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Research has shown a strong relationship between hallucinations and suicidal behaviour in general population samples. Whether hallucinations also index suicidal behaviour risk in groups at elevated risk of suicidal behaviour, namely in individuals with a sexual assault history, remains to be seen.
We assessed whether hallucinations were markers of risk for suicidal behaviour among individuals with a sexual assault history.
Using the cross-sectional 2007 (N = 7403) and 2014 (N = 7546) Adult Psychiatric Morbidity Surveys, we assessed for an interaction between sexual assault and hallucinations in terms of the odds of suicide attempt, as well as directly comparing the prevalence of suicide attempt in individuals with a sexual assault history with v. without hallucinations.
Individuals with a sexual assault history had increased odds of hallucinations and suicide attempt compared to individuals without a sexual assault history in both samples. There was a significant interaction between sexual assault and hallucinations in terms of the odds of suicide attempt. In total, 14–19% of individuals with a sexual assault history who did not report hallucinations had one or more suicide attempt. This increased to 33–52% of individuals with a sexual assault history who did report hallucinations (2007, aOR = 2.85, 1.71–4.75; 2014, aOR = 4.52, 2.78–7.35).
Hallucinations are a risk marker for suicide attempt even among individuals with an elevated risk of suicidal behaviour, specifically individuals with a sexual assault history. This finding highlights the clinical significance of hallucinations with regard to suicidal behaviour risk, even among high-risk populations.
Community studies have found a relatively high prevalence of hallucinations, which are associated with a range of (psychotic and non-psychotic) mental disorders, as well as with suicidal ideation and behaviour. The literature on hallucinations in the general population has largely focused on adolescents and young adults.
We aimed to explore the prevalence and psychopathologic significance of hallucinations across the adult lifespan.
Using the 1993, 2000, 2007 and 2014 cross-sectional Adult Psychiatric Morbidity Survey series (N = 33 637), we calculated the prevalence of past-year hallucinations in the general population ages 16 to ≥90 years. We used logistic regression to examine the relationship between hallucinations and a range of mental disorders, suicidal ideation and suicide attempts.
The prevalence of past-year hallucinations varied across the adult lifespan, from a high of 7% in individuals aged 16–19 years, to a low of 3% in individuals aged ≥70 years. In all age groups, hallucinations were associated with increased risk for mental disorders, suicidal ideation and suicide attempts, but there was also evidence of significant age-related variation. In particular, hallucinations in older adults were less likely to be associated with a cooccurring mental disorder, suicidal ideation or suicide attempt compared with early adulthood and middle age.
Our findings highlight important life-course developmental features of hallucinations from early adulthood to old age.
Self-harm is a common presentation to acute hospitals, associated with increased risk of completed suicide. Safety plans are increasingly recommended to help patients recognise and prevent escalation of self-harm behaviours.
This project aimed to improve quality and documentation of safety planning for patients admitted at an acute general hospital due to self-harm, who were assessed by Liaison Psychiatry. We aimed to increase the number of patients given written safety plans on discharge by 50%.
The PDSA cycle model of quality improvement was used. A retrospective audit of clinical records was conducted over 3 months to establish baseline documentation of safety planning (n = 51). A template for a self-harm crisis plan, used in other areas of the Trust, was adopted, to be adapted to each patient. A leaflet for sources of crisis support and patient feedback form were developed and distributed to clinicians in the team. Data collection was repeated one month later (n = 48). The second set of interventions involved a training session for clinicians on developing safety plans in collaboration with patients, and a poster highlighting the process to be undertaken when discharging a patient admitted with self-harm.
Following initial interventions, 20% of patients had completed safety plans and 50% received advice, an increase of 20% and 40% respectively. The second PDSA cycle showed increase in numbers to 38% and 67% respectively.
Creating a crisis plan with a hospital-specific leaflet for the Liaison Psychiatry team increased the number of patients discharged with safety plans in place. 86% of patients who participated in safety-planning found the process helpful and felt likely to use the plan in future crises. This is an area of ongoing quality improvement which can be implemented in other hospitals to better equip patients with skills and support to reduce self-harm/suicide attempts.
The general health of children of parents with mental illness is overlooked.
To quantify the difference in healthcare use of children exposed and unexposed to maternal mental illness (MMI).
This was a retrospective cohort study of children aged 0–17 years, from 1 April 2007 to 31 July 2017, using a primary care register (Clinical Practice Research Datalink) linked to Hospital Episodes Statistics. MMI included non-affective/affective psychosis and mood, anxiety, addiction, eating and personality disorders. Healthcare use included prescriptions, primary care and secondary care contacts; inflation adjusted costs were applied. The rate and cost was calculated and compared for children exposed and unexposed to MMI using negative binomial regression models. The total annual cost to NHS England of children with MMI was estimated.
The study included 489 255 children: 238 106 (48.7%) girls, 112 741 children (23.0%) exposed to MMI. Compared to unexposed children, exposed children had a higher rate of healthcare use (rate ratio 1.27, 95% CI 1.26–1.28), averaging 2.21 extra contacts per exposed child per year (95% CI 2.14–2.29). Increased healthcare use among exposed children occurred in inpatients (rate ratio 1.37, 95% CI 1.32–1.42), emergency care visits (rate ratio 1.34, 95% CI 1.33–1.36), outpatients (rate ratio 1.30, 95% CI 1.28–1.32), prescriptions (rate ratio 1.28, 95% CI 1.26–1.30) and primary care consultations (rate ratio 1.24, 95% CI 1.23–1.25). This costs NHS England an additional £656 million (95% CI £619–£692 million), annually.
Children of mentally ill mothers are a health vulnerable group for whom targeted intervention may create benefit for individuals, families, as well as limited NHS resources.
The Zero Suicide framework is a system-wide approach to prevent suicides in health services. It has been implemented worldwide but has a poor evidence-base of effectiveness.
To evaluate the effectiveness of the Zero Suicide framework, implemented in a clinical suicide prevention pathway (SPP) by a large public mental health service in Australia, in reducing repeated suicide attempts after an index attempt.
A total of 604 persons with 737 suicide attempt presentations were identified between 1 July and 31 December 2017. Relative risk for a subsequent suicide attempt within various time periods was calculated using cross-sectional analysis. Subsequently, a 10-year suicide attempt history (2009–2018) for the cohort was used in time-to-recurrent-event analyses.
Placement on the SPP reduced risk for a repeated suicide attempt within 7 days (RR = 0.29; 95% CI 0.11–0.75), 14 days (RR = 0.38; 95% CI 0.18–0.78), 30 days (RR = 0.55; 95% CI 0.33–0.94) and 90 days (RR = 0.62; 95% CI 0.41–0.95). Time-to-recurrent event analysis showed that SPP placement extended time to re-presentation (HR = 0.65; 95% CI 0.57–0.67). A diagnosis of personality disorder (HR = 2.70; 95% CI 2.03–3.58), previous suicide attempt (HR = 1.78; 95% CI 1.46–2.17) and Indigenous status (HR = 1.46; 95% CI 0.98–2.25) increased the hazard for re-presentation, whereas older age decreased it (HR = 0.92; 95% CI 0.86–0.98). The effect of the SPP was similar across all groups, reducing the risk of re-presentation to about 65% of that seen in those not placed on the SPP.
This paper demonstrates a reduction in repeated suicide attempts after an index attempt and a longer time to a subsequent attempt for those receiving multilevel care based on the Zero Suicide framework.
Background: Little knowledge exists on the availability of academic and community paediatric neurology positions. This knowledge is crucial for making workforce decisions. Our study aimed to: 1) obtain information regarding the availability of positions for paediatric neurologists in academic centres; 2) survey paediatric neurology trainees regarding their perceptions of employment issues and career plans; 3) survey practicing community paediatric neurologists 4) convene a group of paediatric neurologists to develop consensus regarding how to address these workforce issues. Methods: Surveys addressing workforce issues regarding paediatric neurology in Canada were sent to: 1) all paediatric neurology program directors in Canada (n=9) who then solicited information from division heads and from paediatric neurologists in surrounding areas; 2) paediatric neurology trainees in Canada (n=57) and; 3) community paediatric neurologists (n=27). A meeting was held with relevant stakeholders to develop a consensus on how to approach employment issues. Results: The response rate was 100% from program directors, 57.9% from residents and 44% from community paediatric neurologists. We found that the number of projected positions in academic paediatric neurology is fewer than the number of paediatric neurologists that are being trained over the next five to ten years, despite a clinical need for paediatric neurologists. Paediatric neurology residents are concerned about job availability and desire more career counselling. Conclusions: There is a current and projected clinical demand for paediatric neurologists despite a lack of academic positions. Training programs should focus on community neurology as a viable career option.
X-ray fluorescence (XRF) was used to image 40 histological cross-sections of bovine ovaries (n=19), focusing on structures including: antral follicles at different stages of growth or atresia, corpora lutea at three stages of development (II–IV), and capillaries, arterioles, and other blood vessels. This method identified three key trace elements [iron (Fe), zinc (Zn), and selenium (Se)] within the ovarian tissue which appeared to be localized to specific structures. Owing to minimal preprocessing of the ovaries, important high-resolution information regarding the spatial distribution of these elements was obtained with elemental trends and colocalizations of Fe and Zn apparent, as well as the infrequent appearance of Se surrounding the antrum of large follicles, as previously reported. The ability to use synchrotron radiation to measure trace element distributions in bovine ovaries at such high resolution and over such large areas could have a significant impact on understanding the mechanisms of ovarian development. This research is intended to form a baseline study of healthy ovaries which can later be extended to disease states, thereby improving our current understanding of infertility and endocrine diseases involving the ovary.
Patient registries represent an important method of organizing “real world” patient information for clinical and research purposes. Registries can facilitate clinical trial planning and recruitment and are particularly useful in this regard for uncommon and rare diseases. Neuromuscular diseases (NMDs) are individually rare but in aggregate have a significant prevalence. In Canada, information on NMDs is lacking. Barriers to performing Canadian multicentre NMD research exist which can be overcome by a comprehensive and collaborative NMD registry.
We describe the objectives, design, feasibility and initial recruitment results for the Canadian Neuromuscular Disease Registry (CNDR).
The CNDR is a clinic-based registry which launched nationally in June 2011, incorporates paediatric and adult neuromuscular clinics in British Columbia, Alberta, Ontario, Quebec, New Brunswick and Nova Scotia and, as of December 2012, has recruited 1161 patients from 12 provinces and territories. Complete medical datasets have been captured on 460 “index disease” patients. Another 618 “non-index” patients have been recruited with capture of physician-confirmed diagnosis and contact information. We have demonstrated the feasibility of blended clinic and central office-based recruitment. “Index disease” patients recruited at the time of writing include 253 with Duchenne and Becker muscular dystrophy, 161 with myotonic dystrophy, and 71 with ALS.
The CNDR is a new nationwide registry of patients with NMDs that represents an important advance in Canadian neuromuscular disease research capacity. It provides an innovative platform for organizing patient information to facilitate clinical research and to expedite translation of recent laboratory findings into human studies.
Perceived causes of depression can affect treatment preferences and outcomes. Men and women may have somewhat differing views about the causes of their depression, but there is a paucity of research on gender differences in hospitalised patients with depression.
We examined potential gender differences in hospitalised patients’ perceived causes for their depression and their relationship with treatment beliefs and preferences.
A sample of 52 psychiatric inpatients hospitalised with depression was recruited and completed self-report measures of reasons for depression, depression severity, treatment beliefs and preferences.
Biological reasons for depression were associated with more severe depression and more positive medication beliefs. In addition, results showed that women were significantly more likely to endorse physical and biological reasons for their depression compared with men. Gender moderated the relationship between physical reasons for depression and medication beliefs, such that men endorsing physical reasons found antidepressants less acceptable and had more negative beliefs about medication compared to women.
Findings indicate that depressed men and women in the hospital may have differing views about the causes of their depression and this may affect the acceptability of treatments. Depression treatment in inpatient settings should be better personalised to match the beliefs of individual patients.
In NW Scotland, several alkaline intrusive complexes of Silurian age intrude the Caledonian orogenic front. The most northerly is the Loch Loyal Syenite Complex, which is divided into three separate intrusions (Ben Loyal, Beinn Stumanadh and Cnoc nan Cuilean). Mapping of the Cnoc nan Cuilean intrusion shows two main zones: a Mixed Syenite Zone (MZ) and a Massive Leucosyenite Zone (LZ), with a gradational contact. The MZ forms a lopolith, with multiple syenitic lithologies, including early basic melasyenites and later felsic leucosyenites. Leucosyenite melts mixed and mingled with melasyenites, resulting in extreme heterogeneity within the MZ. Continued felsic magmatism resulted in formation of the relatively homogeneous LZ, invading western parts of the MZ and now forming the topographically highest terrane. The identification of pegmatites, microgranitic veins and unusual biotite-magnetite veins demonstrates the intrusion's complex petrogenesis. Cross-sections have been used to create a novel 3D GoCad™ model contributing to our understanding of the intrusion. The Loch Loyal Syenite Complex is known to have relatively high concentrations of rare earth elements (REEs), and thus the area has potential economic and strategic value. At Cnoc nan Cuilean, abundant REE-bearing allanite is present within melasyenites of the MZ. Extensive hydrothermal alteration of melasyenites here formed steeply dipping biotite-magnetite veins, most enriched in allanite and other REE-bearing accessories. This study has thus identified the area of greatest importance for further study of REE enrichment processes in the Cnoc nan Cuilean intrusion.
Food cost is an important factor influencing the consumption of nutritious foods and subsequent chronic disease risk. The present study compared the cost of branded food products with their generic equivalents across a range of food categories.
The survey was conducted within two major supermarket chains across six locations in Sydney, Australia (n 12).
Price differences were calculated for ‘core’ (nutrient dense and low in energy) and ‘extra’ (high in undesirable nutrients and/or energy) packaged foods (n 22) between generic and branded items.
A cost saving of 44 % was found by purchasing generic over branded products across all food categories. The most significant savings were for core foods, such as bread and cereals, and the smallest cost savings were seen for fruit products. There was little variation in cost saving between branded and generic products by socio-economic status of the supermarket location.
The large price differential between branded and generic food products implies that consumers, particularly those on lower incomes, could benefit financially from purchasing generic items. The promotion of core generic products may be an effective strategy to assist people on lower incomes to meet dietary guidelines.
This paper describes findings from a study that evaluated the implementation and impact of case management for long-term conditions (CMLTC) in 10 primary care trusts (PCTs).
Patients who have long-term conditions and complex health and social needs may require case management to deliver and coordinate their care from a range of agencies.
A cross-sectional postal survey of managers with lead responsibility for CMLTC in each PCT is adopted to describe the implementation of services. A retrospective cohort analysis of longitudinal routinely collected admission data for patients enrolled within the CMLTC service (nine months before and nine months after the entry; n = 867) is used to measure their impact.
The organisation of case management varied between PCTs in some aspects despite a high level of coordination across the geographical area. Mean emergency admissions and associated length of stay (LOS) for patients reduced significantly in the nine months after the service entry. There were a number of fairly robust positive and negative influences on these outcome measures in the regression analysis. Most patients with a history of emergency admissions experienced a marked improvement over time. However, most of those without any or with few admissions experienced an increase in admissions and corresponding LOS. Furthermore, a proportion of frequent service users with particular diagnoses also experienced an increase or remained at a high level. A very modest effect was shown with regard to the features of case management arrangements. For each day spent in hospital before service entry, patients are predicted to experience a reduction of nearly one day after. The main contributor explaining increases in LOS for emergency admissions was the number of primary and secondary diagnoses. Each added diagnosis is associated with a 2.4-day increase in LOS, everything else being equal.
Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear.
A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded.
A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%.
During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes.
This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.
There are few Australian data on the incidence of catheter-associated bloodstream infection (BSI) among patients in hematology-oncology units. We found an increase in catheter-associated BSI rates coincident with the introduction of a mechanical valve connector (2.6 infections vs 5.8 infections per 1,000 catheter-days; incidence rate ratio, 2.2; P = .031).