable to prevention. Accidental blunt force trauma accounted for 41 cases or 58% of all the accident cases. The share of motor vehicle crashes in total blunt force trauma deaths was 33 cases. Natural deaths comprised 42 cases or 30% of all the deaths. Suicide (19 cases or 13.6% of all the deaths) was only encountered in the older age groups, the 10-14 age group (6 cases) and the 15-18 age group (13 cases). However, homicide which was observed as the least common manner of death (7 cases) was more predominant among the younger age groups (0-1 and 1-4 age groups). This review may provide useful information for the forensic pathologist, death investigators, law enforcement officers, policy makers, healthcare providers and Nebraska Child Death Review Team in predicting, preventing and investigating childhood medico-legal deaths.

Use of alcoholic beverages in VA medical centers.

BACKGROUND: Benzodiazepines are the first-line choice for the treatment of alcohol withdrawal syndrome. However, several hospitals continue to provide alcoholic beverages through their formulary for the treatment of alcohol withdrawal. While there are data on the prevalence of this practice in academic medical centers, there are no data on the availability of alcoholic beverages at the formularies of the hospitals operated by the department of Veteran's Affairs. METHODS: In this study, we surveyed the Pharmacy managers at 112 Veterans' Affairs Medical Centers (VAMCs) to ascertain the availability of alcohol on the VAMC formularies, and presence or lack of a policy on the use of alcoholic beverages in their VA Medical Center. RESULTS: Of the pharmacy directors contacted, 81 responded. 8 did not allow their use, while 20 allowed their use. There was a lack of a consistent policy across the VA medical centers on availability and use of alcoholic beverages for the treatment of alcohol withdrawal syndrome. CONCLUSION: There is lack of uniform policy on the availability of alcoholic beverages across the VAMCs, which may create potential problems with difference in the standards of care.