Risk factors leading people into solitary death in Kyoto, Japan

Japan is leading the super aging society. The proportion of people over 65 years old is more than 25 % in 2015 and will be 40% in 2050. The combination of aging society and nuclear family result in the increase of the cases of solitary death in Japan. Being a solitary death is a substantial public health issues since it impair human dignity at the end of the life. In this study, we tried figure out the best prediction of risk factors for solitary death by using the new database system, Kyoto, Japan. A case series study was analyzed to identify characteristics of solitary death versus non-solitary death for people who died unexpectedly and under investigation in forensic department, Kyoto, Japan since 2012 to 2015. Screening was performed for 1089 deceased and 694 were included in the study. The dichotomous outcome was whether the deceased was performed cardiopulmonary resuscitation by ambulance when they were found. Simultaneous multivariate logistic regression was used to perform statistical analysis by SPSS software. As a result, in this model, three predictors were significant, living alone (OR =9.468, 95% CI 5.67 to 15.82,

Estimation of Cadaveric Age by Ultrasonography

(1) Background: While decreasing bone mineral density (BMD) with age in living people has been well documented, a correlation between age and bone mineral density in deceased people has only been reported in a few studies. A correlation between age and BMD in deceased people was investigated as an objective tool for age estimation of unidentified remains. (2) Methods: The Bone Area Ratio (BAR) was measured in 402 autopsy cases (143 females and 259 males over the age of 20). (3) Results: The correlation coefficient in the females was r = −0.5476, and the correlation coefficient in the males was r = −0.2166, indicating a stronger correlation in females than in males. A comparison of the BAR values in the deceased females for each age group with that in live females found no significant differences in the BAR values. BAR values in the deceased were similar to in live individuals, and this did not change with duration of the postmortem interval. (4) Conclusions: Measuring the BAR value based on bone mass using ultrasonic waves is rapid and easy, even for those lacking forensic training, and may be used to estimate the age of an individual and the likelihood of fracture due to trauma

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era