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The 2008 economic recession was associated with an increase in suicide internationally. Studies have focused on the impact in the general population with little consideration of the effect on people with a mental illness.
To investigate suicide trends related to the recession in mental health patients in England.
Using regression models, we studied suicide trends in mental health patients in England before, during and after the recession and examined the demographic and clinical characteristics of the patients. We used data from the National Confidential Inquiry into Suicide and Safety in Mental Health, a national data-set of all suicide deaths in the UK that includes detailed clinical information on those seen by services in the last 12 months before death.
Between 2000 and 2016, there were 21 224 suicide deaths by patients aged 16 or over. For male patients, following a steady fall of 0.5% per quarter before the recession (quarterly percent change (QPC) 2000–2009 –0.46%, 95% CI –0.66 to –0.27), suicide rates showed an upward trend during the recession (QPC 2009–2011 2.37%, 95% CI –0.22 to 5.04). Recession-related rises in suicide were found in men aged 45–54 years, those who were unemployed or had a diagnosis of substance dependence/misuse. Between 2012 and 2016 there was a decrease in suicide in male patients despite an increasing number of patients treated. No significant recession-related trends were found in women.
Recession-associated increases in suicide were seen in male mental health patients as well as the male general population, with those in mid-life at particular risk. Support and targeted interventions for patients with financial difficulties may help reduce the risk at times of economic hardship. Factors such as drug and alcohol misuse also need to be considered. Recent decreases in suicide may be related to an improved economic context or better mental healthcare.
Declaration of interest
N.K. is supported by Greater Manchester Mental Health NHS Foundation Trust. L.A. chairs the National Suicide Prevention Strategy Advisory Group at the Department of Health (of which N.K. is also a member) and is a non-executive Director for the Care Quality Commission. N.K. chairs the National Institute for Health and Care Excellence (NICE) depression in adults guideline and was a topic expert member for the NICE suicide prevention guideline.
Hypoalbuminemia is associated with morbidity and mortality in critically ill children. In this multi-centre retrospective study, we aimed to determine normative values of serum albumin in neonates and infants with congenital heart disease, evaluate perioperative changes in albumin levels, and determine if low serum albumin influences post-operative outcomes. Consecutive eligible neonates and infants who underwent cardiac surgery with cardiopulmonary bypass at one of three medical centres, January 2012–August 2013, were included. Data on serum albumin levels from five data points (pre-operative, 0–24, 24–48, 48–72, 72 hours post-operative) were collected. Median pre-operative serum albumin level was 2.5 g/dl (IQR, 2.1–2.8) in neonates versus 4 g/dl (IQR, 3.5–4.4) in infants. Hypoalbuminemia was defined as <25th percentile of these values. A total of 203 patients (126 neonates, 77 infants) were included in the study. Post-operative hypoalbuminemia developed in 12% of neonates and 20% of infants; 97% occurred in the first 48 hours. In multivariable analysis, perioperative hypoalbuminemia was not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels were associated with increased post-operative morbidity. Pre-operative low serum albumin level was independently associated with increased odds of post-operative hypoalbuminemia (OR, 3.67; 95% CI, 1.01–13.29) and prolonged length of hospital stay (RR, 1.40; 95% CI, 1.08–1.82). Lower 0–24-hour post-operative serum albumin level was independently associated with an increased duration of mechanical ventilation (RR, 1.35; 95% CI, 1.12–1.64). Future studies should further assess hypoalbuminemia in this population, with emphasis on evaluating clinically meaningful cut-offs and possibly the use of serum albumin levels in perioperative risk stratification models.
Objectives: Visual-spatial neglect is a common attentional disorder after right-hemisphere stroke and is associated with poor rehabilitation outcomes. The presence of neglect symptoms has been reported to vary across personal, peripersonal, and extrapersonal space. Currently, no measure is available to assess neglect severity equally across these spatial regions and may be missing subsets of symptoms or patients with neglect entirely. We sought to provide initial construct validity for a novel assessment tool that measures neglect symptoms equally for these spatial regions: the Halifax Visual Scanning Test (HVST). Methods: In Study I, the HVST was compared to conventional measures of neglect and functional outcome scores (wheelchair navigation) in 15 stroke inpatients and 14 healthy controls. In Study II, 19 additional controls were combined with the control data from Study I to establish cutoffs for impairment. Patterns of neglect in the stroke group were examined. Results: In Study I, performance on all HVST subtests were correlated with the majority of conventional subtests and wheelchair navigation outcomes. In Study II, neglect-related deficits in visual scanning showed dissociations across spatial regions. Four inpatients exhibited symptoms of neglect on the HVST that were not detected on conventional measures, one of which showed symptoms in personal and extrapersonal space exclusively. Conclusions: The HVST appears a useful measure of neglect symptoms in different spatial regions that may not be detected with conventional measures and that correlates with functional wheelchair performance. Preliminary control data are presented and further research to add to this normative database appears warranted. (JINS, 2019, 25, 490–500)
Yasmin Saikia, Professor of History and holds the endowed Hardt-Nickachos Chair in Peace Studies at Arizona State University,
M. Raisur Rahman, Associate Professor of History at Wake Forest University
Sitting high above ground in a basket suspended between two scaffolds parallel to the enormous Qutb Minar, Sayyid Ahmad Khan (1817–1898), a young munshi (clerk) of the English East India Company, read and tried to reproduce the indecipherable inscriptions on the tower in his book Asar-us Sanadid (Traces of Noblemen, also called Great Monuments of Delhi). The determination, courage, and resourcefulness demonstrated here were the hallmarks of Sayyid Ahmad's life, which was full of formidable challenges. With his imaginativeness and a keen sense of history, along with his conviction that evidence of progress is within the Muslim community, Sayyid Ahmad embarked on a progressive vision for Muslim community development in British India. His rationalist approach combined with an ethical outlook and passion transformed the lives of Muslims in India and abroad forever.
Sayyid Ahmad was born on 17 October 1817 in Mughal Delhi. He belonged to an aristocratic Muslim family who traced their genealogical roots to Prophet Muhammad. In 1864, Sayyid Ahmad moved to Aligarh – a small town, approximately 100 miles southeast of the capital city – where he spent the rest of his life. In Indian nationalist historiography, Sayyid Ahmad appears, at times, as a promoter of Hindu–Muslim unity in his early years – to him, Hindus and Muslims were ‘the two eyes of the beautiful bride that is Hindustan’. By contrast, Pakistani historiography remembers him as the architect of the two-nation theory, which eventually led to the creation of Pakistan. It is strange to attribute to him a historic event not anticipated during his time: he passed away in 1898 – forty-two years before the Muslim League raised the demand for the creation of Pakistan. Regardless of this contrasting retelling of history (one from India and the other from Pakistan), Sayyid Ahmad can be considered a true historical marker for Muslims in South Asia. Even today, he remains the unchallenged champion of Muslim modernization and community reform. Throughout his lifetime, Sayyid Ahmad envisaged a modern Muslim society by making efforts to promote modern Western education, scientific knowledge, rational thinking, religious pluralism, political accommodation, and participatory community associations founded on ethics and justice.
This volume examines Sayyid Ahmad Khan's life, his contribution, and legacy in the context of current times. The editors engage his writings, ideas, and activities to read and present his work critically, not as a biographical account of his life but approach his work keeping in mind the tumultuous political events and changes of the nineteenth century, after the failed revolt of 1857 when Indians were transformed into colonial subjects. The collective anxieties of the Indian communities, particularly the Muslims, cried out for a new local leadership; Sayyid Ahmad Khan rose up to this occasion etching the way forward for Indians, in general, and Muslims in particular. Sayyid Ahmad Khan's multifaceted work offers an important understanding for national thinking emerging from the location of the Muslim, but it is not a 'minority' voice with vested political interests rather a constructive and integrative voice of relevance even today for addressing difficult problems.
Yasmin Saikia, Professor of History and holds the endowed Hardt-Nickachos Chair in Peace Studies at Arizona State University.,
M. Raisur Rahman, Associate Professor of History at Wake Forest University
‘I aged before my age, I lost my hair, my eyesight, but not my vision. My vision never dimmed, my determination never failed. I built this institution for you and I am sure you will carry the light of this institution far and wide till darkness disappears from all around.’ These last words of Sayyid Ahmad Khan to the students of the Muhammadan Anglo-Oriental (MAO) College – now Aligarh Muslim University (AMU) – are enshrined at an entrance of the university, reminding the obligation to expand the realm of knowledge within and outside the institution. Sayyid Ahmad feared that without knowledge, a community would remain steeped in ignorance and denial. He urged Indians – Muslims and Hindus alike – to embark on the journey of modern education to stop their fall into the abyss of poverty. His pioneering thoughts, ideas, and actions in the field of education, cultural awakening, and social reform produced immediate and positive result during his lifetime, and their overall impact reverberates even today in the India–Pakistan subcontinent. Indeed, this is a rare legacy that the memory of a person can transcend the divides of the South Asian nation-states and bring people together in his memory. Sayyid Ahmad is this figure of unity.
Sayyid Ahmad's name is synonymous with modern Muslim education. His embrace of Western secular learning coupled with the adoption of English language arguably was the most powerful and radical model for Muslim education in nineteenth century India. No one before him had ventured in this direction, in spirit or in magnitude. It was a path plagued with obstacles. Muslim and Hindu opponents attacked, opposed, and reviled him. Despite severe criticisms, he pursued his dream of introducing modern, secular education and founded the MAO College at Aligarh. The benefits of modern education have reached a much larger community, larger than the network of alumni and students of AMU, the Aligs. It embraces everyone – be it Muslims or non-Muslims, Aligs or non-Aligs – who incorporates balanced scientific approach and rational thought with an awareness of religion and cultural practices. Sayyid Ahmad's life and his ideas depict a unique blend of tradition and modernity, rooted in Indian culture with the flexibility to adopt and adapt with Anglo-western culture.
In his short essay published in the Urdu quarterly Fikr-o Nazar, Khaliq Ahmad Nizami (1925–1997), an erudite scholar and eminent historian at Aligarh Muslim University (AMU), makes an interesting observation: ‘Sir Sayyid, in India, had made efforts to prove the uniformity of conceptions of religion and scientific theories. Maulana Abul Kalam Azad has called it unnecessary and even though did not mention the name of Sir Sayyid but … [he] has referred to the same trends of thoughts.’ The ideas, thoughts, and movement represented by Sir Sayyid – as he is known popularly – continued to be debated, challenged, embraced, and opposed during and after his lifetime. Maulana Abul Kalam Azad (1888–1958) was barely 10 years old when Sayyid Ahmad Khan died in 1898. The reference to Azad in this context was but a small part of the engagement Sir Sayyid drew. Succeeding leaders continued to invoke Sayyid Ahmad's thoughts and legacies. One can critique the shortcomings of his work but can hardly disagree that the nature of the tasks he undertook during his time and in the space he inhabited was pioneering. The reception of Sayyid Ahmad's ideas has never been unilinear – neither in his times nor in ours. In fact, as he went along trying to convince his cohorts of the ideas he was deeply committed to in the late nineteenth century, he garnered adversaries and critics alike.
Sayyid Ahmad found strong support in some of his lieutenants such as Nawab Mushtaq Husain Viqar-ul Mulk (1841–1917) and Sayyid Mehdi Ali Mohsin-ul Mulk (1837–1907), both of whom were very close to him – the founder of the Aligarh Movement – and carried on his message shoulder to shoulder, even more vigorously after his death. Those opposing Sayyid Ahmad included both conservatives and liberals, who curtly disapproved of his engagement with Western learning, critiqued his opposition to the Indian National Congress (INC) politics, criticized his deism, and called him naicari (‘naturalist’), a pejorative term meaning someone who had swallowed European agnostic naturalism. Regardless of the support, criticism, or outright rejection, Sayyid Ahmad was a persistent worker, thinker, negotiator, writer, orator, and leader, who tirelessly worked towards his goals, determined not to be cowed down in his vision and mission.
We evaluated the performance of three serological tests – an immunoglobulin G indirect enzyme linked immunosorbent assay (iELISA), a Rose Bengal test and a slow agglutination test (SAT) – for the diagnosis of bovine brucellosis in Bangladesh. Cattle sera (n = 1360) sourced from Mymensingh district (MD) and a Government owned dairy farm (GF) were tested in parallel. We used a Bayesian latent class model that adjusted for the conditional dependence among the three tests and assumed constant diagnostic accuracy of the three tests in both populations. The sensitivity and specificity of the three tests varied from 84.6% to 93.7%, respectively. The true prevalences of bovine brucellosis in MD and the GF were 0.6% and 20.4%, respectively. Parallel interpretation of iELISA and SAT yielded the highest negative predictive values: 99.9% in MD and 99.6% in the GF; whereas serial interpretation of both iELISA and SAT produced the highest positive predictive value (PPV): 99.9% in the GF and also high PPV (98.9%) in MD. We recommend the use of both iELISA and SAT together and serial interpretation for culling and parallel interpretation for import decisions. Removal of brucellosis positive cattle will contribute to the control of brucellosis as a public health risk in Bangladesh.