BACKGROUND: In the United States, over half of all deaths are attributed to five leading underlying causes of death (at the ICD-3 digit level). However, these underlying causes represent only 25% of the total medical information documented on death certificates. While previous studies have investigated associations between causes of death, none have specifically examined the mechanisms of interaction among these causes. This study aims to explore the role of contributory causes of death recorded in Part 2 of the death certificate in the lethal process. METHODS: Working with U.S. Multiple Cause of Death Microdata in 2019, we use causal pie models to model the synergy between multiple causes of death. RESULTS: The findings show how contributory causes in Part 2 affect the sequence of morbid events leading to death. Three broad categories of roles can be distinguished: (i) some contributory causes act as mediators in the chain of morbid events, (ii) others do not exhibit any interaction with the conditions listed in Part 1, and (iii) some might play a role in the development of underlying causes. CONCLUSION: Contributory causes listed in Part 2 play a crucial role in transitions to terminal morbid states. There is evidence that these are more than just conditions without a direct relationship to the underlying cause of death.

• Keywords
• Causal pies, Contributory causes, Mediation, Multiple causes of death,
• MeSH
• Humans MeSH
• Cause of Death MeSH
• Death Certificates * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• United States epidemiology   MeSH

OBJECTIVES: The causes of death in dementia are not established, particularly in rarer dementias. The aim of this study is to calculate risk of death from specific causes for a broader spectrum of dementia diagnoses. DESIGN: Cohort study. SETTING: Swedish Dementia Registry (SveDem), 2007-2012. PARTICIPANTS: Individuals with incident dementia registered in SveDem (N = 28,609); median follow-up 741 days. Observed deaths were 5,368 (19%). MEASUREMENTS: Information on number of deaths and causes of mortality was obtained from death certificates. Odds ratios for the presence of dementia on death certificates were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox hazards regression for cause-specific mortality, using Alzheimer's dementia (AD) as reference. Hazard ratios for death for each specific cause of death were compared with hazard ratios of death from all causes (P-values from t-tests). RESULTS: The most frequent underlying cause of death in this cohort was cardiovascular (37%), followed by dementia (30%). Dementia and cardiovascular causes appeared as main or contributory causes on 63% of certificates, followed by respiratory (26%). Dementia was mentioned less in vascular dementia (VaD; 57%). Compared to AD, cardiovascular mortality was higher in individuals with VaD than in those with AD (HR = 1.82, 95% CI = 1.64-2.02). Respiratory death was higher in individuals with Lewy body dementia (LBD, including Parkinson's disease dementia and dementia with Lewy bodies, HR = 2.16, 95% CI = 1.71-2.71), and the risk of respiratory death was higher than expected from the risk for all-cause mortality. Participants with frontotemporal dementia were more likely to die from external causes of death than those with AD (HR = 2.86, 95% CI = 1.53-5.32). CONCLUSION: Dementia is underreported on death certificates as main and contributory causes. Individuals with LBD had a higher risk of respiratory death than those with AD.

• Keywords
• Alzheimer's, Lewy body dementia, causes of death, death certificate, dementia, respiratory death, survival analyses,
• MeSH
• Alzheimer Disease mortality   MeSH
• Lewy Body Disease mortality   MeSH
• Cardiovascular Diseases mortality   MeSH
• Cohort Studies MeSH
• Humans MeSH
• Respiratory Tract Diseases mortality   MeSH
• Cause of Death * MeSH
• Registries MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Death Certificates * MeSH
• Dementia, Vascular mortality   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Sweden epidemiology   MeSH

BACKGROUND: The COVID-19 pandemic may have caused an underestimation of cardiovascular disease (CVD) mortality, as COVID-19 was predominantly recorded as the underlying cause of death. This study investigates CVD-related excess mortality and recording of CVD on the death certificates during 2020-2021, considering underlying (underlying causes of death (UCD)), immediate and contributory causes. METHODS: We utilize US Multiple-Cause-of-Death Mortality Data. Excess deaths are assessed by comparing actual 2020-2021 deaths with Seasonal Autoregressive Integrated Moving Average model predictions. To understand changes in cause-of-death recording, we use the standardized ratio of multiple to underlying causes (SRMU). RESULTS: Excess CVD mortality is most prominent in contributory causes, including hypertensive disease, essential hypertension, and acute myocardial infarction. While excess of contributory CVDs generally decreased in 2021, acute myocardial infarction, pulmonary heart diseases and other circulatory diseases showed a continual increase. Changes in SRMU from 2020 to 2021, compared to 2010-2019, reveal shifts in coding practices, particularly for pulmonary heart, cerebrovascular diseases, non-rheumatic valve disorders and heart failure. CONCLUSIONS: The COVID-19 pandemic has significantly increased CVD-related mortality, which is not fully captured in conventional analyses based solely on the UCD. The trend of coding CVDs as non-underlying causes of death accelerated during 2020-2021. Multiple-causes-of-death should be employed to evaluate mortality when new leading cause of death emerges.

• Keywords
• COVID-19, circulatory disease, mortality,
• MeSH
• COVID-19 * MeSH
• Myocardial Infarction * MeSH
• Cardiovascular Diseases * MeSH
• Causality MeSH
• Humans MeSH
• Mortality MeSH
• Pandemics MeSH
• Cause of Death MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• United States epidemiology   MeSH

INTRODUCTION: The impact of conditions that partly or indirectly contribute to drinking-related mortality is usually underestimated. We investigate all alcohol-related multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking. METHOD: Analysis of population-level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain. Age-standardised death rates and standardised ratios of multiple to underlying cause were calculated for alcohol-related causes of death. RESULTS: Multiple-cause mortality ranged from 20 to 58 deaths per 100,000 for men and from 5 to 16 per 100,000 for women. Liver diseases were the most common underlying and multiple causes, but mental and behavioural disorders were the second or third, depending on country and sex, most prevalent multiple mentions. Two distinct age patterns of alcohol-related mortality were observed: in Czechia and Poland an inverted-U distribution with a peak at the age of 60-64, in Austria and Spain a distribution increasing with age and then levelling off for older age groups. DISCUSSION AND CONCLUSION: The importance of alcohol-related conditions that indirectly impact mortality can be re-assessed with the use of contributory mentions. The multiple-cause-of-death approach provides convergent results for countries characterised by similar patterns of alcohol consumption. Multiple-cause mortality was almost double the level of mortality with alcohol as the underlying cause, except in Poland. Mental and behavioural disorders were mostly certified as contributory to other, non-alcohol-related underlying causes of death.

• Keywords
• Europe, alcohol, causes of death, mortality, multiple causes of death,
• MeSH
• Adult MeSH
• Humans MeSH
• Mortality * MeSH
• Alcohol Drinking * MeSH
• Cause of Death MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe epidemiology   MeSH
• Poland MeSH

Autosomal-dominant tubulo-interstitial kidney disease (ADTKD) encompasses a group of disorders characterized by renal tubular and interstitial abnormalities, leading to slow progressive loss of kidney function requiring dialysis and kidney transplantation. Mutations in UMOD, MUC1, and REN are responsible for many, but not all, cases of ADTKD. We report on two families with ADTKD and congenital anemia accompanied by either intrauterine growth retardation or neutropenia. Ultrasound and kidney biopsy revealed small dysplastic kidneys with cysts and tubular atrophy with secondary glomerular sclerosis, respectively. Exclusion of known ADTKD genes coupled with linkage analysis, whole-exome sequencing, and targeted re-sequencing identified heterozygous missense variants in SEC61A1-c.553A>G (p.Thr185Ala) and c.200T>G (p.Val67Gly)-both affecting functionally important and conserved residues in SEC61. Both transiently expressed SEC6A1A variants are delocalized to the Golgi, a finding confirmed in a renal biopsy from an affected individual. Suppression or CRISPR-mediated deletions of sec61al2 in zebrafish embryos induced convolution defects of the pronephric tubules but not the pronephric ducts, consistent with the tubular atrophy observed in the affected individuals. Human mRNA encoding either of the two pathogenic alleles failed to rescue this phenotype as opposed to a complete rescue by human wild-type mRNA. Taken together, these findings provide a mechanism by which mutations in SEC61A1 lead to an autosomal-dominant syndromic form of progressive chronic kidney disease. We highlight protein translocation defects across the endoplasmic reticulum membrane, the principal role of the SEC61 complex, as a contributory pathogenic mechanism for ADTKD.

• MeSH
• Alleles MeSH
• Anemia genetics   MeSH
• Biopsy MeSH
• Chronic Disease MeSH
• Zebrafish embryology   genetics   MeSH
• Child MeSH
• Genes, Dominant MeSH
• Adult MeSH
• Endoplasmic Reticulum metabolism   MeSH
• Exome genetics   MeSH
• Phenotype MeSH
• Golgi Apparatus metabolism   MeSH
• Heterozygote * MeSH
• Middle Aged MeSH
• Humans MeSH
• RNA, Messenger analysis   genetics   MeSH
• Mutation, Missense genetics   MeSH
• Young Adult MeSH
• Models, Molecular MeSH
• Mutation * MeSH
• Kidney Diseases genetics   pathology   MeSH
• Neutropenia genetics   MeSH
• Infant, Newborn MeSH
• Disease Progression MeSH
• Pedigree MeSH
• Fetal Growth Retardation genetics   MeSH
• Amino Acid Sequence MeSH
• Aged MeSH
• Syndrome MeSH
• SEC Translocation Channels chemistry   genetics   MeSH
• Animals MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Infant, Newborn MeSH
• Aged MeSH
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• RNA, Messenger MeSH
• SEC61A1 protein, human MeSH Browser
• SEC Translocation Channels MeSH

The author describes postsurgical formation of a cerebrospinal fluid (CSF) pseudocyst after anterior decompression and stabilization for cervical spine injury. The CSF pseudocyst was caused by extensive lacerations to the spinal dura mater. A further contributory factor was a circulation blockage of CSF in the spinal canal, brought about by edema of the contused spinal cord. Ventricular drainage caused rapid collapse of the pseudocyst and its subsequent healing.

• MeSH
• Cysts diagnosis   etiology   MeSH
• Adult MeSH
• Dura Mater injuries   MeSH
• Edema complications   MeSH
• Cervical Vertebrae injuries   surgery   MeSH
• Humans MeSH
• Cerebrospinal Fluid physiology   MeSH
• Spinal Cord Diseases complications   MeSH
• Spinal Canal physiopathology   MeSH
• Cerebrospinal Fluid Shunts * MeSH
• Ventriculostomy MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Road users' inattention is one of the leading factors that contribute to crashes. It has been thoroughly researched from many perspectives, but there is limited information about the factors that influence risk perception and road users' attitudes. These factors are formed by personal and mediated experience, but education and public awareness play important roles. In this context, media seems to significantly influence risk perception and it may result in behavioural changes. This study aimed to review the coverage of driver inattention in the Czech media to analyse how it covers different types of inattention. Both quantitative and qualitative content analyses were conducted, and the sources of inattention mentioned in media reports were coded. We found the following: distraction is the most often reported inattention subtype; the media often communicates illegal behaviour, such as mobile phone handling; the preventive and educational potential of media coverage seems to not be fully utilized; and media reports are often focused on specific crashes, consequences, and immediate causes. Other risky aspects or inattention contributory factors tend to be neglected.

• Keywords
• Crash, Distraction, Inattention, Media, Traffic safety,
• Publication type
• Journal Article MeSH

PURPOSE: The aim of this study was to assess the diagnostic value of catecholamines and their O-methylated metabolites in vitreous humor samples in identifying antemortem cold exposure and fatal hypothermia in the forensic casework. METHODS: A total of 80 autopsy cases (40 hypothermia fatalities and 40 cases in which hypothermia as the main or contributory cause of death was excluded) were selected for this study. Catecholamines and their O-methylated metabolites were measured in urine and vitreous humor samples collected at autopsy. RESULTS: Urine catecholamine and their O-methylated metabolite concentrations were significantly higher in hypothermia-related deaths. On the other hand, measurements in vitreous humor samples did not reveal statistically significant differences between hypothermia-related deaths and controls. CONCLUSIONS: Globally considered, our findings seem to suggest that, contrary to urine catecholamines and their O-methylated metabolites, vitreous levels of these compounds appear to be of limited value in characterizing human antemortem stress reactions due to cold exposure and can hardly be used in the forensic setting to support the diagnosis of hypothermia.

• Keywords
• Catecholamines, Hypothermia, Metanephrines, Postmortem biochemistry, Vitreous humor,
• MeSH
• Epinephrine metabolism   MeSH
• Dopamine analogs & derivatives   metabolism   MeSH
• Adult MeSH
• Hypothermia diagnosis   metabolism   MeSH
• Catecholamines metabolism   MeSH
• Middle Aged MeSH
• Humans MeSH
• Metanephrine metabolism   MeSH
• Young Adult MeSH
• Norepinephrine metabolism   MeSH
• Normetanephrine metabolism   MeSH
• Postmortem Changes MeSH
• Aged MeSH
• Vitreous Body metabolism   MeSH
• Forensic Pathology MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• 3-methoxytyramine MeSH Browser
• Epinephrine MeSH
• Dopamine MeSH
• Catecholamines MeSH
• Metanephrine MeSH
• Norepinephrine MeSH
• Normetanephrine MeSH

Geocaching is a high-tech treasure-hunt game that uses GPS-enabled devices or smartphone apps to find cleverly hidden treasures marked by GPS coordinates that are shared online. Like any other outdoor activity, geocaching is associated with risks of falls, environmental injuries, asphyxia and natural events. Despite the apparent risk of serious injury and potential death, no relevant reports aiming to identify the characteristics of geocaching-related deaths have appeared in the medical literature to date. We report a case of an experienced geocacher who was found suspended from a bridge pillar with his climbing ropes and helmet straps twisted across his face and neck; he had apparently attempted to rappel from a 30-m-high railway bridge to find a geocache. A recording of the rappelling sequence from the camera found on the chest strap assisted in reconstructing what had actually happened. An autopsy confirmed that the cause of death was asphyxiation due to hanging, with the occlusion of the external airways and positional asphyxia serving as contributory factors. The salient features of this unusual case are discussed, and several forensic issues of geocaching are highlighted.

• Keywords
• Asphyxia, Autopsy, Geocaching, Hanging, Rappelling,
• MeSH
• Asphyxia etiology   pathology   MeSH
• Smartphone MeSH
• Geographic Information Systems MeSH
• Middle Aged MeSH
• Humans MeSH
• Posture * MeSH
• Recreation * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Over recent decades, various hypotheses and theoretical frameworks have been advanced to elucidate the aetiology of normal pressure hydrocephalus (NPH). This reversible neurological condition, characterised by the classical clinical triad of gait disturbance, urinary incontinence and cognitive impairment, represents a multifactorial interplay of pathophysiological processes that co-occur, rather than originating from a single, defined cause. Despite extensive research efforts, the precise aetiology and underlying pathophysiological pathways remain indeterminate. Contributory factors such as dysfunction of the glymphatic system, diminished arterial pulsatility, metabolic and osmotic dysregulation, astrogliosis and neuroinflammatory processes are acknowledged as critical in the pathogenesis of NPH. Recent advancements in the understanding of these pathophysiological aberrations have substantially refined the conceptualisation of the NPH phenotype, enhancing the predictive accuracy for cerebrospinal fluid diversion interventions. This review addresses the definition and classification of NPH and emphasises future research directions aimed at further elucidating the molecular and physiological mechanisms underlying the disease. A comprehensive understanding of this syndrome is critical for informed clinical decision-making and optimising therapeutic outcomes. With the global increase in ageing populations, accurately differentiating NPH from other neurodegenerative disorders and managing overlapping comorbidities has become increasingly significant.

• Keywords
• CEREBRAL METABOLISM, CSF DYNAMICS, DEMENTIA, GERIATRICS, MRI,
• Publication type
• Journal Article MeSH
• Review MeSH