Abstract The 3243A>G mutation in mitochondrial DNA (mtDNA), the most common cause of the syndrome of mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes, is also associated with many other phenotypes such as hearing loss, diabetes mellitus, epilepsy, cognitive decline, myopathy and cardiomyopathy. The prevalence of the mutation has been shown to be 16.3/100 000 adults in Northern Finland. The present study was performed to estimate the frequency and progression of cardiac abnormalities and to examine causes of death in patients with 3243A>G. Left ventricular hypertrophy (LVH) was found in echocardiography in 56% of patients with 3243A>G and in 15% of age and sex-matched controls. The median thickness of the diastolic interventricular septum or posterior wall was 14 mm in the patients with LVH. The prevalence of LVH determined by echocardiography increased from 40% to 56% in 25 patients with 3243A>G during three years of follow-up, this trend being especially marked among the diabetic patients. The ultra-low-frequency (ULF) and very-low-frequency (VLF) components of the spectral analysis of heart rate variability (HRV) were lower among the patients with 3243A>G than in matched controls (p = 0.02 in ULF and p = 0.04 in VLF), and the short-term fractal scaling exponent in detrended fluctuation analysis of HRV was lower in the patients with 3243A>G (1.16 ± 0.18 vs. 1.28 ± 0.13) (p < 0.01). Survival analysis of a birth cohort from pedigrees with 3243A>G revealed excess mortality before the age of 50 years. Neurological and cardiovascular diseases accounted for 32% of all the underlying causes of death in families with 3243A>G. Death was sudden and unexpected in 31% of cases in which 3243A>G was considered to be involved in the cause of death. The results show that cardiac abnormalities are frequent and progressive in patients with the 3243A>G mtDNA mutation and that cardiac autonomic regulation is disturbed. Patients with the 3243A>G mutation and their first degree maternal relatives died younger than was presupposed by their life expectancy at birth or at 15 years. The most common causes of death were neuropsychiatric and cardiovascular diseases.

Trends and patterns of cancer mortality in Kazakhstan in comparison with some selected European countries from 1986 to 2008 Abstract This thesis primarily addresses mortality patterns and trends by main causes of death and by major neoplasms in Kazakhstan in comparison with the selected European countries: the Czech Republic, France and Sweden during 1986-2008. Within the whole group of main causes of death, the changes of mortality levels in different groups of neoplasms are analyzed. The analysis is accompanied with the comparison of mortality levels from major neoplasms within the selected countries. Afterwards the thesis focuses on cancer causes and risk factors in the countries under observation. The analysis concludes that the current mortality situation in Kazakhstan follows up long term adverse mortality trends of the past two decades and neoplasms remain an important public health problem in Kazakhstan. Key Words: mortality, cancer, malignant neoplasms, cause of death, standardized mortality rates, comparison, Kazakhstan, Czech Republic, France, Sweden

Using data collected in 2007 for Addis Ababa Mortality Surveillance, the paper examines the effect of cause of death/type of illness on choice of health care in adults 12 years and above. The multinomial logit model using bootstrapped standard errors is used to investigate the relationship between dominant type of treatment and the covariates: cause of death, gender, age, education, occupation, ethnicity and religion. Availability of water, television and telephone in the household are used as a proxy for economic status. After controlling for duration of illness (exposure), type of illness, gender and marital status are significant. Those who die of HIV/TB and cancer behave similar in way they seek help, and have high likelihood of using traditional healers as the first point for help compared to those who died as a result of other illnesses. Thus the study concludes that cause of death; gender and marital status affect choice of health service.

Die Feststellung der Todesursache und der Todesart ist eine ärztliche Aufgabe, welche medizinisch nicht trivial und gesellschaftlich bzw. rechtlich relevant ist. Dabei spielt die Unterscheidung zwischen einem natürlichen und einem nicht natürlichen Tod eine wichtige Rolle. Im folgenden Aufsatz soll vor dem Hintergrund dreier Fallvignetten aus einem hausärztlichen Versorgungskontext heraus das Themenfeld der Bewertung des Todes durch „freiwilligen Verzicht auf Essen und Trinken“ (im Folgenden: fVET) näher betrachtet werden. Die Autoren plädieren ausdrücklich für die Verwendung des Begriffes „freiwilliger Verzicht auf Essen und Trinken“. Dadurch soll deutlich gemacht werden, dass es eben nicht um den Verzicht auf ggf. über eine Sonde oder über einen venösen Gefäßzugang „künstlich“ zugeführte „Nahrung und Flüssigkeit“ als ärztliche Behandlungsmaßnahme geht 1.

Introdução: As estatísticas de mortalidade são usadas pelo mundo inteiro e por isso precisa ter dados confiáveis e comparáveis. Uma das estratégias para melhorar sua qualidade é a automação de etapas do fluxo dos dados. O Iris é um sistema que codifica as causas de morte da declaração de óbito (DO) e seleciona a causa básica de morte. Objetivos: adaptar o software para uso no Brasil, testá-lo e comparar seu uso com a codificação manual e com a seleção do sistema usado na rotina brasileira, o Sistema de Seleção da Causa Básica de Morte (SCB). Métodos: foram utilizadas uma amostra de declarações de óbito de óbitos ocorridos no período de janeiro a junho de 2014 em nove cidades representando as cinco regiões do Brasil. Foram selecionados óbitos pelas causas mais comuns, com menção de doença transmissível, assim como óbitos infantis, maternos e óbitos com menção de causa externa ou cirurgia. A fase 1 visou a conclusão do dicionário e a fase 2 testar e comparar o uso do Iris. Resultados: 1848 DO, com uma média de 3,1 linhas preenchidas por DO. Foram realizadas 618 ajustes ou adições nas tabelas do dicionário ou nas tabelas de padronização. Em 45,9 por cento das DO o Iris codificou todas as causas de morte presente na DO assim como selecionou a causa básica de morte. Das DO que o Iris não conseguiu concluir o processo, a maioria (97,8 por cento) dessas rejeições foi por dificuldade em encontrar ou processar um código da CID. A concordância do Iris com a codificação manual nos níveis de 4 caracteres, 3 caracteres e 1 caractere dos códigos da CID-10 foi de 73,3 por cento, 78,2 por cento e 83,9 por cento respectivamente. Isso representou uma discordância em 49,1 por cento das DO. A concordância da causa básica de morte com o SCB foi de 74,2por cento, 84,3 por cento e 91,8 por cento nos níveis de 4 caracteres, 3 caracteres e 1 caractere dos códigos da CID-10 respectivamente. A principal causa de discordância (71 por cento) foi por codificações diferentes. Após as pequenas correções, o Iris finaliza 66,6 por cento das DO. Conclusão: As discordâncias tiveram como causa os hábitos e rotinas dos codificadores que variam entre eles, enquanto no Iris a codificação de uma causa é sempre a mesma. As tabelas de decisão do SCB precisam ser revistas. Os dados mostram que é possível usar esta ferramenta e que ela vai diminuir o trabalho dos codificadores. O Iris teve uma boa taxa de finalização, semelhante a países que o utilizam na sua rotina. / Introduction: Mortality statistics is used all over the world and therefore needs reliable and comparable data. One of the strategies to improve quality is an automated data collection. Iris is a system that codes the causes of death of the death certificate (DC) and selects the underlying cause of death. Objective: To adapt Iris software to Brazil finalising the Portuguese dictionary, to test Iris and to compare it with manual coding and with the selection of the Basic Death Cause Selection System (Portuguese acronym is SCB). Methods: The sample was death certificates occurred from January to June of 2014 in nine cities representing the five regions of Brazil. Were selected to compose the sample: routine deaths, DC with mention of communicable disease, infant death, maternal death and DC with mention of external cause or surgery. Phase 1 aimed to complete the dictionary and phase 2 aimed to test and compare Iris. Results: The sample was1848 DC, with an average of 3.1 lines filled by DC. There were 618 adjustments or additions to dictionary tables or standardization tables. In 45.9 per cent of DC Iris coded all causes of death and selected the underlying cause of death. Of the DC that Iris was unable to complete the process, the majority (97.8 per cent) of these rejections were due to difficulty in finding or processing an ICD code. Iris agreement with manual coding at the 4-character, 3- character, and 1-character levels of ICD-10 codes was 73.3 per cent, 78.2 per cent and 83.9 per cent, respectively. This represented a disagreement in 49.1 per cent of DC. The concordance of the underlying cause of death with SCB was 74.2 per cent, 84.3 per cent and 91.8 per cent at the 4- character, 3-character and 1-character levels respectively. The main cause of discordance (71 per cent) was by different codes for the same cause of death. After the small corrections, Iris finalised 66.6 per cent of the DC. Conclusion: The disagreements were caused by coders routines that can vary between them, whereas in Iris the codification of a cause is always the same. The SCB decision tables need to be reviewed. The data show that it is possible to use this tool and that it will decrease the work of the coders. Iris had a good finalisation rate, similar to countries that use it in their routine.

Comitês de Mortalidade Materna, que não investigam todos os óbitos de mulheres de 10 a 49 anos, utilizam lista de causas presumíveis de morte materna para a busca ativa de causas maternas de óbito. Mediante dados do Comitê de Estudo e Prevenção da Mortalidade Materna, para o Município de São Paulo (CMMSP), e do “Estudo de mortalidade de mulheres de 10 a 49 anos, com ênfase na mortalidade materna", realizado nas capitais de estados brasileiros e Distrito Federal (GPP), analisou-se a utilização da lista de causas presumíveis do Manual dos Comitês de Mortalidade Materna do Ministério da Saúde. Conforme investigação do CMMSP, em relação às causas maternas declaradas em 2001, houve um acréscimo de 72,7% de causas maternas. A análise dos dados com a utilização da lista mostrou que 39,4% eram causas maternas presumíveis e 33,3% não eram causas presumíveis. Entre as Declarações de Óbito (D.O.) originais do primeiro semestre de 2002, do estudo do GPP, em que causas maternas não estavam declaradas e se tornaram causas maternas, verificou-se que 52,6% eram presumíveis e 47,4% não eram presumíveis. Quanto à variável da D.O., que informa se a mulher estava grávida no momento da morte, ou esteve grávida nos doze meses que antecederam a morte, verificou-se a ausência de preenchimento dos campos 43 e 44, em mais de 50% das D.O. com outras causas declaradas e que se tornaram causas maternas, tanto na investigação do CMMSP quanto na do GPP. Concluiu-se que os Comitês de Prevenção da Mortalidade Materna deveriam investigar todas as mortes de mulheres de 10 a 49 anos. / Committees of Maternal Mortality, which do not investigate all the deaths of women between 10 and 49 years old, use a list of presumable causes of maternal death for the active search of maternal causes of death. Based on the data from the Committee of Studies and Prevention of Maternal Mortality for the Municipality of São Paulo (CMMSP) and on the “Study of mortality of women between 10 and 49 years old with an emphasis on maternal mortality", developed for the Brazilian state capitals and the Federal District (GPP), the utilization of the list of presumable causes from the Health Ministry Manual of the Committees of Maternal Mortality was analyzed. According to the CMMSP data, there was an increase of 72,7% of maternal causes in relation to the declared maternal causes in 2001. The analysis of data with the use of the list showed that 39,4% were presumable maternal causes and 33,3% were not presumable causes. Among the maternal causes which were not declared in the original Death Certificates of the GPP Study for the first semester of 2002, it was verified that 52,6% were presumable and 47,4% were not presumable. As to the pregnancy variable of Death Certificates, it was verified the absence of information in the form in more than 50% of the Certificates with other causes declared and that were maternal causes in the CMMSP and in the GPP investigation. The conclusion is that the Committees of Prevention of Maternal Mortality should investigate all the deaths of women in ages between 10 to 49 years old.

No Brasil, no transcorrer da última década tem-se aumentado a produção de energia renovável. Dessa forma, empreendimentos visando produção e distribuição de energia tem sido desenvolvidos, exemplo disto são as Pequenas Centrais Hidrelétricas (PCHs). Perda e fragmentação de habitat são consideradas fatores negativos para a conservação in situ</i/>, sendo que podem colocar em perigo de extinção numerosas espécies de vertebrados terrestres. Durante a construção de hidrelétricas, esses dois eventos podem ocorrer em um espaço de tempo curto e abranger pequenas ou grandes extensões de habitat natural dessas espécies. Dentro do âmbito ambiental, essas obras demandam a criação e desenvolvimento de programas de monitoramento e conservação, visando diminuir o impacto sobre as populações silvestres que ocorrem na área diretamente afetada pelo empreendimento, resultando no óbito de numerosos indivíduos durante o desenvolvimento das etapas desse programa. Sendo assim, visando entender quais são os fatores que podem levar à perda de um animal silvestre nesses programas se projetou acompanhar entre 2008 e 2010 as etapas do programa de monitoramento e conservação e as do centro de triagem de animais selvagens (CETAS) da PCH Anhanguera, que foi construída no nordeste do Estado de São Paulo. Vertebrados terrestres e aves que vieram a óbito foram submetidos à necropsia e amostras dos principais órgãos e lesões representativas foram fixadas em formalina 10% e posteriormente processadas para avaliação histopatológica. Ao final do exame necroscópico, laudo macroscópico foi elaborado e quando possível foi determinada a causa de morte. Havendo impossibilidade da determinação da causa de morte, resultados dos exames complementares foram aguardados. Foram avaliados 486 animais, entre anfíbios (81), aves (12), mamíferos (164) e répteis (229) em três momentos: monitoramento, resgate na supressão da vegetação e centro de triagem de animais silvestres. As causas de morte estiveram associadas a processos não infecciosos (64,82%), seguido por causa indeterminada (22,43%), eutanásia (9,26%), suspeita de infeccioso (2,26%) e processos infecciosos (1,23%). Acidentes por objetos contundentes durante supressão que causaram trauma foram relevantes em répteis durante a supressão (&chi;2= 23.3490; &rho;= 0.0000). Ataques por contactantes ou predação e acidentes (afogamento e hipotermia) acontecidos nas armadilhas de captura foram significativas causas de morte para mamíferos durante o monitoramento (&chi;2= 25.5620; &rho;= 0.0003). Para anfíbios, as eutanásias induzidas na supressão em decorrência de injúrias graves em tecidos moles e de tecido muscular esquelético foram a causa de morte que mais afetou esse grupo (&chi;2= 8.2437; &rho;= 0.0041). A conservação da fauna durante um programa faunístico de um empreendimento está associada ao manejo adequado dessas populações em campo e centros de triagem. Aumento da captura prévia nas áreas a serem suprimidas, das vistorias nas armadilhas de captura e propensão por uma destinação oportuna dos indivíduos capturados facilitaria a sobrevivência da fauna acometida pelo empreendimento. / In the course of the last decade Brazil has increased the production of renewable energy. Thus, projects aiming energy production and distribution have been developed such as Small Hydro Power Stations (SHPS). Loss and fragmentation of habitat are considered negative factors for in situ conservation, and can put many endangered species of terrestrial vertebrates. During the construction of dams, these two events may occur in a short space of time and cover small or large tracts of natural habitat of these species. Within an environmental framework these enterprise create and develop conservation programs in order to reduce the impact on wild populations that occur in the influence area project. Commonly, many individuals may die during the stages of the program. In order to understand what are the factors that can lead to loss of wild animals in these programs, monitoring, rescue and triage center activities, of the program of the SHP Anhanguera, were accompanied between 2008 and 2010. Dam and reservoir were built in the northeastern of São Paulo State, Brazil. Post-mortem examinations were performed in terrestrial vertebrates and birds that died. Samples of major organs were collected and representative lesions were fixed in 10% formalin and later processed to pathological evaluation. At the end of the necropsy, macroscopic report was prepared and, if possible, it was determined the cause of death. Were not possible laboratory tests were awaited. It was evaluated 486 animals, including amphibians (81), birds (12), mammals (164) and reptiles (229) in three phases: monitoring, rescue in forest clearing and triage center. Causes of death were associated with non-infectious processes (64.82%), followed by unknown causes (22.43%), euthanasia (9.26%), suspected infection (2.26%) and infectious processes (1,23%). Accidents caused by blunt objects that resulted in trauma during removal forest were relevant in reptiles (&chi;2 = 23.3490, &rho; = 0.0000). Attacks by predators or contacted and accidents (drowning and hypothermia) that occurred in the traps capture were significant causes of death of mammals during monitoring (&chi;2 = 25.5620, &rho; = 0.0003). For amphibians, euthanasia induced due to severe soft tissue and skeletal muscle injuries in the suppression, were the cause of death that most affected this group (&chi;2 = 8.2437, &rho; = 0.0041). The conservation of wildlife fauna during a conservation program of a hydroelectric enterprise is linked to the appropriate management of these populations in the affected areas and triage centers. Increase of previous captures in the areas of vegetal suppression, check of traps capture and opportune destination of captured animals facilitate the survival of wildlife affected by the project.

No Brasil, no transcorrer da última década tem-se aumentado a produção de energia renovável. Dessa forma, empreendimentos visando produção e distribuição de energia tem sido desenvolvidos, exemplo disto são as Pequenas Centrais Hidrelétricas (PCHs). Perda e fragmentação de habitat são consideradas fatores negativos para a conservação in situ</i/>, sendo que podem colocar em perigo de extinção numerosas espécies de vertebrados terrestres. Durante a construção de hidrelétricas, esses dois eventos podem ocorrer em um espaço de tempo curto e abranger pequenas ou grandes extensões de habitat natural dessas espécies. Dentro do âmbito ambiental, essas obras demandam a criação e desenvolvimento de programas de monitoramento e conservação, visando diminuir o impacto sobre as populações silvestres que ocorrem na área diretamente afetada pelo empreendimento, resultando no óbito de numerosos indivíduos durante o desenvolvimento das etapas desse programa. Sendo assim, visando entender quais são os fatores que podem levar à perda de um animal silvestre nesses programas se projetou acompanhar entre 2008 e 2010 as etapas do programa de monitoramento e conservação e as do centro de triagem de animais selvagens (CETAS) da PCH Anhanguera, que foi construída no nordeste do Estado de São Paulo. Vertebrados terrestres e aves que vieram a óbito foram submetidos à necropsia e amostras dos principais órgãos e lesões representativas foram fixadas em formalina 10% e posteriormente processadas para avaliação histopatológica. Ao final do exame necroscópico, laudo macroscópico foi elaborado e quando possível foi determinada a causa de morte. Havendo impossibilidade da determinação da causa de morte, resultados dos exames complementares foram aguardados. Foram avaliados 486 animais, entre anfíbios (81), aves (12), mamíferos (164) e répteis (229) em três momentos: monitoramento, resgate na supressão da vegetação e centro de triagem de animais silvestres. As causas de morte estiveram associadas a processos não infecciosos (64,82%), seguido por causa indeterminada (22,43%), eutanásia (9,26%), suspeita de infeccioso (2,26%) e processos infecciosos (1,23%). Acidentes por objetos contundentes durante supressão que causaram trauma foram relevantes em répteis durante a supressão (&chi;2= 23.3490; &rho;= 0.0000). Ataques por contactantes ou predação e acidentes (afogamento e hipotermia) acontecidos nas armadilhas de captura foram significativas causas de morte para mamíferos durante o monitoramento (&chi;2= 25.5620; &rho;= 0.0003). Para anfíbios, as eutanásias induzidas na supressão em decorrência de injúrias graves em tecidos moles e de tecido muscular esquelético foram a causa de morte que mais afetou esse grupo (&chi;2= 8.2437; &rho;= 0.0041). A conservação da fauna durante um programa faunístico de um empreendimento está associada ao manejo adequado dessas populações em campo e centros de triagem. Aumento da captura prévia nas áreas a serem suprimidas, das vistorias nas armadilhas de captura e propensão por uma destinação oportuna dos indivíduos capturados facilitaria a sobrevivência da fauna acometida pelo empreendimento. / In the course of the last decade Brazil has increased the production of renewable energy. Thus, projects aiming energy production and distribution have been developed such as Small Hydro Power Stations (SHPS). Loss and fragmentation of habitat are considered negative factors for in situ conservation, and can put many endangered species of terrestrial vertebrates. During the construction of dams, these two events may occur in a short space of time and cover small or large tracts of natural habitat of these species. Within an environmental framework these enterprise create and develop conservation programs in order to reduce the impact on wild populations that occur in the influence area project. Commonly, many individuals may die during the stages of the program. In order to understand what are the factors that can lead to loss of wild animals in these programs, monitoring, rescue and triage center activities, of the program of the SHP Anhanguera, were accompanied between 2008 and 2010. Dam and reservoir were built in the northeastern of São Paulo State, Brazil. Post-mortem examinations were performed in terrestrial vertebrates and birds that died. Samples of major organs were collected and representative lesions were fixed in 10% formalin and later processed to pathological evaluation. At the end of the necropsy, macroscopic report was prepared and, if possible, it was determined the cause of death. Were not possible laboratory tests were awaited. It was evaluated 486 animals, including amphibians (81), birds (12), mammals (164) and reptiles (229) in three phases: monitoring, rescue in forest clearing and triage center. Causes of death were associated with non-infectious processes (64.82%), followed by unknown causes (22.43%), euthanasia (9.26%), suspected infection (2.26%) and infectious processes (1,23%). Accidents caused by blunt objects that resulted in trauma during removal forest were relevant in reptiles (&chi;2 = 23.3490, &rho; = 0.0000). Attacks by predators or contacted and accidents (drowning and hypothermia) that occurred in the traps capture were significant causes of death of mammals during monitoring (&chi;2 = 25.5620, &rho; = 0.0003). For amphibians, euthanasia induced due to severe soft tissue and skeletal muscle injuries in the suppression, were the cause of death that most affected this group (&chi;2 = 8.2437, &rho; = 0.0041). The conservation of wildlife fauna during a conservation program of a hydroelectric enterprise is linked to the appropriate management of these populations in the affected areas and triage centers. Increase of previous captures in the areas of vegetal suppression, check of traps capture and opportune destination of captured animals facilitate the survival of wildlife affected by the project.

近年來電腦等高科技的快速成長，進而促進資訊化的過程。資料庫的蓬勃發展，使得資料大量累積，長久之下，卻造成資料過多，資訊不足的嚴重問題。因此資料庫內的知識探索議題也隨之興起，而資料採礦（Data Mining）的過程，更是其中重要的一環。 相同的，預防醫學資訊的發展，流行病學資料庫中亦累積了大量關於死亡統計資料，而這些資料中，隱藏可能存在的知識，能加強我們對疾病進展的瞭解。若將資料採礦的概念應用於流行病學領域，相信必能相輔相成。 本研究的重點在於結合統計軟體 STATISTICA，以Visual Basic 6.0語言開發一個簡易的資料採礦系統之使用者介面，並將資料採礦技術應用於死亡統計資料中。系統中的挖掘方法主要採用敘述統計、交叉分析與多變量分析中的群集分析與區別分析，根據行政院衛生署統計室所提供之民國八十三年至八十八年台灣地區人口死亡原因資料，來發現隱藏在資料中的趨勢與模式。 / For the past decade the development in computer technology has advanced so rapidly that it brings forth the enormous supply of data information. As time passes by the data information has been increasingly accumulated yet little can be inferred from the data thus resulting a loss of information which might be of significant. Bearing with the existence of such issue, this research presents the process of data mining as one of the solution. Similarly, the data base in the field of medical science may have contained a large amount of information. If one can appropriately apply the application of data mining into this huge database then we may be able to extract some valuable findings. The focus of this research is to develop a user friendly operating system using Visual Basic 6.0 and integrates the statistical software-STATISTICA into the operating system. The research applies the application of data mining on the death data provided by Statistics Office, Department of Health from 1994 to 1999. The methods used in this application are descriptive statistics, cross tabulation, cluster analysis, and discriminant analysis of multivariate analysis in an attempt to find out if there is any pattern in the cause of death.

<p>Violence against children and particularly the “Bobby Case” in spring 2006 initiated an unprecedented debate in the Swedish media about child maltreatment and child murder. There are however some children whose death causes never will be solved, and some of these cases are erroneously classified as something else.</p><p>The present survey is commissioned by the Swedish Rescue Services Agency and the Swedish Centre for Lessons Learned from Incidents & Accidents, and will serve as the basis for a children safety council which will be established 2006.</p><p>In this survey the answer to the question how deaths among children and youth under the age of 18 years caused by accidents, suicides and violence are investigated when the background and the intention is uncertain is elaborated. A statistical report of how many deaths are classified as uncertain intent is given in the survey. The statistics shows that 26 children and youths under the age of 18 have died from uncertain intent between the years 1997-2003.</p><p>There are many purposes to a death investigation, for example to determine the cause and manner of death. With help from the Statue Book of Sweden knowledge has been obtained about which authorities that are handling death investigations when the cause and manner of death is uncertain. The authorities involved are the physicians, the police force and the National Board of Forensic Medicine. The physician determines whether deaths shall be reported to the police or not i.e. when the cause of death or the manner of death is uncertain. The police then make death investigations to determine whether there is a crime or not. The National Board of Forensic Medicine is contacted to perform autopsies.</p><p>Interviews were performed with police and forensic medicine staff to find out which methods they were using to investigate deaths. The methods used are autopsies and crime investigations. There are no differences when it comes to the age of the deceased, neither of the classification nor the investigation. The police use the classification “uncertain manner of death” when the main cause of death can’t be determined. The forensic medicine physician uses the classification uncertain when the body is so decomposed that there is no possible way to determine cause or manner of death.</p><p>A conclusion in this report is that lack of communication exists between the different government authorities and that this may be a reason to why deaths sometimes are classified incorrectly. Some investigations are also performed by policemen without proper education and this is a possible reason to why some classifications are changed during the process of investigation.</p> / <p>Den senaste tiden har våld mot barn och då framförallt omständigheterna kring tioårige Bobbys död våren 2006 gett upphov till en intensiv debatt i svenska media om barnmisshandel och barnamord. Ett i detta sammanhang mindre uppmärksammat problem är att det med stor sannolikhet finns barnamord som aldrig blir uppklarade eller som klassificeras som något helt annat.</p><p>Föreliggande arbete är ett uppdrag från Räddningsverket och NCO och undersökningen kommer att ligga som underlag i en nulägesredovisning till Barnsäkerhetsrådet som kommer att bildas under 2006. I uppsatsen beskrivs hur dödsfall utreds där barn och ungdomar under 18 år har avlidit på grund av olyckor, suicid och våld där bakgrund och avsikten är oklar.</p><p>Det finns en mängd syften med att göra en dödsfallsutredning, bland annat att fastställa dödsorsak och dödssätt. Med hjälp av bland annat lagtexter fås svar på vilka som utför dödsfallsutredningar där bakgrund och avsikt är oklar. En statistisk genomgång visade att 26 barn och ungdomar under 18 år har avlidit med oklar skadehändelse (avsikt) mellan åren 1997-2003.</p><p>Tillkallad läkare beslutar om att dödsfallet ska anmälas till polis. Detta görs bland annat när dödsfallets bakgrund och avsikt är oklar. Polisen gör då en dödsfallsutredning för att fastställa om något brott har begåtts. De tar då hjälp av Rättsmedicinalverket för att göra en rättsmedicinsk undersökning.</p><p>För att få reda på vilka metoder som användes för att utreda oklara dödsfall genomfördes intervjuer med rättsmedicinare och polis. Man gör inte någon skillnad på utredning beroende på ålder på den avlidne, varken utredningsmässigt eller klassifikationsmässigt. Polisen använder klassificeringen oklar när dödsfallen beror på kombinationer av olika faktorer och huvuddödsorsaken inte går att fastställa. Rättsmedicinarna använder klassificeringen oklar när den avlidne är så likomvandlad att varken dödssätt eller dödsorsak går att fastställa.</p><p>I undersökningen framkommer det att det finns en brist i kommunikationen mellan de olika myndigheterna och att detta kan vara en anledning till att det sker felklassificeringar. Det framkommer även att det ibland inte är utbildade poliser som påbörjar en utredning. Detta kan vara en bidragande orsak till att det är en så stor del av alla utredningar som ändrar klassificering under utredningens gång.</p>