Sudden death due to asphyxia by esophageal polyp: two case reports and review of asphyxial deaths

Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging.We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.     

Reducing violence in serious juvenile offenders using intensive treatment

This study reports on the reduction in violent offending in a population of serious and violent juvenile offenders following an intensive institutional treatment program. The treatment group (N=101) is compared to a similar group that was assessed but not treated (N=147). All youth were sent to the program from a juvenile corrections institution where they had received the customary rehabilitation services. The results show a significant reduction in the prevalence of recidivism in the treated group after controlling for time at risk in the community and other covariates. The effects of non-random group assignment were reduced by including a propensity score analysis procedure in the outcome analysis. Untreated comparison youth appeared to be about twice as likely to commit violent offenses as were treated youth (44% vs. 23%). Similarly, treated youth had significantly lower hazard ratios for recidivism in the in the community than the comparison youth, even after accounting for the effects of non-random group assignment.     

Distinctive patterned injuries caused by an expandable baton

Identification and documentation of patterned blunt-force injuries at autopsy is of utmost forensic importance, particularly when the object or surface producing the injury is unknown or uncertain. Documentation of patterned injuries produced by known objects contributes to the catalogue of forensic knowledge regarding those objects and the injuries they cause. This report presents a case in which a 27-year-old male sustained multiple nonlethal patterned blunt-force injuries produced by an expandable baton and subsequent multiple gunshot wounds during apprehension by police.     

The role of moral disengagement in the execution process

The present study tested the proposition that disengagement of moral self-sanctions enables prison personnel to carry out the death penalty. Three subgroups of personnel in penitentiaries located in three Southern states were assessed in terms of eight mechanisms of moral disengagement. The personnel included the execution teams that carry out the executions; the support teams that provide solace and emotional support to the families of the victims and the condemned inmate; and prison guards who have no involvement in the execution process. The executioners exhibited the highest level of moral, social, and economic justifications, disavowal of personal responsibility, and dehumanization. The support teams that provide the more humane services disavowed moral disengagement, as did the noninvolved guards but to a lesser degree than the support teams.     

Assisting altruism: evaluating legally binding consent in organ donation policy

The growing need for organ and tissue transplants has led a number of states to enforce a policy that views a donor's declared intent to be an organ donor as legally binding. This allows health officials to harvest organs without the permission of the next of kin. Legally binding consent is controversial because of concerns that it may anger family members, lead to negative publicity, and discourage potential donors. We use interviews and a pooled time-series data set of cadaveric donation rates in U.S. states to evaluate the effectiveness of this policy. Our research indicates that enforcement of legally binding consent has marginally increased cadaveric donations while not significantly affecting donor registration. We also find evidence that the effect of the policy might be greater if it were more fully implemented and coordinated with efforts to improve public acceptance and awareness.     

Public opinion and the politics of obesity in America

Health policy experts have recently sounded the warning about the severe health and economic consequences of America's growing rates of obesity. Despite this fact, obesity has only begun to enter America's political consciousness and we have little information about what average Americans think of obesity or whether they support obesity-related policies. Using unique survey data collected by the authors, this essay examines public attitudes toward obesity and obesity policy. We find that, contrary to the views of health experts, most Americans are not seriously concerned with obesity, express relatively low support for obesity-targeted policies, and still view obesity as resulting from individual failure rather than environmental or genetic sources. Given the absence of elite discourse on this problem, we also find that typical determinants of policy preferences, such as ideology or partisanship, are not good predictors of attitudes on obesity policy. Rather, with a low-valence issue such as obesity, the public utilizes other attitudinal frameworks such as their opinions on smoking policy and the environmental culpability for obesity. The implications of these findings for obesity policy and research on health-related public opinion are discussed.     

Carbon monoxide-related deaths in a metropolitan county in the USA: an 11-year study

Carbon monoxide (CO) poisoning as a cause of death is well documented in industrialized countries. The objective of this study was to compare demographic data in deaths due to accidents (in fires) and suicides in the same population between 1988 and 1998. Furthermore, the potential effect of a community wide education effort regarding safety in the home was assessed. Postmortem reports were reviewed for all deaths examined at the Office of the Cuyahoga County Coroner in Cleveland, OH, USA. During the study period, there were 209 accidental deaths due to fires in the home (6.5% of all accidents in the home) and 182 CO deaths by suicide (9.8% of all suicides). Demographic characteristics of the two groups differed: while males represented the majority of cases in both groups (55% of accidents, 70% suicides), race specific death rates were higher for whites than blacks (18/100,000 white, 3/100,000 black) in suicides compared with 29/100,000 deaths for blacks and 11/100,000 for whites in accidental cases. Fire deaths were prevalent in the young (0-9 years) and old (>60) whereas in the suicide group the age specific death rate was highest for those over 70 years. The majority of fire deaths occurred in the city of Cleveland but suicides were prevalent in the suburbs. More fire deaths occurred in December than any other month whereas more suicides occurred in April. In 1992, there was a community wide effort to provide free smoke detectors to residents in Cleveland. In 1992, there were 4.2/100,000 fire deaths in the city. This decreased to 0.6/100,000 in 1996, increased to 1.2/100,000 in 1997 followed by a decrease to 0.8/100,000 in 1998. This suggested that the program may have aided in decreasing these types of deaths. Deaths due to fires in the suburbs were <1/100,000 throughout the study period.     

Loneliness and associated violent antisocial behavior: analysis of the case reports of Jeffrey Dahmer and Dennis Nilsen

It can be theorized that loneliness plays a significant role in the development and continuation of violent, antisocial attitudes and behavior. Analysis of case reports of two serial killers, Dennis Nilsen and Jeffrey Dahmer, indicate that there is evidence for such a link. In this article, a list of significant correlates of loneliness and antisocial behavior is presented. This may be useful for the assessment of possible dangerousness and in the development of prevention and intervention programs. Suggestions are made for the adequate treatment of loneliness and correlated violent, antisocial behavior. A need is recognized for more research into the psychosocial, emotional, neurobiological, cultural, and ethnic determinants of loneliness and their correlation to specific antisocial and/or criminal behavior.