Failure to Autopsy: The Otto Warmbier Case

Coroner and medical examiner offices are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profile case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities. Medico legal death investigation offices, including both medical examiner and coroner offices, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d’être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the next-of-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the office resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offices. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offices. Specifically, we believe the recent case of Otto Warmbier is such a case

THE ROLE OF RACE/ETHNICITY, DIETARY INTAKE AND MOVEMENT ON OBESITY IN CHILDREN ATTENDING OKLAHOMA CHILD-CARE CENTERS

Chelsea L. Smith1, June Eichner1, Michael A. Anderson1, Ashley Weedn1 & Susan B. Sisson1, FACSM. 1University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; email: [email protected] There are racial/ethnic differences in prevalence of overweight and obesity in 2-5 year old children. An important factor in early obesity development for all children includes unhealthy dietary patterns and movement behaviors. Child-care centers can be an intervention target for developing healthy patterns since 60% of young children spend substantial time in these facilities. PURPOSE: The purpose of this study is to examine the relationship of race/ethnicity, dietary intake and movement by Body Mass Index (BMI) percentile in children attending child-care centers. METHODS: An observational study at child-care centers was conducted between 2011-2014. BMI was calculated from measured height and weight and BMI percentile was calculated based on age and sex. Parental report of race included American Indian/Alaska Native (AI/AN), white and black. Dietary intake was determined from observed lunch food consumption and analyzed using dietary analysis software. Independent dietary variables used included sugars (g), total kcal and total fruits-and-vegetables consumed. Physical activity intensity and duration was measured for the entire school day using waist-worn accelerometers. Data was recorded in 15 second epochs and analyzed with age-specific cut points to determine intensity. Independent movement variables included minutes of sedentary, light and moderate-to-vigorous physical activity. RESULTS: Participants included 174 children, age 3.8±0.7, 51% male, AI/AN 32%, white 46% and black 20%. AI/AN had the highest mean BMI percentile (72.2±25.8) compared to white (62.9±27.8, p=0.02) and black (65.2±27.8, p=0.05). When a second race was included for AI/AN children of mixed heritage, AI/AN-only children (79.8±21.8) had a higher BMI percentile compared to AI/AN-mixed children (61.8± 27.3, pp=0.004) was associated with higher BMI percentile. CONCLUSION: In support of previous research, AI/AN children had a higher mean BMI percentile than other races. This difference was further amplified when AI/AN-only children were examined; AI/AN-mixed BMI percentile was not different than white. Race/ethnicity may not be the driver of lunch dietary patterns at child-care centers since after adjusting for race, total kcal was still associated with BMI Percentile. Health and child-care providers should be aware of the differences in dietary intake and maximize the opportunity for health promotion in this sensitive environment with higher-risk populations