Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries

OBJECTIVE: To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries. METHODS: Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up. FINDINGS: Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; chi2 = 13.83, P < 0.001). CONCLUSION: This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.     

A Mechanical Analysis of Chemically Stimulated Linear Shape Memory Polymer Actuation

In the present work, we study the role of programming strain (50% and 100%), end loads (0, 0.5, 1.0, and 1.5 MPa), and chemical environments (acetone, ethanol, and water) on the exploitable stroke of linear shape memory polymer (SMP) actuators made from ESTANE ETE 75DT3 (SMP-E). Dynamic mechanical thermal analysis (DMTA) shows how the uptake of solvents results in a decrease in the glass temperature of the molecular switch component of SMP-E. A novel in situ technique allows studying chemically triggered shape recovery as a function of time. It is found that the velocity of actuation decreases in the order acetone > ethanol > water, while the exploitable strokes show the inverse tendency and increases in the order water > ethanol > acetone. The results are interpreted on the basis of the underlying chemical (how solvents affect thermophysical properties) and micromechanical processes (the phenomenological spring dashpot model of Lethersich type rationalizes the behavior). The study provides initial data which can be used for micromechanical modeling of chemically triggered actuation of SMPs. The results are discussed in the light of underlying chemical and mechanical elementary processes, and areas in need of further work are highlighted.     

Association of symptoms with gastrointestinal microbiota in irritable bowel syndrome

AIM:To investigate the correlations between selfreported symptoms of irritable bowel syndrome(IBS) and the gastrointestinal(GI) microbiota composition.METHODS:Fecal samples were collected from a total of 44 subjects diagnosed with IBS.Their symptoms were monitored with a validated inflammatory bowel disease questionnaire adjusted for IBS patients.Thirteen quantitative real-time polymerase chain reaction assays were applied to evaluate the GI microbiota composition.Eubacteria and GI bacterial genera(Bifidobacterium,Lactobacillus and Veillonella),groups(Clostridium coccoides/Eubacterium rectale,Desulfovibrio desulfuricans) and distinct bacterial phylotypes [closest 16S rDNA sequence resemblance to species Bifidobacterium catenulatum,Clostridium cocleatum,Collinsella aerofaciens(C.aerofaciens),Coprococcus eutactus(C.eutactus),Ruminococcus torques and Streptococcus bovis ] with a suspected association with IBS were quantified.Correlations between quantities or presence/absence data of selected bacterial groups or phylotypes and various IBSrelated symptoms were investigated.RESULTS:Associations were observed between subjects’ self-reported symptoms and the presence or quantities of certain GI bacteria.A Ruminococcus torques(R.torques)-like(94% similarity in 16S rRNA gene sequence) phylotype was associated with severity of bowel symptoms.Furthermore,among IBS subjects with R.torques 94% detected,the amounts of C.cocleatum 88%,C.aerofaciens-like and C.eutactus 97% phylotypes were significantly reduced.Interesting observations were also made concerning the effect of a subject’s weight on GI microbiota with regard to C.aerofaciens like phylotype,Bifidobacterium spp.and Lactobacillus spp.CONCLUSION:Bacteria seemingly affecting the symptom scores are unlikely to be the underlying cause or cure of IBS,but they may serve as biomarkers of the condition.     

The impacts of an inflammatory bowel disease nurse specialist on the quality of care and costs in Finland

Abstract:

Introduction: A specialized inflammatory bowel disease (IBD) nurse is considered a valuable and cost-effective member of a multidisciplinary team, not all clinics responsible for IBD care employ such nurses. We evaluated IBD nurse resources, quality of care and cost effects on IBD patients care in a nationwide study in Finland.

Methods: A healthcare professional electronic survey was conducted in order to assess the impact of an IBD nurse on the quality of care. To study the cost effects, we obtained nationwide comprehensive data covering years between 2008 and 2016 from major administrative healthcare districts of Finland. Patients with a diagnosis of IBD (ICD-code K50 or K51) were identified from the data and their personal contacts and hospitalization were analyzed. The results were compared between healthcare districts with an IBD nurse and healthcare districts without an IBD nurse.

Results: Forty-nine physicians and 88 nurses responded to the survey. Of the physicians, 92% reported that an established IBD nurse had released physician’s resources. The most important IBD nurse contributions listed were patient support and follow-up (79–81% of the respondents).

Healthcare district, which had an established IBD nurse, produced more patient contacts. A larger proportion of the contacts was managed by the IBD nurse. Clinics with an IBD nurse reported less patient hospitalization (4–9% vs 11–19%, p?Conclusion: The introduction of an IBD nurse led to better quality of care and potentially significant cost savings by reducing hospitalization rates and reallocating physician’s time resources.     

Factors predicting suicide among Russians in Estonia in comparison with Estonians: case-control study

Aim

To explore differences between suicide victims among Russian immigrants in Estonia and native Estonians, according to socio-demographic background, substance use pattern, and recent life events to find out immigration-specific factors predicting suicide.

Methods

The psychological autopsy study included 427 people who committed suicide in 1999 and 427 randomly selected controls matched by region, gender, age, and nationality.

Results

The only variable that differed significantly between Russian and Estonian suicide cases was substance use pattern. Logistic regression models showed that factors associated with suicide for both nationalities were substance dependence and abuse (Russians: odds ratio [OR], 12.9; 95% confidence interval [95% CI], 4.2-39.2; Estonians: OR, 8.1; 95% CI, 3.9-16.4), economical inactivity Russians: OR 5.5; 95% CI, 1.3-22.9; Estonians: OR, 3.1; 95% CI, 1.3-7.1), and recent family discord (Russians: OR, 3.2; 95% CI, 1.1-9.9; Estonians: OR, 4.5; 95%, CI, 2.1-9.8). The variables that remained significant in the final model were having no partner (Estonians: OR, 3.0; 95% CI, 1.6-5.5), being unemployed (Estonians: OR, 5.5; 95% CI, 2.0-15.4), and being an abstainer (Estonians: OR, 6.7; 95% CI, 2.5-17.6) for Estonians, and somatic illness (Russians: OR, 4.1; 95% CI, 1.4-11.7), separation (Russians: OR, 32.3; 95% CI, 2.9-364.1), and death of a close person (Russians: OR, 0.2; 95% CI, 0.04-0.7) for Russians.

Conclusion

Although the predicting factors of suicide were similar among the Estonian Russians and Estonians, there were still some differences in the nature of recent life events. Higher suicide rate among Estonian Russians in 1999 could be at least partly attributable to their higher substance consumption.Several studies compared suicide rates of immigrant population, native population in the host country, and population in the country of origin. Previous research has shown variance in the suicide rates of immigrant groups with different ethnic background, as well as different suicide rates in their home countries (1-8). Differences between suicide rates of immigrant groups and native population are not quite clear, but most of the immigrant groups have higher suicide rates than the population in their countries of origin. A number of studies found that migrants who had high suicide rates came from countries with high rates and vice versa (1,2,4,9,10).Reports from England and Wales (3), Canada (5), and Sweden (6,11) showed very high suicide rates among Russian immigrants compared with the rates of the population both in their country of origin and in the host country. Johansson et al (11) found that suicide rate of Russian male immigrants in Sweden was 201.9 per 100 000 in comparison with 41.4 in Russian men in Russia and 44.5 in Swedish men in 1986-1989.Värnik et al (12) compared suicide rates of Russians in Estonia, Estonians in Estonia, and inhabitants of Russia before (1983-1990) and after (1991-1998) Estonia gained independence. Suicide rates of Russian immigrants were lowest in the period before Estonian independence and highest in the period after reestablishing independence. In 1998, Russian and Estonian suicide rates were similar (12), but in the 1991-2001period, mean suicide rates in Estonian Russians were higher than in Estonians (38.2 and 31.9 per 100 000, respectively) (13).There is a lack of studies on specific suicide risk factors for immigrants on the individual level. As far as we know, the only study available was a psychological autopsy study on suicides of Ethiopian immigrants to Israel (14). They found that 67% of suicide victims were dissatisfied with their employment, 50% with their economic status, 44% with their marital relationships, and 53% with their fluency in the host language. However, in this study no controls were used.Since there were differences in suicide rates between Russian immigrants in Estonia and native Estonians, the purpose of the present study was to explore possible differences between suicide victims of these two main ethnic groups in Estonia according to socio-demographic background, substance use pattern, and recent life events to find out immigration-specific factors predicting suicide on the individual level.     

Children’s Depression Inventory in Estonia

The aim of study was to estimate the score of symptoms of depression with the Children’s Depression Inventory (CDI) among Estonian schoolchildren aged 7–13-year-old, according to age and gender differences, and to identify the components in factor analysis characterising self-reported childhood symptoms of depression. The applicability of the CDI in 7-year-old children was also estimated. The number of subjects in the study was 725 (342 girls and 383 boys), and the mean age was 10.2 (SD 1.7). The mean total score of the CDI for the whole sample was 9.96 (SD = 6.3, range 0–39, median 9.0). The mean scores of symptoms of depression among children did not differ by gender or age. There were no significant differences in the CDI mean scores between 7-year-old compared to older schoolchildren in the present study. Factor analysis obtained five factors: anhedonia, ineffectiveness, negative self-esteem, negative mood and interpersonal problems. Significant gender and age differences were found: girls reported more symptoms of anhedonia and negative self-esteem, and boys reported more symptoms of ineffectiveness. Younger children reported more symptoms of anhedonia and ineffectiveness, and older children negative self-esteem. The study serves as baseline data before intervention of the EC project “European Alliance Against Depression”.     

Strength and mobility of the neck-shoulder region in adolescent headache

The significance of the musculoskeletal function of the neck-shoulder region in different headache types in children and adolescents is not clear. The purpose of this study was to investigate the association between different types of headache and the strength and mobility of the neck-shoulder region in 13-year-old schoolchildren. A structured questionnaire on headache was sent to all 1,409 children in the sixth grade in the city of Turku. Of the 1,135 (81%) children who completed the questionnaire, a sample from different headache groups was randomly selected for clinical examination. The study consisted of 59 children with migraine, 65 with episodic tension-type headache (TTHA), and 59 headache-free controls. Dynamic muscle strength of the upper extremities (UE endurance), mobility of both shoulders (UE mobility), and the cervical range of motion (CROM) were measured. Girls with episodic TTHA had lower UE endurance of both dominant and nondominant sides than girls in the other study groups. Girls with migraine had lower UE endurance of nondominant side than girls in the control group. In boys, no significant differences were observed. An interesting association between the function of the neck-shoulder region and headache complaints in adolescents was ascertained.     

Osteonecrosis in children treated for acute lymphoblastic leukemia

The purpose of the study was to find out the prevalence of osteonecrosis in children with acute lymphoblastic leukemia (ALL) in complete bone marrow remission at the end of the treatment. Twenty-eight children with ALL underwent MRI of the upper and/or lower extremities. Bone marrow signal intensity was analyzed on T1-weighted images, where cir-cumscribed lesions with a rim of low signal intensity were considered typical of osteonecrosis. Osteonecrosis was found in 9 of the 28 children (32%, 95% CI 16% to 52%). Five of them were asymptomatic. They had been treated with high risk and intermediate risk protocols, both of which include a delayed intensification phase with dexamethasone. None of the patients with standard risk ALL were found to have developed osteonecrosis. Osteonecroses occurred unexpectedly in symptomless patients and in patients with mild transient symptoms treated with high risk and intermediate risk protocols. Our study suggests that the intensification phase of the treatment protocols with intensive dexamethasone medication might be responsible for the development of osteonecrosis. Med. Pediatr. Oncol. 29:260–265, 1997. © 1997 Wiley-Liss, Inc.