Death as a result of asthma in Wayne County Medical Examiner cases, 1975-1987

All deaths ascribed to asthma in the 5-to-40-year age group at the Wayne County Medical Examiners' Office were reviewed from 1975 to 1987 inclusive. Fifty-eight deaths were attributed solely to asthma, and the annual number increased fivefold in the 1980s to a rate of approximately 0.5 per 100,000 per year when extrapolated to the Wayne County population. Blacks were overrepresented to double their proportion in the general population. Almost all cases were known asthmatics, and many had received previous emergency care. Most fatalities occurred at night and did not demonstrate any seasonal variation. The onset of the fatal attack was apparently very rapid in most cases, with many engaged in routine activities and few surviving any length of time in hospital or having sought treatment earlier. Our data reveal a significant increase in sudden death in previously well asthmatics in Wayne County in the 1980s. Similar increases in deaths as a result of asthma have been noted previously in other countries for reasons that remain unclear.     

Book reviews

R. Bahro: Die Alternative. Koln‐Frankfurt, 1977, 542 pp. 34.00DM.

R. Bahro: The alternative in Eastern Europe, New Left Books, 1978. 463 pp. £9.50.

Bergson, Abram, Productivity and the Social System—The USSR and the West, Cambridge, Mass.: Harvard University Press, 1978. xi+256 pp. £12.25.

Alec Nove; Political Economy and Soviet Socialism, London, Boston, Sydney: George Allen & Unwin, 1979. 249 pp. £10.00.

Gail Warshofsky Lapidus, Women in Soviet Society: Equality, Development and Social Change. Berkeley, Los Angeles and London: University of California Press, 1978. x + 381 pp. £12.25.

Nationalism in the USSR & Eastern Europe in the Era of Brezhnev and Kosygin. Papers and Proceedings of the Symposium held at University of Detroit on 3–4 October, 1975. Edited by George W. Simmonds. Detroit, Mich.: University of Detroit Press, 1977. 534 pp. $6.95 soft bound, $12.00 hard bound.

Alexander Yanov, The Russian New Right: Right‐ Wing Ideologies in the Contemporary USSR. Berkeley: Institute of International Studies, University of California, 1978. 185 pp. $3.95.

John J. Stephan, The Russian Fascists: Tragedy and Farce in Exile, 1925–1945. New York: Harper and Row, 1978. 450 pp. $15.00.

Michael A. Newcity, Copyright Law in the Soviet Union. New York: Praeger Publishers, 1978. x + 212 pp. Appendix and selected bibliography.

Robin Higham and Jacob W. Kipp, Soviet Aviation and Air Power. A Historical View. London: Brasseys’, 1978; Boulder Co.: Westview Press, 1977. xii + 328 pp. $25.

James Riordan (ed.), Sport Under Communism. London: C. Hurst & Company, 1978. x +177 pp. £6.95.

Vahan D. Barooshian, Brik and Mayakovsky, Slavistic Printings and Reprintings 301. The Hague: Mouton, 1978. 154 pp. + index. Paperback.

Vladimir FiSera (ed.), Workers’ Councils in Czechoslovakia: Documents and Essays 1968–69. London: Motive, 1978. 200 pp. £8.50.

Richard F. Starr (ed.), Yearbook on International Communist Affairs 1978, Stanford, California: Hoover Institution Press, Stanford University, 1978. 497 pp. $35.00.

G. E. Skorov (ed.), Science, Technology and Economic Growth in Developing Countries. Oxford: Pergamon Press, 1978. (tranlated by J. Warren).     

Urban Refugees in Nairobi: Problems of Protection, Mechanisms of Survival, and Possibilities for Integration

This article examines the legal status and economic livelihoodsof refugees in Nairobi, focusing on Somalis, the largest urbanpopulation residing in the city. The results of the study challengethe Government of Kenya's (GOK) official position and the popularlocal perception that refugees are an economic burden, and showinstead that these urban refugees are economically self-sufficient.Despite this economic independence, conditions for most refugeesin Nairobi are extremely difficult. Urban refugees live largelywithout material assistance or legal protection from the GOKor UNHCR, are vulnerable to police arrest at any time and facehigh levels of xenophobia from the local population. By highlightingrefugee self-sufficiency in Nairobi, this article lends supportto the idea of local integration as a viable, durable solutionto their situation of protracted exile.     

Can epidemiological studies assist in the evaluation of community treatment orders? - The experience of Western Australia and Nova Scotia

Epidemiological studies using administrative databases have several advantages over other methodologies in studying the effectiveness of compulsory community treatment such as community treatment orders (CTOs). We compared patients placed on CTOs in Western Australia with controls drawn from both within the jurisdiction and from another without this measure (Nova Scotia). Although in different countries, the mental health services in both jurisdictions share common characteristics. Notably, we were able to control for forensic history in our comparison within Western Australia. We analysed predictors of admission and number of bed-days using multiple, logistic or Cox regression as appropriate. Of the 274 subjects placed on a CTO, we were able to find controls for up to 96% (n=265). CTO placement was not associated with reduced admissions or mean bed-days, although there was a threshold effect with a reduced risk of inpatient stays exceeding 100 days. Outpatient contacts were significantly greater for the CTO group. However, we do not know whether the intensity of treatment, or its compulsory nature, effected outcome.     

Comparative Fiscal Analysis for Counties

This article describes the implementation and use of a decision support system designed to conduct cross-sectional analyses of local government finances. A hypothetical situation using actual data from Illinois counties is constructed to illustrate the uses of the system. It is argued that the incorporation of this type of information, in conjunction with other local data, may lend additional capacity in resource allocation and policy formation at both the state and local levels of government.     

A death in the family: household structure and mortality in rural Liaoning: life-event and time-series analysis, 1792-1867.

"Through a discrete-time life-event analysis of triennial household register data from a northeast Chinese village, Daoyi, between 1774 and 1873, we find that an individual's probability of dying, which we treat as an indicator of access to resources and the nature of household roles, was affected by the composition of their coresident kin....Widows and widowers had higher mortality than the currently married. Orphans had higher mortality than children with at least one parent present. Reflecting the dependence of a wife's status on whether she had produced an heir for her husband, married women in young adulthood and middle age who had at least one son had substantially lower mortality than those without. Reflecting the strength of the claim that elderly males could make on household resources, children with coresident grandfathers had higher mortality than those without. Even though sons were supposed to be a form of old-age security, however, the death rate of the elderly was not reduced by the presence of sons and grandsons."     

An elliptical incised wound of the breast misinterpreted as a bite injury

Bite injuries upon homicide victims are most often initially identified by the forensic pathologist during the course of the autopsy examination. Following such recognition, the injury or photographs of the traumatized site are then referred to a forensic odontologist for his or her examination, further characterization, and subsequent comparison with any suspect's dentition. However, if the pathologist misidentifies an injury caused by another mechanism as a human bite, this mistake can potentially be perpetuated by the dental consultant, since relatively few dentists regularly examine traumatic injuries other than those arising from bites. To illustrate such an event, a case is presented involving an incised wound of the breast, which was originally identified as an avulsive bite wound. Detailed examination by two odontologic consultants confirmed the wound as having been caused by human teeth, and further, they related the "bite injury" to a specific individual. The bite injury interpretation represented the only scientific evidence implicating the suspect at a subsequent trial for capital murder. Later examination of the tissues and photographs by a forensic pathologist and another dental consultant revealed that the injury was not due to human dentition, but rather resulted from a sharp-edged instrument. These consultants conducted a unique experiment to reduplicate the injury and prove its causation. This information was presented to the jury during the suspect's trial and resulted in his acquittal on all charges.