Pedestrian fatalities. The Metropolitan Dade County experience, 1984-1988

The case files of the Dade County Medical Examiner Department of Metropolitan Dade County were used to study pedestrian fatalities. Epidemiologic data are correlated and compared with those of other studies.     

Accidental childhood deaths. The Metropolitan Dade County experience, 1978-1982

Accidental deaths in childhood were studied between 1978 and 1982 in Metropolitan Dade County. Cases were collected from both traffic and nontraffic accidental fatalities in which the victim was less than 12 years of age. Cases were then subdivided into traffic and nontraffic groups. Each group was then analyzed as to age, race, sex, cause of death, and scene circumstances. A total of 294 cases was studied.     

Suicide among nonwhites. The Metro Dade County experience, 1982-1986

Suicide among nonwhites was studied using the case files of the office of the Medical Examiner of Metropolitan Dade County in Miami, Florida. A total of 116 cases, during the years 1982-1986, were analyzed as to the age, sex, cultural background, cause of death, blood alcohol content at autopsy, and reason for the suicide of the victim. By analyzing the ethnic/cultural backgrounds of the victims, it was noted that the overall rate of suicide among nonwhites in Dade County was 5 per 100,000 population per year. However, the rate varies within the overall group such that black-Hispanics, American Indians, and Haitians have suicide rates of 13.9, 11, and 3.1 per 100,000 population per year, respectively. Some of these rates are higher than the U.S. national nonwhite suicide rate of 7 per 100,000 population. Interestingly, while suicide rates are variable, the reasons listed for the suicide and the high frequency of young adult victims are similar to those for whites. A discussion ensues concerning this similarity and what future work in the field remains to be done.     

Fatal occupational accidents--the five-year Metro Dade County experience, 1979-1983

A study of fatal occupational accidents in Metropolitan Dade County between the years 1979 and 1983 was performed from the case files of the office of the medical examiner. A total of 147 cases were collected and were subdivided into 25 traffic-related and 122 nontraffic-related cases. Cases were then analyzed as to age, race, sex, cause of death, alcohol, toxicology, scene circumstances, and who was at fault in the accidental fatality. Traffic-related fatalities, comprising 17% of the cases, were young white males, commonly less than 45 years of age, who died of multiple injuries in the majority of instances while working as drivers on tractor trailers, migrant farms, or fruit produce trucks. The most common seenario was a vehicle-vehicle collision in which seat belts were not used and the decedent or the decedent's driver was at fault. Nontraffic-related fatalities, comprising 83% of the cases, were likewise white males, commonly less than 45 years of age, who died of multiple injuries in the majority of instances as construction workers or as loading/forklift operators. The most common seenario was one in which alcohol or drugs were not involved. While the "fault" was unassignable in the majority of cases, in those in which it could be, the deceased was at fault approximately half the time with the company or others at fault the other half.     

Teenage suicide--the five-year Metro Dade County experience from 1979 until 1983

A study of suicide among teenagers was performed on the case files of the Office of the Medical Examiner of Metro Dade County in Miami, Florida, U.S.A. during the years 1979 until 1983. A total of 65 cases were studied and analyzed as to age, race, sex, cause of death, blood alcohol content at autopsy, drugs detected at autopsy, location of incident, presence or absence of a suicide note, and the reason for the suicide. The majority of the cases involved 16-19-year-old white males who took their life by handgun wounds. Predominantly they were sober. They killed themselves at home and half the time a note was left. Frequent reasons for the suicide included 'lover's quarrels" or drug problems.     

Accidental non-commercial aircraft fatalities: the 7-year Metro-Dade County experience from 1977-1983

A study of accidental non-commercial aircraft fatalities was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, FL, U.S.A., between the years 1977 through 1983. A total of 57 cases were collected and analyzed as to the age of the victim, the race and sex of the victim, the cause of death, the blood alcohol content at autopsy, the drugs detected at autopsy, the type of aircraft, the occupant role, the risk factor responsible for the crash, the time of the fatality, and the nature of usage of the aircraft. Essentially, these 57 cases comprised 1.2% of the non-vehicular accidental fatalities during the period. The age of distribution is relatively evenly distributed from age 16 to 65 years with white males predominating. Multiple injuries were the most common cause of death although conflagration injuries (e.g., smoke inhalation, burns) were frequent. The victims were sober and free of drugs in the majority of cases. Most fatalities occurred in a single engine plane with the victim, the pilot, flying for private reasons in the afternoon or evening hours. The most common identifiable risk factor was human error (e.g., judgement), rather than mechanical or plane failure.     

An assessment of lung weights in drowning cases. The Metro Dade County experience from 1978 to 1982

The lung weights in known cases of drownings, both fresh and salt water, were studied in 220 cases over the past 5 years. Statistical comparison was performed with both a natural disease and a "normal" population. The frequency of "dry lungs" in drowning was also noted.     

Non-vehicular accidents among teenagers--the 5-year Metro Dade County experience from 1979 to 1983

A study of non-vehicular accidents among the teenage population of Metropolitan Dade County, Miami, Florida, U.S.A., was performed. The case files of the Office of the Medical Examiner were reviewed and all teenage non-vehicular accidents during the 5-year period from 1979 to 1983 were collected. These 102 cases were then analyzed as to the age, race, sex, cause of death, blood alcohol content at autopsy, and drugs detected of the victim. The geographic location, scene circumstances, and presence of human error were also noted. Predominantly, a white male population between 16 and 19 years is involved. Usually they die from drowning at home or in a natural body of water, commonly drugs or alcohol are involved; human error or poor judgment is noted two-thirds of the time.     

Police shootings. The Metropolitan Dade County experience from 1956 to 1982

Police shootings, or, when law enforcement officers shoot and kill criminal suspects, have been studied in metropolitan Dade County from 1956 to 1982. A total of 194 cases have been studied and analyzed according to age, race, sex, Spanish surname, alcohol and/or drugs detected at autopsy, and prior criminal arrest record of the victim. The reason(s) for the shooting and any agencies involved have also been noted. Finally, an appendix is included that provides guidelines for the forensic pathologist on how to approach a case.     

Accidental fire deaths. The 5-year Metropolitan Dade Country experience from 1979 until 1983

Accidental fire deaths that occurred in Metropolitan Dade County, encompassing Miami, Fla., USA, during the years from 1979 until 1983 were studied. A total of 108 cases were collected, representing 6.1% of the nontraffic-related accidents during this 5-year period, and analyzed as to the age, race, sex, cause of death of the victim along with the blood alcohol content at autopsy, toxicologic analysis, location of the fire, and how the fire started. Essentially, the victims ages cluster in the 0-5 years and does 70 years, although other age groups are evenly distributed. A white male population predominates. The cause of death is listed as either smoke inhalation or thermal injury. Most toxicologic analyses were not performed due to the high rate of fire rescue intervention and at least emergency room hospitalization prior to death. Carboxyhemoglobin levels, when analyzed, ranged from less than 20% to over 80%. In a smaller group of cases, cyanide was analyzed for and was found negative (or none detected) in the majority of the cases. More fires occurred in residences and started due to cigarette smoking or electric malfunction.     

Accidental sharp force injury fatalities.

The authors review all accidental sharp force injury deaths investigated at the Southwestern Institute of Forensic Sciences from 1990 to 1999. Twenty-two cases of accidental sharp force injury were identified, accounting for 0.29% of all accidental deaths (9,562) during the 10-year study period. Included in this series are 5 incised wounds, 11 stab wounds, 4 chop wounds, and 2 deaths caused by dog attacks. About half of the cases involved some type of motorized machinery. The victims' ages ranged from 2 years to 71 years, with most deaths occurring in older teenagers and younger adults. Male subjects (17) were involved much more frequently than female subjects (5). In 50% of the cases, ethanol or other drug use was a possible underlying contributing factor in the accident. The cases are briefly reviewed, and the importance of detailed investigation in manner-of-death certification is emphasized.     

Cocaine-related deaths in Pima County, Arizona, 1982-1984

A three-year review of toxicology data from medical examiner autopsies in Pima County, Arizona, has demonstrated that cocaine has rapidly become a leading substance of abuse, second only to alcohol in the frequency of drugs detected by toxicologic analysis of all suspicious deaths, motor vehicle accident fatalities, homicides, and suicides. Gastric contents and urine were analyzed by thin-layer chromatography, and nasal swabs, blood, and urine were tested for the combination of cocaine and its metabolite benzoylecgonine by quantitative radioimmunoassay. A total of seventy-two deaths in Pima County from 1982 to 1984 have involved cocaine. Seventy percent of these have occurred in the last fifteen months. Marked variation in the individual response to cocaine compared to the blood concentration of cocaine/metabolite was noted.     

Suicide in Fulton County, Georgia (1975-1984)

Demographic and trend analysis of 881 consecutive suicides in blacks and whites is presented. For the years 1975 through 1984, the suicide rate was 15.1/100 000 and did not significantly change. White males were overrepresented in all age groups, had an overall suicide rate of 34.9, and showed a small but statistically significant increase in rate which was not accounted for by any specific age group. White females, in general, were represented in proportion to their prevalence in the population, and those ages 20 to 24 demonstrated an increasing suicide rate which was small. Black males were at highest risk in their twenties, showed no significant trends, and were also represented near their prevalence in the population. Black females of all ages were underrepresented, and had low suicide rates which decreased with time. No significant rate changes were noted for teenagers or the elderly. Firearms was the method of choice in all groups, although methods varied with age, race, and sex, and male children preferred hanging. Small but significant increases were noted for the prevalence of nondrug methods in females and carbon monoxide deaths in white males. Similarities and differences to larger scale studies are discussed. Suicide may have characteristics unique to given geographical areas and pervasive to all areas. The authors advocate study and publication of local data to clarify further the nature of suicide.     

Death wearing a badge--a study of police officers who died in the line of duty in Metro Dade County from 1956 to 1982

A study of police officers who died in the line of duty in Metro Dade County, U.S.A. was performed. All cases in which a law enforcement officer died while on duty or, off duty while performing police action were collected from the files of the Medical Examiner Department from 1956 to 1982. Cases were then analyzed as to age, race, sex, cause and manner of death, scene circumstances, alcohol and drugs detected at autopsy. A total of 37 cases was studied.     

Fatal accidents and blood ethanol levels in adolescents and adults. The Wayne County experience, 1978-1988

The files of 874 fatal traumatic accident victims, aged 12-25 years, examined at the Wayne County Medical Examiner's Office during the period 1978-1988 were reviewed. Postmortem blood alcohol results of individuals who died after less than 15 min of hospitalization were utilized to approximate alcohol levels at the time of the fatal injury. Relationships between types of accidents, sex, age, race, and time of accident were examined. White victims were far more likely to have been drinking than blacks, and the data indicated that underaged drinkers were involved in fatal accidents at lower levels of blood alcohol than their counterparts of legal drinking age. Consistent racial differences in average alcohol levels were not observed, however. Unlike female and black victims, who much less frequently tested positive for alcohol when underage, white male victims 16-21 years of age were just as likely to have been drinking as those aged 21-25. The results of the study show that postmortem blood alcohol level can be used to identify differences in alcohol consumption among groups of accident victims in a major metropolitan area.     

Antidepressants at Autopsy in Hispanic Suicidal Youth in Miami‐Dade County,Florida*

Abstract: Controversy has surrounded the use of antidepressants and suicidal behaviors in youth. This study reviewed the Medical Examiner’s Office records of 253 persons aged 24 years or younger classified as suicides in Miami‐Dade County, Florida, from 1990 to 2007. Information was collected regarding demographic information, suicidal characteristics, psychiatric and psychosocial factors, and toxicology results. Eighty‐five percent of the sample was men, and 53.4% of the subjects were Hispanic. Consistent with previous literature, the existence of antidepressants at autopsy was rare; present in only 6% (n = 15) of the victims. The occurrence of antidepressants was not significantly different between Hispanics (n = 7) and non‐Hispanics (n = 8). The incidence of antidepressants was weakly correlated with a tendency to be men and no history of psychiatric illness. The presence of antidepressants in Hispanic youth suicide victims was similar to non‐Hispanics.     

The Dynamics of Female Delinquency, 1976-1980

This article employs self-report delinquency data from a national probability sample of adolescents to describe the epidemiology and dynamics of female delinquency from 1976 to 1980. Both age and cohort effects are examined, utilizing incidence and prevalence data categorized by race, social class, and place of residence. Within years there are few consistent, significant differences in the incidence of delinquency by any of the demographic variables analyzed. Significant race and social class differentials exist, however, in the prevalence of assaultive crimes among the panel, with substantially higher proportions of black and lower-class females reporting involvement in violent behavior for three of the five years. Strong cohort effects are observed for all delinquency measures. In general, the incidence and prevalence of serious female delinquency appear to decline with age, and the 15-17-year-old females in 1980 are significantly less involved in delinquency than their same-age peers were in 1976.     

The politics of discretionary Medicaid spending, 1980-1993

Why do some states choose to spend more than four times as much as others to provide health care to the disadvantaged? Political scientists who have traditionally explored this question by analyzing trends in overall Medicaid expenditures lumped states' discretionary spending in with other money that states are mandated to spend. Analyses of total expenditures found that socioeconomic factors drove spending but that party control of state legislatures made no difference in health policy making. By isolating discretionary state Medicaid expenditures from total spending figures, I reexamine the influences of political as well as economic and demographic factors. The often-doubted importance of party control becomes clear. This study investigates spending patterns in the discretionary portions of state Medicaid programs in forty-six states from 1980 to 1993 and analyzes both incremental program changes and absolute differences in state spending. To discover how greatly the researcher's choice of dependent variables can affect results, optional spending is separated from total spending levels and the variation is modeled in both. Focusing not on the spending that the federal government requires of state officials but on the policies that state officials actually choose allows a balanced exploration of both political and economic effects on welfare expenditures. This research also provides new insights about which forces will shape policy decisions if more and more control of the public health care system is devolved to the states.     

Toxicological findings in military aircraft fatalities from 1986-1990.

Toxicological findings in all military aircraft fatalities investigated by the Division of Forensic Toxicology at the Armed Forces Institute of Pathology from 1986-1990 are presented. Carbon monoxide saturation levels greater than 10% were found in 4% of the 535 cases where appropriate specimens were collected. Positive ethanol findings were more indicative of postmortem formation than antemortem consumption. In only 1 case were abused drugs (cannabinoids in a passenger) detected. Other drugs identified included nicotine, chloroquine and over-the-counter analgesic agents, antihistamines and sympathomimetic drugs.