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Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusion To evaluate if state death investigation systems affect the reporting of suicides, particularly when comparing medical examiners to coroners.We used restricted‐access state mortality data from National Vital Statistics System between the years 1959 to 2016. These data were matched with state‐level changes in death investigation systems reported by the Centers for Disease Control and Prevention database on the Public Health Law Program: Coroner/ME Laws.We used difference‐in‐differences and event study methods for the analysis. We estimated the relative per capita changes in suicides, accidental deaths, and homicides when comparing coroner‐only states with other death investigation types. Sub‐analyses estimated differences by sex, race, and if coroners were required to receive training.Not Applicable.Coroners‐only states underreported suicides by 17.4% (p < 0.05) and performed 20.4% (p < 0.05) fewer autopsies compared to states with county coroners and a state medical examiner. This pattern is consistent by sex and race. Required coroner training did not affect death determination significantly.Coroners‐only states underreported suicides compared to states with county coroners and a state medical examiner. The disparity in the use of autopsies is a potential mechanism for underreporting of suicides by coroners. If all coroners‐only states adopted a state medical examiner, suicide reporting would increase by 2243–3100 deaths in the United States annually. [ABSTRACT FROM AUTHOR]

The burgeoning social significance borne by death inquests in Hong Kong has ushered in a string of judicial decisions that seeks to remould the interpretation and operation of provisions in the Coroners Ordinance. This article subjects attempts to marshal the right to life as an interpretive conduit to remould these provisions to scrutiny, focusing on its impact on the remit of inquests and the Court of First Instance's power to override the Coroner's refusal to hold one which ought to be held. It contends that such interpretive endeavours are unlikely to yield practical dividends, emerge effective, sustainable or consequential in the long run, or prove defensible on doctrinal grounds. The principal reason lies in the fact that local jurisprudence on the right to life remains thin and underdeveloped, such that it lacks the necessary doctrinal and jurisprudential arsenal to sustain such judicial efforts and furnish principled guidance to the courts on how to arm the remoulded law with real bite. [ABSTRACT FROM AUTHOR]

Food aspiration is one of the major health risks for elderly people in nursing homes which could lead to death. Moreover, misconducts in pharmacotherapy may represent a potential risk of adverse drug reactions. It is reported here the toxicological evaluation of a combined death by food aspiration and acute escitalopram intoxication of a psychiatric subject, occurred in a nursing home. An 89-year-old man, suffering from dysphagia and Alzheimer's, was resident in a nursing home. He was fed with a liquid diet administered directly in mouth using a syringe. The man was also being treated with escitalopram 10 mg tablet. One evening, after receiving the meal in the usual way, the man complained of sudden illness. Carried to the emergency room, the man died about 3 h later with a diagnosis of cardiogenic shock subsequentially to ab ingestis. The histological findings revealed the presence of exogenous material, probably food, up to the finest bronchial branches. The toxicological examination revealed the presence of escitalopram and its main metabolite, desmethylcitalopram: in the blood 1972 ng/ml and 285 ng/ml, in the brain 4657 ng/g and 1025 ng/g, in the gastric content 2317 ng/g and 423 ng/g, in the lung 21,771 ng/g and 468 ng/g, respectively. The bad practice of the nurses to dissolve the escitalopram tablet in the liquefied food and to administer the therapy with a syringe directly into the mouth emerged thanks this investigation. Following food aspiration, escitalopram was absorbed by inhalation route, reaching high concentrations in blood and tissues. The death occurred due to a combined mechanism between food aspiration and the escitalopram toxic action. [ABSTRACT FROM AUTHOR]

Bees are the most important insect pollinators of the crops humans grow, and Apis mellifera, the Western honey bee, is the most commonly managed species for this purpose. In addition to providing agricultural services, the complex biology of honey bees has been the subject of scientific study since the 18th century, and the intricate behaviors of honey bees and ants, fellow hymenopterans, inspired much sociobiological inquest. Unfortunately, honey bees are constantly exposed to parasites, pathogens, and xenobiotics, all of which pose threats to their health. Despite our curiosity about and dependence on honey bees, defining the molecular mechanisms underlying their interactions with biotic and abiotic stressors has been challenging. The very aspects of their physiology and behavior that make them so important to agriculture also make them challenging to study, relative to canonical model organisms. However, because we rely on A. mellifera so much for pollination, we must continue our efforts to understand what ails them. Here, we review major advancements in our knowledge of honey bee physiology, focusing on immunity and detoxification, and highlight some challenges that remain. [ABSTRACT FROM AUTHOR]

The article discusses the findings of a coroner's inquest into the deaths of three Aboriginal women from rheumatic heart disease (RHD) in the remote town of Doomadgee in Queensland, Australia. The inquest highlights the preventable nature of RHD and the inequitable burden experienced by Aboriginal and Torres Strait Islander peoples. The article presents recommendations for improving health service provision, including cultural safety, community engagement, data collection, and collaboration. It also addresses the issue of institutional racism within the healthcare system and calls for transformative action to achieve health equity for First Nations communities. [Extracted from the article]

This article examines how mental health related deaths (MHRDs) in England and Wales are counted and accounted for. Data collated by the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) constructs such deaths as being predominantly the result of suicide. This article examines 221 Reports to Prevent Future Deaths (PFDs) issued by coroners’ courts in relation to MHRDs. It establishes that in 49% of cases suicide is not recorded as the sole cause of death. The article also provides thematic findings that emerged from the qualitative analysis of these PFDs and identifies issues with errors or deficiencies in the provision of care (in 72% of cases), communication (55%) and policy (26%). The findings emphasise that organisational and structural issues contribute to deaths of people in connection with mental healthcare and that these deaths should not solely be considered suicides. The article raises significant questions about the accuracy of mortality data and the capacity of public organisations to learn lessons that might prevent future deaths.

The communicating safely policy, publicised by the catchphrase See Something, Say Something was released by the Medical Radiation Practice Board of Australia in 2019. It was developed to support medical radiation practitioners (MRPs) upholding the obligation to communicate urgent or unexpected findings in a timely manner, when identified on medical images. Prior to this policy being part of the professional capabilities, several untimely deaths occurred—the majority of whose causal factors could have been mitigated if imaging findings were urgently communicated by MRPs. This commentary summarises three coronial inquests that involved MRPs, discusses how these coronial findings are reflected in the communicating safely policy and provides some recommendations for the profession to ensure this policy is enacted in clinical practice. [ABSTRACT FROM AUTHOR]

This article examines how mental health related deaths (MHRDs) in England and Wales are counted and accounted for. Data collated by the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) constructs such deaths as being predominantly the result of suicide. This article examines 221 Reports to Prevent Future Deaths (PFDs) issued by coroners’ courts in relation to MHRDs. It establishes that in 49% of cases suicide is not recorded as the sole cause of death. The article also provides thematic findings that emerged from the qualitative analysis of these PFDs and identifies issues with errors or deficiencies in the provision of care (in 72% of cases), communication (55%) and policy (26%). The findings emphasise that organisational and structural issues contribute to deaths of people in connection with mental healthcare and that these deaths should not solely be considered suicides. The article raises significant questions about the accuracy of mortality data and the capacity of public or ganisations to learn lessons that might prevent future deaths. [ABSTRACT FROM AUTHOR]

Background: The anticipatory prescribing of injectable controlled drugs (ICDs) by general practitioners (GPs) to care home residents is common practice and is believed to reduce emergency hospital transfers at the end-of-life. However, evidence about the process of ICD prescribing and how it affects residents' hospital transfer is limited. The study examined how care home nurses and senior carers (senior staff) describe their role in ICDs prescribing and identify that role to affect residents' hospital transfers at the end-of-life. Methods: 1,440 h of participant observation in five care homes in England between May 2019 and March 2020. Semi-structured interviews with a range of staff. Interviews (n = 25) and fieldnotes (2,761 handwritten A5 pages) were analysed thematically. Results: Senior staff request GPs to prescribe ICDs ahead of residents' expected death and review prescribed ICDs for as long as residents survive. Senior staff use this mechanism to ascertain the clinical appropriateness of withholding potentially life-extending emergency care (which usually led to hospital transfer) and demonstrate safe care provision to GPs certifying the medical cause of death. This enables senior staff to facilitate a care home death for residents experiencing uncertain dying trajectories. Conclusion: Senior staff use GPs' prescriptions and reviews of ICDs to pre-empt hospital transfers at the end-of-life. Policy should indicate a clear timeframe for ICD review to make hospital transfer avoidance less reliant on trust between senior staff and GPs. The timeframe should match the period before death allowing GPs to certify death without triggering a Coroner's referral. [ABSTRACT FROM AUTHOR]

This article discusses the impact of excess short-acting β2-agonist (SABA) inhaler prescriptions on healthcare resource utilization in the management of asthma. The authors argue that regular use of SABAs without inhaled corticosteroids can have dangerous adverse effects and lead to increased asthma attacks, healthcare utilization, and deaths. They present data from two studies that demonstrate higher healthcare resource utilization costs associated with high SABA prescriptions, including increased hospital admissions. The authors suggest implementing an anti-inflammatory reliever therapy approach using a combination inhaler to replace SABA prescriptions, which may reduce asthma admissions and overall healthcare resource utilization costs. They also emphasize the importance of considering patient outcomes and clinical cost-effectiveness in medicines management strategies. [Extracted from the article]

This document is a list of references for research articles related to substance use and misuse. It includes articles on various topics such as developing interventions to support peer workers in overdose response settings, engaging people with lived experience in the grant review process, and the role of research, policy, and practice in addressing substance use. The document provides links to the full articles for further exploration. [Extracted from the article]

Introduction: Substance-related acute toxicity deaths (ATDs) are a public health crisis in Canada. Youth are often at higher risk for substance use due to social, environmental and structural factors. The objectives of this study were to understand the characteristics of youth (aged 12-24 years) dying of accidental acute toxicity in Canada and examine the substances contributing to and circumstances surrounding youth ATDs. Methods: Data from a national chart review study of coroner and medical examiner data on ATDs that occurred in Canada between 2016 and 2017 were used to conduct descriptive analyses with proportions, mortality rates and proportionate mortality rates. Where possible, youth in the chart review study were compared with youth in the general population and youth who died of all causes, using census data. Results: Of the 732 youth who died of accidental acute toxicity in 2016-2017, most (94%) were aged 18 to 24 years. Youth aged 20 to 24 who were unemployed, unhoused or living in collective housing were overrepresented among accidental ATDs. Many of the youth aged 12 to 24 who died of accidental acute toxicity had a documented history of substance use. Fentanyl, cocaine and methamphetamine were the most common substances contributing to death, and 38% of the deaths were witnessed or potentially witnessed. Conclusion: The findings of this study point to the need for early prevention and harm reduction strategies and programs that address mental health, exposure to trauma, unemployment and housing instability to reduce the harms of substance use on Canadian youth. [ABSTRACT FROM AUTHOR]

This article discusses the need for a more effective approach to managing asthma, particularly in the UK. It highlights the overuse of short-acting β2-agonist bronchodilators (SABAs) and the underprescribing of inhaled corticosteroids (ICS) as major issues. The article suggests adopting an evidence-based, anti-inflammatory reliever treatment (AIR) as recommended by the Global Initiative for Asthma (GINA) to reduce the risk of severe asthma attacks. The use of ICS-formoterol reliever therapy is proposed as a simple and effective solution, with evidence showing its ability to reduce severe exacerbations compared to other treatments. The article emphasizes the importance of taking asthma seriously as a chronic disease and improving access to appropriate care. The authors argue for the use of ICS-formoterol as a reliever therapy for asthma instead of SABA inhalers, citing improved outcomes. They call for more research in children aged 4-11 years and propose the immediate implementation of strategies to replace SABA inhalers with ICS-formoterol therapy for individuals over the age of 12. They emphasize the need for a comprehensive approach to asthma management, including patient education and consideration of overlapping disorders and environmental factors. The authors suggest that a new national asthma strategy incorporating ICS-formoterol therapy could lead to improved outcomes and reduced healthcare costs. [Extracted from the article]

Climate change is causing more frequent and severe extreme heat events (EHEs) in Canada, resulting in significant loss of life. However, patterns across mortality reporting for historical EHEs have not been analyzed. To address this gap, we studied deaths in Canadian EHEs from 1936 to 2021, identifying trends and challenges. Our analysis revealed inconsistencies in mortality data, discrepancies between vulnerable populations identified, difficulties in determining the cause of death, and inconsistent reporting on social vulnerability indicators. We provide some observations that could help inform solutions to address the gaps and challenges, by moving toward more consistent and comprehensive reporting to ensure no population is overlooked. Accurately accounting for affected populations could help better target evidence‐based interventions, and reduce vulnerability to extreme heat. Plain Language Summary: Climate change in Canada is leading to more severe heatwaves, causing many unnecessary deaths. However, there is no understanding of patterns of death across these extreme heat events (EHEs). To fill this gap, we studied data from EHEs in Canada between 1936 and 2021 to help identify trends and challenges. Our analysis revealed inconsistent and limited information about deaths, discrepancies between vulnerable populations identified in literature and reported data, difficulty in determining direct heat‐related causes of death, and inconsistent consideration of social vulnerability indicators. We provide some observations that could help inform ways to address these challenges, by moving toward more consistent and comprehensive reporting of heat‐related mortality data across Canada. This more accurate information could help target evidence‐based interventions, reduce vulnerability, and improve Canadians' ability to adapt to extreme heat. Key Points: There is an inconsistency in the amount, type, and depth of mortality data across extreme heat events (EHEs) in CanadaThere are challenges in ascertaining heat as the direct or indirect cause of deathConsideration of compounding impacts of social vulnerability indicators is inconsistent across reports of EHE‐related deaths [ABSTRACT FROM AUTHOR]

Background: The need for better end-of-life care for people with dementia has been acknowledged. Existing literature suggests that people dying with dementia have less access to palliative care, yet little is known about the care provided to people with dementia at the end of life. This study aimed to establish evidence related to end-of-life care for people dying with dementia in hospital compared to other settings. Methods: A retrospective clinical audit of people who had a diagnosis of dementia and had accessed services within a local health district, who died between 2015 and 2019, was conducted. A total of 705 people were identified, and a subset of 299 people randomly selected for manual audit. Chi-square p-values were used to compare the place of death, and a t-test or non-parametric test was used to assess the significance of the difference, as appropriate. Measures of functional decline within one month of death were assessed using mixed effects logistic regression models. Results: The characteristics of people differed by place of death, with people who died in hospital more likely to be living at home and to not have a spouse. Less than 1 in 5 people had advance care directives or plans. Many were still being actively treated at the time of death: almost half of people who died in hospital had an investigation in their final 72 hours, less than half of people were coded as receiving palliative care at death, and more than 2 in 3 people did not get access to specialist palliative care. Declining function was associated with the terminal phase. Conclusion: This study provides novel insights for those providing end-of-life care for people with dementia. Healthcare professionals and policy makers should consider how demographic characteristics relate to the places people with dementia receive end-of-life care. The care provided to people with dementia in the last year of their life highlights the need for more support to prepare advance care documentation and timely consideration for palliative care. Changes in markers of nutritional status and function in people with advanced dementia may help with identification of terminal phases. [ABSTRACT FROM AUTHOR]

This article discusses the role of pediatric pathologists during and after a disaster, using Hurricane Katrina as an example. The article highlights the extent of the disaster, including the damage to hospitals and the evacuation of Children's Hospital. It also discusses the activities of pathologists during this time, such as volunteering at the coroner's office and assessing laboratory damage. The article also addresses the impact on education, research, and other aspects of the medical community. Overall, it emphasizes the important role that pediatric pathologists play in disaster situations and the challenges they face in providing healthcare services. [Extracted from the article]

"Ordinary Lives, Death, & Social Class: Dublin City Coroner’s Court, 1876-1902" by Ciara Breathnach is a historical book that focuses on the deaths of ordinary people in Dublin during the late 19th and early 20th centuries. The author uses coroners' inquests and eyewitness testimonies to shed light on the lives of the poor, women, and children who are often overlooked in grand narratives of death. The book examines the socio-economic contexts of these deaths, including causes and locations such as domestic settings, public and workplace settings, and unnatural, suspicious, and violent deaths. It also explores issues of gender, class, and the law during this period. [Extracted from the article]

A recent article in Frontiers in Psychiatry examines the presence of kratom in opioid overdose deaths, based on a toxicological report from a coroner. Kratom, a botanical product, has gained attention in the US due to reports of adverse effects and fatalities. While kratom is unregulated at the federal level in the US, it is considered illegal in some European and Southeast Asian countries. The article highlights some issues with the report, such as the misinterpretation of a blood concentration as a lethal dose. It also discusses the complexities of kratom use, the lack of established lethal doses, and the need for accurate information and documentation. The authors stress the importance of federal oversight to establish safe dosing recommendations and regulations for kratom products, ensuring consumer access to safe and properly labeled products. The article provides information about the authors' contributions, funding sources, conflicts of interest, and a disclaimer that the views expressed are solely those of the authors. [Extracted from the article]

This article examines the historical practice of overlaying, which is the accidental suffocation of infants while sharing a bed with adults. The study focuses on archival records from Tasmania in the 19th century and finds that 128 deaths were attributed to overlaying during this time period. The deaths showed a seasonal pattern, with more occurring in winter. The article highlights the need to consider different populations and risk factors when studying infant deaths. [Extracted from the article]

In 2015, the combined average life expectancy for males and females in Australia was ranked 6th in the world at 82.5 years. The exact age at which a person can be classified as being elderly will differ amongst countries but is generally between 60–65 years. The increase in life expectancy and increased recognition of the elderly as a vulnerable group will most likely lead to an increased workload in the medico-legal death investigation system. [ABSTRACT FROM AUTHOR]

The article discusses the need for detailed and accurate mortality data in Canada to inform efforts to prevent premature deaths. It highlights the value of collaboration between public health and death investigation systems in addressing issues such as drug overdoses and the COVID-19 pandemic. The article emphasizes the importance of using data collected during death investigations to inform prevention efforts and understand the impact of public health measures. It also calls for enhanced collaboration and standardization of death investigation data to address various public health issues, including substance-related toxicity, suicide, violence, and climate-related deaths. [Extracted from the article]

This article discusses the use of shackles and restraints on palliative prisoner patients in hospital settings. It examines international standards and guidelines that emphasize the need for humane treatment and the limited use of restraints. The article highlights cases in Australia and the United Kingdom where prisoners were restrained for extended periods, despite their deteriorating health and minimal security risk. The practice of shackling dying prisoner patients is criticized for impeding the provision of palliative care and causing distress to patients and their families. The article calls for a review and overhaul of this practice to ensure that prisoners are granted the right to a dignified death. [Extracted from the article]

Background: The burden of healthcare associated infections (HCAIs) in low- and middle-income countries (LMICs) remains underestimated due to diagnostic complexity and lack of quality surveillance systems. We designed this study to determine clinical diagnosis, laboratory-confirmed, associated factors and risks of HCAIs. Methods: This hospital-based longitudinal cohort study was conducted between March and June 2022 among adults (≥ 18 years) admitted in medical wards at BMC in Mwanza, Tanzania. Patients who were negative for HCAIs by clinical evaluations and laboratory investigations during admission were enrolled and followed-up until discharge or death. Clinical samples were collected from patients with clinical diagnosis of HCAIs for conventional culture and antimicrobial sensitivity testing. Results: A total of 350 adult patients with a median [IQR] age of 54 [38–68] years were enrolled in the study. Males accounted for 54.6% (n = 191). The prevalence of clinically diagnosed HCAIs was 8.6% (30/350) of which 26.7% (8/30) had laboratory-confirmed HCAIs by a positive culture. Central-line-associated bloodstream infection (43.3%; 13/30) and catheter-associated urinary tract infection (36.7%; 11/30) were the most common HCAIs. Older age was the only factor associated with development of HCAIs [mean (± SD); [95%CI]: 58.9(± 12.5); [54.2–63.5] vs. 51.5(± 19.1); [49.4–53.6] years; p = 0.0391) and HCAIs increased the length of hospital stay [mean (± SD); [95%CI]: 13.8 (± 3.4); [12.5–15.1] vs. 4.5 (± 1.7); [4.3–4.7] days; p < 0.0001]. Conclusion: We observed a low prevalence of HCAIs among adult patients admitted to medical wards in our setting. Central-line-associated bloodstream infections and catheter-associated urinary tract infections are common HCAIs. Significantly, older patients are at higher risk of acquiring HCAIs as well as patients with HCAIs had long duration of hospital stays. [ABSTRACT FROM AUTHOR]

A significant problem facing routine medicolegal coroner-referred autopsies is a shortfall of pathologists prepared to perform them. This was particularly acute in Lancashire, where the coroner decided to initiate a service that relied on post-mortem computed tomography (PMCT). This involved training anatomical pathology technologists (APTs) to perform external examinations, radiographers to perform scans, and radiologists to interpret them. The service started in 2018 and now examines over 1,500 cases per year. This study outlines the PMCT process using NHS staff, with CT equipment and logistics managed by the commercial sector. It compares the demographics and outcomes of PM investigations for two 6-month periods: the autopsy service prior to 2018, and then the PMCT service. These data were then compared with previous UK PMCT data. Referrals for adult non-suspicious deaths were made in 913 cases of which 793 (87%) had PMCT between 01/10/2018 and 31/03/2019. Fifty-six cases had autopsy after PMCT, so 81% of cases potentially avoided autopsy. The PMCT service did not delay release of bodies to the next-of-kin. Comparing the cause of death given shows no difference in the proportions of natural and unnatural deaths. There was an increase in diagnosis of coronary artery disease for PMCT, with less respiratory diagnoses, a feature not previously demonstrated. These data suggest PMCT is a practical solution for potentially failing autopsy services. By necessity, this involves changes in diagnoses, as PMCT and autopsy have different strengths and weakness, but the ability to pick up unnatural death appears unaffected. [ABSTRACT FROM AUTHOR]

Source material for the use of firearms in sixteenth-century England outside military contexts is sparse. This article uses coroners' inquest reports to examine who used guns of what types, for what purposes, in different parts of England and at different phases of their diffusion. Artisans were prominent among early adopters, but by the end of the century yeomen were the most frequent gun owners. It shows what hazards guns with different firing mechanisms such as matchlocks and snaphances presented, the steps users took to mitigate such risks, and the severity of gunshot wounds, which caused two-thirds of victims of fatal firearms accidents to die instantly. [ABSTRACT FROM AUTHOR]

Autism in England: assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data. Primary care clinicians, therefore, should not be expected to make a formal autism diagnosis, but should be able to recognise features suggestive of autism, and refer onwards for an assessment if appropriate. CONCLUSION Primary care clinicians should be aware of the substantial rate of underdiagnosis of autism in adults. [Extracted from the article]

Background Falls in older people are common, leading to significant harm including death. Coroners have a duty to report cases where action should be taken to prevent future deaths, but dissemination of their findings remains poor. Objective To identify preventable fall-related deaths, classify coroner concerns and explore organisational responses. Design A retrospective systematic case series of coroners' Prevention of Future Deaths (PFD) reports, from July 2013 (inception) to November 2022. Setting England and Wales. Methods Reproducible data collection methods were used to web-scrape and read PFD reports. Demographic information, coroner concerns and responses from organisations were extracted and descriptive statistics used to synthesise data. Results Five hundred and twenty-seven PFDs (12.5% of PFDs) involved a fall that contributed to death. These deaths predominantly affected older people (median 82 years) in the community (72%), with subsequent death in hospital (70.8%). A high proportion of cases experienced fractures (51.6%), major bleeding (35.9%) or head injury (38.7%). Coroners frequently raised concerns regarding falls risks assessments (20.9%), failures in communication (20.3%) and documentation issues (17.5%). Only 56.7% of PFDs received a response from organisations to whom they were addressed. Organisations tended to produce new protocols (58.5%), improve training (44.6%) and commence audits (34.3%) in response to PFDs. Conclusions One in eight preventable deaths in England and Wales involved a fall. Addressing concerns raised by coroners should improve falls prevention and care following falls especially for older adults, but the poor response rate may indicate that lessons are not being learned. Wider dissemination of PFD findings may help reduce preventable fall-related deaths in the future. [ABSTRACT FROM AUTHOR]

Abstract Climate change is causing more frequent and severe extreme heat events (EHEs) in Canada, resulting in significant loss of life. However, patterns across mortality reporting for historical EHEs have not been analyzed. To address this gap, we studied deaths in Canadian EHEs from 1936 to 2021, identifying trends and challenges. Our analysis revealed inconsistencies in mortality data, discrepancies between vulnerable populations identified, difficulties in determining the cause of death, and inconsistent reporting on social vulnerability indicators. We provide some observations that could help inform solutions to address the gaps and challenges, by moving toward more consistent and comprehensive reporting to ensure no population is overlooked. Accurately accounting for affected populations could help better target evidence‐based interventions, and reduce vulnerability to extreme heat.

Background: Coroners, who hold inquests to determine the causes of unnatural deaths in England and Wales, having recognised factors that could cause other deaths, are legally obliged to signal concerns by sending 'Reports to Prevent Future Deaths' (PFDs) to interested persons. We aimed to establish whether Coroners' concerns about medications are widely recognised. Methods: We searched MEDLINE, Embase and Web of Science up to 30 November, 2022 for publications linking PFDs and medications using a combination of search terms "coroner*", "inquest*", "medicine*", "medication*" and "prevent*". We also searched the BMJ, a UK journal that carries news items; and the databases Nexis Advance and News On the Web for reports in national newspapers between 2013 and 2022, using the search terms ("regulation 28" OR "prevent future deaths" OR "prevention of future deaths") AND "coroner". We recorded the number of publications, as well as their citations in Google Scholar at 23 May, 2023. Results: Only 11 published papers on medicines referenced UK PFDs, nine of which were from our group. The BMJ carried 23 articles mentioning PFDs, five related to medicines. Of 139 PFDs (out of over 4000) mentioned in national newspapers, only nine related to medicines. Conclusions: The PFDs related to medicines are not widely referred to in medical journals or UK national newspapers. By contrast, the Australian and New Zealand National Coronial Information System has contributed cases to 206 publications cited in PubMed, of which 139 are related to medicines. Our search suggests that information from English and Welsh Coroners' PFDs is under-recognised, even though it should inform public health. The results of inquiries by Coroners and medical examiners worldwide into potentially preventable deaths involving medicines should be used to strengthen the safety of medicines. [ABSTRACT FROM AUTHOR]

Studies of the coroner in nineteenth century England suggest that inquests became increasingly medicalised. Much of this research was conducted in London. My research reveals that in Newcastle upon Tyne medicine did not dominate: the solicitor coroner used his skills and knowledge to maintain the legal focus of the inquest. This study reveals a fascinating dynamic between the legally qualified coroner and the local medical profession. In presenting an analysis of examples of the interactions between the Newcastle coroner and the medical profession, this article makes a significant contribution to scholarship on the relationship between medicine and law in the Victorian coroner's court. I offer insight into inquests in an important provincial town and discover that the coroner relocated the Newcastle court from official buildings to the public house, its traditional home. Rather than a story of increased medicalisation, the inquest in Newcastle was firmly the preserve of the law. The character and choices of an individual coroner are revealed to have a significant impact on the relationship between law and medicine in the coroner's court. I seek to encourage further research into the work of coroners, to develop a fuller picture of the inquest in the nineteenth century. [ABSTRACT FROM AUTHOR]

In England and Wales, coroners are required to write Prevention of Future Deaths reports when a death is deemed preventable so that action is taken to avert similar deaths. Since July 2013, Prevention of Future Deaths reports have been openly available via the Courts and Tribunals Judiciary website (https://www.judiciary.uk/prevention-of-future-death-reports/). However, their presentation to date have been insufficient to identify trends and learn lessons. We designed a web scraper to create the Preventable Deaths Tracker (https://preventabledeathstracker.net/). On 22 June 2022, 4001 PFDs were scraped, analysed, and compared to the Office of National Statistics' preventable mortality statistics. This commentary summarises the key findings and offers recommendations to improve the Prevention of Future Deaths system so lessons can be learnt to avert preventable deaths. [ABSTRACT FROM AUTHOR]

Background: Serial killing by doctors or nurses is rare. When it occurs, it is generally only detected after multiple homicides by the same perpetrator have escaped detection in the past. The persons at greatest risk are multimorbid elderly patients whose sudden death for natural reasons would not come as a surprise. However, patients' risk of falling victim to homicide is increased only if such vulnerable patients are exposed to perpetrators with certain personality traits. In this situation, homicides can be committed in which little or no evidence of the crime is left behind. In this review, we address the frequency, nature, and circumstances of serial killings and attempted serial killings in hospitals, nursing homes, and nursing care. Methods: This review is based on publications retrieved by a selective review of the literature in monographs, medical databases, specialty journals, general-interest media, and the Internet. Results: An evaluation of searchable, published case descriptions of serial killings and attempted serial killings in hospitals, nursing homes, and nursing care, mainly from Europe and the English-speaking countries, enables identification of the type of patients at risk, the modes of homicide, and the personality traits of the perpetrators. Multimorbid, care-dependent and nursing-dependent persons are the main victims. The perpetrators (men and women) generally act alone and have often been working in patient care for many years. The most common method of homicide is by drug injection; violent physical homicide is rarer. In many cases, irregularities in drug stocks, erratic behavior of a staff member, and/or a cluster of sudden deaths are indeed noticed, but are too slowly acted upon. Conclusion: Irregularities in drug stocks, inexplicably empty drug packages and used syringes, erratic behavior of a staff member before and after a patient's death, or a cluster of unexpected deaths mainly involving elderly, multimorbid patients (detectable from internal mortality statistics) should always lead to further questioning and investigation. [ABSTRACT FROM AUTHOR]

Background: Suicide is a serious public health problems worldwide. Although suicide rates in the eastern Medetranian region are lower than western countries, increasing incidences is reported. This study aims to explore the demographic, clinical characteristics, and associated variables of people died by suicide in Iraq through a limited retrospective sample symbolized as biopsy. Methods: The retrospective analysis included the electronic records of a hundred cases of suicide saved in the archives of the Medico-Legal Directory in Baghdad. Data were extracted from the legal investigation which included police investigations, family reports, and post-mortem reports. Simple descriptive satstistical analyses of the selected data was conducted. Results: It estimated through this study that the crude rate of suicide was 1.75 per 100,000 population which is higher than 1.09/10,000, previously reported by the Iraq national study of suicide 2016. Most cases occurred in ≤ 29 years old, Muslims, city dwellers, and middle-class people aged 29 years or less. The prevalence of suicide was significantly associated with unemployment, good education, and income. The most common methods used were self-burning, gunshot, hanging, and jumping from heights. The reason for taking their own life was unknown for half of the sample. Depression was relatively common, while other mental disorders were of low rate or unrecognized. Family conflicts and environmental stressors were considered as motives. Conclusions: This study exemplifies suicide patterns where young age, female gender, and violent methods are represented more than before, reflecting the impact of environmental and personal stressors and may be related to violence and the post-conflict situation initiated by the 2003 war. Little is known about suicide architecture due to stigma and poor surveillance system. A multidisciplinary suicide prevention strategy is crucial to implement in Iraq's health service. Large-scale studies are called to cover the data gap. [ABSTRACT FROM AUTHOR]

According to hospital records, 5 months after reporting its first case of COVID-19, Côte d'Ivoire reported only 102 deaths. We conducted a community mortality survey in the 13 districts where 95% of COVID-19 cases were reported to assess COVID-19 mortality in nonhealthcare settings. To identify suspected COVID-19 deaths in communities, we used data from social and administrative institutions, such as police and fire departments, funeral homes, and places of worship, whose functions include providing services related to deaths. Our survey identified 54 (17.6%) suspected COVID-19 deaths, which is more than half of the official reported number. Our study showed that in areas with low access to healthcare and poorly functioning death notification and registration systems, community-based data sources could be used to identify suspected COVID-19 deaths outside of the health sector. They can provide early warning data on events, such as an unusual number of community deaths or diseases. [ABSTRACT FROM AUTHOR]

Coroners' inquests in Australia and New Zealand are no longer formally part of the criminal justice process. However, they can take place after the resolution of criminal charges and, although coroners' findings cannot be expressed in terms of persons' criminality, inquests can also result in referrals to prosecuting authorities. In addition, referrals to professionals' disciplinary regulators can be made by coroners. The potential for such adverse outcomes for the individuals affected makes it essential for those representing parties or witnesses at coronial hearings to consider carefully the forensic strategies that they deploy and, in particular, the advice that they provide, including in relation to claims to the privilege against self-incrimination. By reason of the partial abolition of the doctrine of autrefois acquit in a number of Australian jurisdictions, the potential for new and compelling evidence to emerge during an inquest takes on additional significance for persons who have been found not guilty of offences such as a murder at a previous trial. [ABSTRACT FROM AUTHOR]

Introduction: Medicines cause over 1700 preventable deaths annually in England. Coroners' Prevention of Future Death reports (PFDs) are produced in response to preventable deaths to facilitate change. The information in PFDs may help reduce medicine-related preventable deaths. Objectives: We aimed to identify medicine-related deaths in coroners' reports and to explore concerns to prevent future deaths. Methods: We carried out a retrospective case series of PFDs across England and Wales, dated between 1 July, 2013 and 23 February, 2022, collected from the UK's Courts and Tribunals Judiciary website using web scraping, generating an openly available database: https://preventabledeathstracker.net/. We used descriptive techniques and content analysis to assess the main outcome criteria: the proportion of PFDs in which coroners reported that a therapeutic medicine or drug of abuse had caused or contributed to a death; the characteristics of included PFDs; coroners' concerns; the recipients of PFDs; and the timeliness of their responses. Results: There were 704 PFDs (18%; 716 deaths) that involved medicines, representing an estimated 19,740 years of life lost (average of 50 years lost per death). Opioids (22%), antidepressants (9.7%), and hypnotics (9.2%) were the most common drugs involved. Coroners expressed 1249 concerns, primarily around the major themes of patient safety (29%) and communication (26%), including minor themes of failures of monitoring (10%) and poor communication between organizations (7.5%). Most expected responses to PFDs (51%; 630/1245) were not reported on the UK's Courts and Tribunals Judiciary website. Conclusions: One in five coroner-reported preventable deaths involved medicines. Addressing coroners' concerns, including problems with patient safety and communication, should reduce harms from medicines. Despite concerns being raised repeatedly, half of the PFD recipients failed to respond, suggesting that lessons are not generally learned. The rich information in PFDs should be used to foster a learning environment in clinical practice that may help reduce preventable deaths. Clinical Trial Registration: https://doi.org/10.17605/OSF.IO/TX3CS. [ABSTRACT FROM AUTHOR]

Background: Antidepressant (AD) medications increase suicidality for some, or all, age groups. Some, or all, types of ADs, are frequently used in suicides involving overdoses. Methods: The article examines a previously unanalyzed data set summarizing 7,829 media reports of Coroners' inquests in England and Wales that mention ADs, between 2003 and 2020. Results: The most frequently cited ADs were SSRIs (48.9%) and tricyclics (24.6%). The specific drugs cited most often were the SSRI drug citalopram (19.8%) and the tricyclic drug amitriptyline (17.5%). Of 2,329 cases of death by overdose, 933 (40.1%) were overdoses of ADs, 512 of which (54.9%) did not involve other substances. The ADs most frequently named were amitriptyline (186), and citalopram (86). A further 929 were overdoses of unnamed medicines, a proportion of which may have been ADs. Limitations: The data set, which relies primarily on archives of local newspapers, is incomplete and therefore underestimates the total numbers involved. The accuracy of coroners' verdicts is not perfect. Conclusions: If preventing suicide is a primary reason for prescribing ADs, this data set includes several thousand people for whom the drugs clearly did not work. Furthermore, about 1,000 people used the drugs that were supposed to alleviate their depression to kill themselves. Systematic analyses of all inquests would be more informative. Meanwhile, reducing the overprescribing of these relatively ineffective and, for some, lethally dangerous substances is suggested, to reduce suicides. [ABSTRACT FROM AUTHOR]

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Deaths of participants in sport from the effects of concussive injuries and from chronic traumatic encephalopathy (CTE) raise confronting social issues and challenges for tort law. An uncertainty that often needs to be addressed in such cases is proof of the causes of the former athlete's symptomatology, especially when they may be multifactorial, some or all of which were not directly related to sport. Accounts from the person prior to their death and from family members can be vital sources of such information. Coroners' analyses of evidence in concussion-related deaths constitute an important opportunity for perspectives which can form a sound empirical basis for changes to sporting practices, rules and administration. This editorial reviews a series of biographical and autobiographical accounts of sportspersons with concussion and CTE. It also identifies a corpus of coronial decisions from England, New Zealand, Canada and Australia which have addressed the risks posed to athletes from concussive injuries. It highlights recommendations made by coroners in relation to management of concussion in sport and argues that there is considerable scope for further valuable recommendations based upon their investigations during inquests. [ABSTRACT FROM AUTHOR]

Introduction: Substance-related acute toxicity deaths continue to be a serious public health concern in Canada. This study explored coroner and medical examiner (C/ME) perspectives of contextual risk factors and characteristics associated with deaths from acute toxic effects of opioids and other illegal substances in Canada. Methods: In-depth interviews were conducted with 36 C/MEs in eight provinces and territories between December 2017 and February 2018. Interview audio recordings were transcribed and coded for key themes using thematic analysis. Results: Four themes described the perspectives of C/MEs: (1) Who is experiencing a substance-related acute toxicity death?; (2) Who is present at the time of death?; (3) Why are people experiencing an acute toxicity death?; (4) What are the social contextual factors contributing to deaths? Deaths crossed demographic and socioeconomic groups and included people who used substances on occasion, chronically, or for the first time. Using alone presents risk, while using in the presence of others can also contribute to risk if others are unable or unprepared to respond. People who died from a substance-related acute toxicity often had one or more contextual risk factors: contaminated substances, history of substance use, history of chronic pain and decreased tolerance. Social contextual factors contributing to deaths included diagnosed or undiagnosed mental illness, stigma, lack of support and lack of follow-up from health care. Conclusion: Findings revealed contextual factors and characteristics associated with substance-related acute toxicity deaths that contribute to a better understanding of the circumstances surrounding these deaths across Canada and that can inform targeted prevention and intervention efforts. [ABSTRACT FROM AUTHOR]