Sudden Death: A Public Health Problem

Source: UNC SUDDEN“9-1-1 … Hello! Somebody just collapsed on MLK Road near the Root Cellar café,” said a bystander as he rushed towards the man lying still in the parking lot. A second young man on the scene was already performing CPR.

The bystander asked the young man, “What just happened? I saw him walking a few minutes ago and he seemed fine.”

The young man responded with a broken voice: “Andrew is our neighbor. I don’t know what happened. I found him unresponsive and lying on the ground beside his car door.”

This unfortunate scenario is most commonly attributed to sudden cardiac (heart) death, which is defined by the World Health Organization as a death occurring within an hour of symptom onset or an unexpected death within 24 hours of having been seen alive. This definition is restricted by timing and manner of death, and also assumes that death within this time frame is due to a cardiac event. This often results in the mischaracterization of non-cardiac incidents of sudden death. Seeking to address these limitations in the examination of sudden death, both due to cardiac and noncardiac causes, physician scientists in the Division of Cardiology at the University of North Carolina at Chapel Hill Hospital initiated a project studying  all causes of out-of-hospital sudden unexpected death in North Carolina. This initiative is called the SUDDEN Project.

What is the SUDDEN Project?

Sudden death is a term encompassing all causes of out-of-hospital sudden unexpected death (SUD). The SUDDEN project, led by principal investigator Ross J Simpson Jr., was piloted in Wake County, North Carolina in March 2013. All natural deaths, regardless of underlying cause, were studied. “Unexpectedness” was determined based on the location of death, manner of death, and medical history in persons aged 18 to 64. Victims who had an unexpected death were characterized based on their demographic and medical disease profile to understand the risk factors.  As our understanding advances regarding sudden deaths, we can begin to understand risk factors for both cardiac and non-cardiac deaths. The initiative has now expanded to more than 10 counties in North Carolina and a few counties in South Carolina.

Why is it important to study out-of-hospital sudden unexpected death?

Previously, sudden death had been considered to be an unpredictable first sign of an underlying disease. However, Lewis M.E., , described out-of-hospital SUD as a syndrome with a hefty price tag, with 1 out of 3 victims characterized as high utilizers of the health care system. These individuals die not only due to cardiac events such as heart attacks, but also due to worsening chronic diseases including diabetes, hypertension, obesity, lung disease, and kidney disease. Investigators described risk factors and medical disease profiles of out-of-hospital SUD victims by different age groups. All of these diseases decrease quality of life for their victims, and this deterioration is primarily due to frequent hospitalizations, clinic visits, and emergency department visits. Sudden death victims also can suffer from unaddressed mental health issues, exacerbating the management of their baseline chronic disease. Out-of-hospital SUD is not only an individual burden, but also a familial and a societal burden. This loss of life incurs countless unforeseen medical and end-of-life expenses. However, these costs do not begin to compare to the emotional impact on the families of those who die suddenly. These economic and emotional burdens could be minimized by identification and treatment of  underlying diseases that eventually cause sudden death. Identifying risk factors to predict SUD victims could allow for timely interventions and prevent their death.

Figure Source: Maradey, J.  Comorbidity Profile for Out of Hospital Sudden Unexpected Deaths Varies By Age. Presented at European Society of Cardiology. 2016. Pub Status: In-Print

People who die from SUD also suffer numerous health problems.

Future of out-of-hospital sudden unexpected death prevention

Characterizing the profiles of  out-of-hospital SUD victims will lead to the development of strategies focused on intervention planning. This will identify and treat the potential out-of-hospital SUD victims. In order to develop community-based paramedicine programs, SUDDEN has developed close collaborations with the Gillings School of Public Health, the ODUM Institute, and the Eshelman School of Pharmacy at UNC, as well as the Emergency Medical Services of several counties. They have also developed national collaborations with both the Environmental Protection Agency and the Center for Disease Control. These collaborations will aim to build a framework of targeted  prevention plans through meaningful partnerships with community health partners across North Carolina and the United States to provide adequate access to health care resources and social support networks. The SUDDEN Project is fortunate enough to welcome students from multiple educational backgrounds to collaborate on their ongoing projects. For general inquiries and/or questions, please email

Peer edited by Michelle Engle and Nicole Tackmann. 

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An Apple Logo a Day Means Your Memory’s Okay, But Not Perfect

Immediately close your eyes and draw the Apple logo from memory. How confident are you that your drawing is accurate? Keep reading to see how well you did!

Companies change logos frequently. Google, Uber, and Instagram all rebranded in the past year or so. But how well do we actually know what these logos look like? Consider this: which way is Lincoln facing on the penny? Don’t dig into your pocket. Think about it for a second.

In a now classic study, people could not accurately identify the details of pennies. Features were confused, misplaced, or left out altogether. We’ve seen pennies many times throughout our lives, yet we are remarkably poor at remembering their design.

The penny result may seem surprising. But when we are not specifically asked to learn something – and even when we are – our memory doesn’t always come through. Our memories are not perfect. They are a combination of the actual object or event that we experienced and our own expectations and knowledge.  “But okay,” you’re thinking, “I rarely use pennies. Surely I would remember something more meaningful.”

Since the penny study, researchers have continued to explore the connection between our exposure to objects and our memory for them. In one recent study researchers looked at the Apple logo, a symbol that is everywhere; it’s on TV, on billboards, and in the hands of the person sitting next to you. Logos are also made to be recognizable, so we must know what it looks like, right?

Once again, the answer is “Not really.” Participants were, justifiably, very confident in their ability to draw the logo from memory, but only one (out of 85!) did so perfectly. The drawings tended to include parts of apples that are not in the logo, such as stems, consistent with the idea that our memory is based on our expectations (in this case, expectations of what an apple should look like). Participants even struggled to pick out the logo from eight different variations: less than half chose the correct one.

Source: By Apple, Inc. [Public domain], via Wikimedia Commons

How well did you draw the Apple logo from memory?

A similar pattern is found for locating potentially life-saving objects. Here, researchers asked university faculty, staff, and students about the location of the nearest fire extinguisher in their building. These participants had worked in the building for about 5 years, yet most (about 75%) could not report the location.

Even frequent physical interaction with objects does not guarantee success: We can have poor memory for a well-traveled elevator, and self-identified Apple users were just as overconfident in their memory for the logo as were non-users.

Here’s what is happening. Passively encountering or interacting with something does not ensure we’ll remember it. We have little trouble remembering the gist of an event or object, but picking out particular features or locations is difficult.

Cognitive psychologist Alan Castel and colleagues differentiate between “seeing” and “noticing.” Being exposed to information frequently (or “seeing” it) does not guarantee we will notice and remember it. Actually, all that exposure may encourage us to stop paying attention to the details, particularly when they do not hold any real benefit, which is the case for specifics of a penny or the Apple logo. We know it’s a penny because of its size and color, not because of the direction Lincoln faces (it’s to the right).

But these memory lapses are not necessarily a bad thing. Not keeping track of every detail leaves us room to process other important things in the world around us. We can also rely on our expectations for where objects will be, such as that a fire extinguisher will be in an easily accessible place, or that the random piece of trivia knowledge can be found on Google.

Here’s a good place to start if you want to remember something: think about it. Cognitive scientist Daniel Willingham says that memory is the residue of thought. So when you want to remember the layout of that nickel in your pocket, spend some time mulling it over.

Peer edited by Amy Rydeen

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Why Oreos Are Not As Addictive As Cocaine

They had to go. Their cream filled indifference stared back at me as I decided their final seconds were nigh. The Oreos. They would all disappear into my face tonight. All I knew was that by the next day, I wanted to be released from their siren song. You might imagine that my reasoning is similar to that of a cocaine addict, vowing to dispose of the last of their stash to aid going clean the next day.

Yet I can assure you, I am not addicted to Oreos.

You may have been concerned about your beloved cookie after reading articles that poured forth from the internet in 2013 making bold claims about Oreo addictiveness. Even though research suggests that sugary foods like the Oreo have negative health consequences, rest assured, there is little evidence to support sensationalist headlines like “Rats find Oreos as addictive as cocaine”. Continue reading